Herniated disc treatment
The first point of contact for back problems or a herniated disc is usually your family doctor or an orthopedic surgeon. They will either refer you to a consultant or request a second opinion from another specialist, such as a neurologist. Back pain can have many causes and requires thorough examination and evaluation. Not all lower back pain in the lumbar spine necessarily means a herniated disc: every second person experiences back pain at some stage in their life, but only every twentieth has a herniated disc. Physical examination by your doctor is aimed first and foremost at identifying the exact cause of your back pain. If a herniated disc is discovered, the appropriate herniated disc treatment can be determined.
Symptoms determine the therapy
The treatment of the herniation depends largely on the level of discomfort. In 70-90% of cases, the degree to which the nerve roots are irritated does not warrant immediate surgical herniated disc treatment. For these patients, conservative therapy is always first in line in the treatment concept. Conservative herniated disc treatments often consist of a combination of active (e.g. physiotherapy, back exercises) and passive treatments (e.g. heat treatment, massage) – supported by analgesics if required. Acupuncture, relaxation therapy, back training, or medical strength training have also proven successful for many patients. Nonsurgical conservative herniated disc treatments provide a very good chance of a sustainable improvement in symptoms or even total freedom from discomfort.
If there are clear signs of compression of the nerves or the spinal cord, imaging can identify the exact cause or extent of the disc herniation. Of course, it is important to understand that there is no direct relationship between the image itself and mediated symptoms; images may even have the negative effect of reinforcing the symptoms. Therefore X-rays or MRIs are usually only performed for more serious cases (for example, those involving neurological symptoms). During evaluation of the severity of the herniated disc, many factors are assessed such as the intensity of the pain and the length of time the dysfunctions have been apparent. Special consideration is given to cases in which paralysis, disorders of the bladder, or disordered rectal function have occurred. For severe dysfunctions such as these, a surgical approach to herniated disc treatment should be considered.
There are rare situations in which immediate surgical intervention is the required herniated disc treatment. For example, if you are experiencing incontinence, difficulty urinating, or progressive numbness of the thighs and lower buttocks (“saddle anesthesia”) your herniated disc may be compressing your cauda equine – the bundle of nerve roots right below your hips. This is a serious complication and can result in permanent paralysis if not treated quickly enough.
Conservative herniated disc treatment
For almost all cases of disc herniation, symptoms can be resolved in as little as a few days to a few weeks through the completion of a well thought out conservative treatment plan and thus do not require surgery. Effective treatment plans for herniated discs are usually comprised of a carefully selected combination of passive and active methods including such things as physical therapy, medication, temperature therapy, and holistic treatments. Your doctor and anyone else on your treatment team (individuals such as a physical therapist, a neurologist, and/or a licensed massage therapist) will work with you to put together the best possible plan for your specific case.
Non-surgical therapies aim to relieve tension and pain as well as reduce pressure on the spine and rebuild and strengthen all core muscles. Passive treatments such as massage and hydrotherapy help to loosen the spine, elongating it and removing pressure from the vertebrae and discs. In other words, these treatments are meant to get the spine back into the correct position. Once it is there, active treatments – such as stability exercises – are used to strengthen the muscles surrounding the spine so that they are better able to hold the spinal column in place.
Special exercises, physical therapy, and medical strength training are particularly suitable for targeting the muscles. Stretching is also often very helpful in relieving the stress placed on intervertebral discs. Avoiding positions that cause pain is so simple it is almost easy to overlook, and yet it remains an important aspect of treating a herniated disc. While physical strengthening and flexibility training are key parts of spine health management, overdoing it or ignoring your body’s pain signals could result in injury. Patients desiring the quickest possible recovery should be careful not to engage in activities that cause pain whenever possible, while still doing those exercises that can be completed pain-free. Over time, as your spine continues to heal and get stronger, you will likely be able to engage in more rigorous training.
