The treatment plan you and your doctor decide on for a herniated disc will depend on several factors, including the severity of your symptoms, your activity level, and how your lifestyle is affected.
The treatment of a herniated disc can include non-surgical and surgical options. In most cases treatment starts conservatively with non-surgical options, which are effective for more than 90% of people. If non-surgical options are not effective, then surgical options are considered. For people whose symptoms are progressively worsening or who experience loss of bladder and bowel control, surgical options will be considered much earlier.
Non-surgical options for a herniated disc include trying to stay active, unless pain is severe. If you do need bed rest, your doctor will likely suggest that you limit this to 1 or 2 days. Anything longer than this may cause muscles to weaken and worsen your symptoms. Avoid activities that aggravate your symptoms, such as bending, lifting, or sitting for long periods of time. Using a firm mattress while sleeping may help. It may also help to put a pillow under the waist and another under the shoulder if you sleep on your side, or putting a pillow under your knees if you sleep on your back.
Your doctor may suggest medications such as acetaminophen* or nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen) to help relieve pain. If the pain is severe, your doctor may prescribe opioid (also called narcotic) pain medications such as codeine or oxycodone, muscle relaxants, or other medications that help with nerve pain (e.g., amitriptyline, gabapentin). Corticosteroids by mouth or by injection may be prescribed for severe and persistent pain. Occasionally, injecting lidocaine and corticosteroids into a very painful spasmodic part of the back muscle can give temporary relief.
Cold compresses or ice can help with pain when applied several times a day for no more than 20 minutes. Heat application may also help.
To prevent recurrences, it is very important to lose excess weight, particularly in the abdomen, and do exercises when you are feeling better to improve posture (strengthening abdominal muscles and stretching back muscles).
The vast majority of cases are resolved with conservative treatment: Being active within sensible limits, exercising, taking over-the-counter pain relievers, controlling your weight, and having heat and cold therapy.
Manipulation of the spine is a commonly used treatment by various practitioners, such as chiropractors and some doctors. Studies have shown little or no advantage to spine manipulation over conservative treatment, and it can cause severe damage to discs, muscle, nerves, and blood vessels (fortunately, this does not occur too often).
Other methods such as ultrasound, TENS (transcutaneous electrical nerve stimulation, which is using an electrical current to stimulate the nerves), and massage therapy may sometimes provide relief by helping to ease muscle spasm, which is a secondary effect of disc disease. Acupuncture has shown mixed results. If it is used, to prevent transmitting infection it is extremely important that needles not be reused.
Physiotherapy and exercises help strengthen the spine muscles and help reduce the risk of injury to the disc and spinal nerves. Your doctor or physiotherapist will show you exercises that are suitable for you. Some exercises they may suggest include flattening the curve in the neck and lower back to release the pressure on the discs and provide more space for the spinal nerves, or lying on the back and pulling each knee to the chest. Supervision by a physical therapist may be helpful if you are not sure you can do it on your own.
Changing sitting position can also help. Put the feet up on a low stool to flatten the back against the back of the chair, or adjust the chair so it tilts forward. A mattress with good, firm support and proper pillows for sleep is also very important.
Back braces are usually of little help, though many people use them anyway. They are not a substitute for other care.
Surgery isn't usually considered unless you develop severe pain or nerve damage that gets steadily worse. Surgery is called for when there is such severe damage to nerve or spinal cord that relief is necessary to preserve or to try to restore some function (such damage may not be reversible). It is also considered when all other pain relief methods fail, and people are unwilling or unable to give it more time and feel that the benefits of surgery outweigh the risks.
If you have loss of bladder or bowel control, you may need surgery right away. When possible, surgery to remove the ruptured disc is done through a very small incision under general anesthesia, but in other cases, major surgery is required.
Traction and a supportive neck collar can help a herniated disc in the cervical spine. During traction, a machine gently pulls the spine to relieve the pressure on it. A doctor or physiotherapist needs to show the person how to safely use the traction equipment. Traction therapy may be recommended for use at home. It must be used properly to avoid doing harm.
Studies have shown that 2 years or less of conservative treatment for back pain in which there is no significant nerve damage works just as well as surgery, physical therapy, and any of the other treatments described here.
Do the following to help prevent a recurrence of a herniated disc:
- Do exercises that strengthen the abdominal and back muscles.
- Maintain good posture (stand up straight, sit straight, lift things with the back straight).
- When sitting, sit with your backside against the back of the seat, do not slide forward, and use a foot rest.
- Bend the knees and hips when lifting something and keep the back straight.
- Hold an object close to the body when carrying it.
- Avoid wearing high-heeled shoes.
- Keep at a healthy weight with a trim abdomen.
- Don't smoke.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
All material copyright MediResource Inc. 1996 – 2017. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Herniated-Disc