There are a number of medications that can also be used to treat a herniated disc which are most often administered as tablets, injections, or infusions. Some of these medications are available only by prescription and some can be purchased over-the-counter at your local pharmacy. NSAIDS, or nonsteroidal anti-inflammatory drugs, such as naproxen and ibuprofen can alleviate inflammation caused by the herniated portion of disc compressing nearby nerves. Some patients, such as those with certain gastrointestinal or cardiovascular illnesses are not able to safely take NSAIDS. For these individuals, over-the-counter analgesics – such as acetaminophen — may be recommended. Unlike NSAIDS, which inhibit the inflammatory response, analgesics block pain signals sent from spine to the brain. Liver damage is a risk associated with long-term use of analgesics. For this reason is typically advised that they be taken only for a short time.
In most cases, over-the-counter medications are effective, but for those patients whose symptoms are not resolved after a few weeks, prescription medications are available. Narcotic pain relievers (such as oxycodone), muscle relaxants (such as cyclobenzaprine), epidural corticosteroid injections, and anticonvulsants are all prescription treatments that you and your doctor may consider should non-prescription medications fail to adequately reduce your pain. Due to a risk of addiction, most muscle relaxants and all narcotics should be used only in severe cases and not over a prolonged period of time. There are potential side effects with all medications and it is important to research these and discuss them with your physician before taking any new medications.
Temperature therapy is also commonly used in the treatment of a herniated disc. Thermotherapy, or heat therapy, helps to alter perception of pain and alleviate muscle spasms, providing relief to many patients. Cryotherapy, or cold therapy, on the other hand, helps to reduce swelling and inflammation. Warm and cold packs, compresses, and the like can often be used effectively together. However, in some cases, either heat therapy or cold therapy may cause discomfort instead of relief as ice can aggravate muscle spasms and heat is not helpful to inflammation. As with every aspect of your treatment plan, discuss your options with your doctor and determine whether and how to incorporate temperature therapy into your treatment regimen.
Acupuncture, massage, and chiropractic corrections are a few alternative herniated disc treatments that provide relief in some cases. Chiropractic adjustments sometimes used as part of a herniated disc treatment plan include flexion-distraction technique, pelvic blocking techniques, and manipulation under anesthesia. All of these methods aim to reduce the pressure the affected disc is placing on nearby nerves. Massage can be useful in reducing tension in the muscles supporting the spine and in alleviating pressure on the herniated disc but it is very important that the person performing the massage be well-informed about the specifics of an individual’s case to ensure that they do not further aggravate the injury. It is crucial that you discuss all the treatments you are considering with your doctor before proceeding with them — you want to be sure that what you are doing will actually help and will not make things worse. While many patients report that alternative therapies help them to manage their pain, it is worth noting that the medical community has not reached consensus about the efficacy of these treatments.
For some patients, treatment methods that focus on the mind-body connection – such as relaxation therapy, hypnosis, biofeedback treatment, and cognitive therapy – can help to mediate pain. By helping patients to remain hopeful, learn how to relax themselves physically and mentally, and adopt effective attitudes and thought patterns, psychotherapy can play a significant role in pain management. Biofeedback therapy seeks to record and give the patient increased control over the relationship between their behaviors and emotions and their physiological responses, such as pain or spasms. The idea is that with increased awareness of when and how their symptoms are triggered, patients may be able to use deep breathing and other exercises to prevent or reduce the symptoms. These therapies are often not adequate treatments for disc herniation on their own, but can be useful in conjunction with other treatment methods.
There is always a chance that the discomfort of a herniated disc improves or stops of its own accord, because the prolapsed tissue of the herniated disc gradually dries and shrinks. However, it is unfortunately not possible to predict the outcome with any certainty. Pain sometimes persists even when the MRI image indicates the disc herniation is reducing in size.
Try your best to remain patient and persistent. It will likely take some time to find and put into practice the combination of treatments that is going to be best for your specific case. Don’t lose hope – as long as you get it treated, the chances that your herniated disc symptoms will get better is very good.
Conservative treatments are favored because they are typically less invasive and less expensive. However, for patients whose pain is intolerable, or for those who have exhausted non-surgical options to no avail, getting evaluated for surgery is the next step.
Herniated disc – surgical treatment
Most herniated discs in the lumbar spine respond well to conservative treatment. But disc surgery is a necessary option for certain symptoms such as paralysis due to nerve root compression or persistent radicular pain without lasting improvement despite extensive conservative treatment. Over a longer period of time persistent pain can become chronic pain. And in addition to ongoing pain, there is also an increased risk of irreversible nerve damage in unresolved cases involving nerve compression, which can reduce the prospects of a cure. Intervertebral disc surgery may then be a necessary consideration.
The purpose of herniated disc surgery is to relieve the pressure on your nerves and, when necessary, to stabilize the spine. Surgical procedures that may be used together or in isolation to treat your herniated disc include a laminectomy, a discectomy, artificial disc surgery, and spinal fusion.
In most herniated disc cases that require surgery, a discectomy will be the prescribed procedure. In a discectomy, the herniated portion of the disc – or the part of the disc that is sticking out and pressing on nerves — is removed, thus relieving pain and discomfort. If the entire disc is not removed, it can rupture again over time. For this reason, and in situations where the outer shell of the disc is substantially deteriorated, it is sometimes better for the surgeon to remove the entire disc.
In these cases, artificial disk surgery, wherein the affected disc is taken out completely and replaced with a disk made of metal and plastic, is sometimes advised. However, when multiple discs are damaged, or if an individual suffers from osteoporosis or arthritis, artificial disk surgery is typically not recommended.
The surgical treatment by which a physician makes an incision in the lamina, or vertebral arch is known as a laminotomy. In some cases it is necessary to remove the entire vertebral arch – this is known as a laminectomy. In either case the removal or opening of the lamina reduces stress on the nerve roots and can thus alleviated the symptoms of a herniated disc.
In severe cases, a spinal fusion may be necessary. A spinal fusion surgery involves the removal of the affected disc or discs and the permanent fusing together of the associated vertebrae. Organic bone grafts and/or inorganic rods and screws may be used as part of your spinal fusion procedure. This is a major surgery and is usually associated with a longer hospital stay.
Most of these surgeries can be performed either as minimally invasive surgeries or as traditional open surgeries. Make sure to fully research your surgical options and discuss the advantages and disadvantages of each with your treatment team.
Minimally invasive surgeries use much smaller incisions that are typical in open surgeries and seek to disrupt the tissues surrounding the affected area as little as possible. Whereas in open surgery muscle tissues are often cut through in order to reach the target area, in minimally invasive procedures, muscle and other tissue is gently separated to allow the passage of the surgical instruments and endoscope (a small camera used to guide many minimally invasive procedures). Minimally invasive surgeries are associated with a reduced risk of substantial blood loss, shorter recovery times, and less collateral tissue trauma as compared to traditional surgery. For this reason, it is increasingly the norm for minimally invasive procedures to be performed whenever possible and for open surgery to be reserved for emergencies or situations where minimally invasive surgery is not a viable option.
Herniated disc surgeries typically have good prognoses, but there are risks associated with every surgery. Infection, excess bleeding, damage to surrounding tissues or nerves, are all potential consequences of herniated disc surgery. Additionally re-rupturing of the disc (if it was not removed) or degeneration of other discs or spinal structures may occur even after surgery.
It is imperative to pay close attention to your discharge instructions after any surgical procedure. These instructions will detail how long your individual recovery is expected to take, when and how to resume physical activity, and outline any follow-up treatments (such as physical therapy or medication). Close adherence to these directions provides the best chance for you to avoid complications and experience a recovery that is as speedy as possible..
Learn more about the options for disc surgery.
Prevention is better than cure
If you are experiencing some back pain but it has not yet escalated in severity enough to require treatment or if you are recovering from treatment and have the go-ahead from your doctor, get moving and keep moving! The best exercise is an endurance sport such as cycling, swimming, aerobics, walking, Nordic walking, hiking and dancing. Yoga, stretching, and other flexibility exercises can also be great for developing and maintaining fluidity and increased mobility of the spine. Be careful with badminton, weightlifting, golf, hockey, rowing, alpine skiing and squash – these sports can strain your back.
It is clear that there are many options for the successful treatment for a herniated disc. But in the end — whenever possible — prevention is always better than cure.
Prevention and self-care: how to avoid a herniated disc
Everyday life is full of “back hazards” – modern lifestyle usually involves of a lot of sitting and lack of exercise. This means that our bodies, and especially our backs, do not get enough time spent working out. If you do not train your back and abdominal muscles sufficiently, the muscles become weak and unable to cope with strain or overloading, which can lead to a herniated disc, as well as a wide variety of other complications.
You can help to avoid this by developing and adapting a back-friendly lifestyle, with a happy balance of varied physical activity and sufficient rest. Relieve your spine with back-friendly lying beds, sitting, standing, carrying, and lifting—it is important to change positions at regular intervals to avoid stiffness and tension in the back. Additionally, holding different positions throughout the day without overstraining helps to strengthen and keep flexible different parts of your spine and body. On the other hand, maintaining the same positions for extended periods of time throughout the day can have the opposite effect, causing the muscles, bones, ligaments, and other tissues to become distressed, sometimes resulting in injuries such as herniated discs.
The key is to make sure that ALL parts of your body are regularly getting moved and even lightly challenged, but that NO parts of your body are being held in the same position for too long or placed under excessive stress.
Listen to your body—if something hurts it is usually best to stop and pay mindful attention to the message your nerves are trying to communicate to you. Then reassess what you are doing, and decide what course of action will best help you maintain a healthy back and body. If unsure, always ask your doctor.
You can consult with your community physician, physical therapist, or a qualified personal trainer to get help determining the best regimen for your body. With some effort and time, most anyone can develop a manageable routine that helps to keep their spines healthy and strong!
- Sitting correctly: for those who have to spend a lot of time at a desk, standing up and stretching your legs regularly is important. A frequent change of sitting position also helps to relieve the back from time to time, and to keep it moving.
- Sleep properly: if you want to relax properly after a busy day, you need the right mattress. A flexible slatted frame and a high-quality mattress, which adapts to the body shape and is neither too soft nor too hard, are crucial.
- Lift correctly: it is very important not to overload the intervertebral discs by making sure you assume the correct posture when lifting loads. When lifting anything heavy your back should be kept straight and instead of bending over with a hunched back, you bend your knees.
Special back training not only teaches such techniques, but also relaxation methods, loosening, toning and stretching exercises to strengthen the muscles of the spine. Ask about courses at your local health center or fitness studio. It is imperative that after recovering from a successful surgical herniated disc treatment you start or resume a training routine!
Eat well and manage your stress
As with so many things, maintaining a healthy intake of varied and nutritious foods is integral to keeping your spine healthy.
Poor nutrition can contribute to the development of herniated discs and other issues. Once these issues have presented, continuing to eat poorly can exacerbate symptoms. Diet is related to spine health in two primary ways: first and foremost because excessive body weight places repetitive stress on the spinal column. Secondly, nutritional deficiencies inhibit the ability of the components of the body to stay strong, heal, and engage effectively in other functions. A body weight that does not stress and compress your spine and a nutrient-rich diet help to keep your back resilient to degenerative injuries.
Smoking tobacco introduces a variety of toxins into your system that can contribute to the deterioration of your organs and tissues, including your intervertebral discs. Additionally, smoking negatively affects the processes by which your body moves nutrients and oxygen throughout itself.
Repeated and sustained hunching or tensing of the spine and supporting muscle tissues due to stress or poor posture can contribute to back problems such as disc herniation. Remembering to keep your back straight and relaxed as well as remembering to handle daily stresses mindfully (so that you do not unintentionally contribute to additional physical stress) are additional ways that you can help protect the health of your spine.
Even with a healthy diet, good exercise habits, and other prevention-minded efforts, herniated discs can occur due to a person’s genetics, a specific traumatic injury, aging, or other cause. If you experience persistent back pain or other symptoms in spite of your preventative efforts, do not hesitate to seek the advice of your doctor in getting diagnosed and appropriately treated. As you know, there are plenty of research and experience supported herniated disc treatments available to you!