What to Know About Herniated Disc Treatment

So you find out you have a herniated disc. Now what? A herniated disc occurs when the softer material inside a spinal disc pushes out through a crack in its tougher exterior, potentially irritating or compressing nearby nerves. Imagine squishing a jelly donut… the jelly that oozes out is like the soft material that pushes out of the disc. Now there are varying degrees to how severe a herniated disc may be (the soft inner material doesn’t always completely push out of the exterior of the disc). Depending on how severe, this can lead to symptoms like back pain, neck pain, numbness, or weakness. Everyday activities can turn into challenging hurdles. Addressing this health issue is crucial not only for immediate relief but also for maintaining long-term spinal health. This article reviews different treatment options, including physical therapy, for herniated discs and what to expect for herniated disc treatment.

**This is not medical advice. Please consult your medical provider for more information.

Anatomy of an Intervertebral Disc

Diagnosis of Herniated Discs

Diagnosing a herniated disk starts with a trip to a health care professional where you’ll undergo a comprehensive physical exam. Herniated discs are more commonly found in the lumbar spine, however can also occur within the cervical spine. Depending on where the symptoms are, they will assess various parts of your body for tenderness, observe your range of motion, test reflexes, and check your strength. Special tests can be performed to further rule in or rule out a potential disc herniation. Should your symptoms suggest the need for a deeper investigation, an MRI will confirm a disc herniation and can help with staging.

There are different stages of a herniated disc. Staging is as follows:

• Bulging/Herniation: slight displacement of the nucleus pulposus; most are asymptomatic
• Protrusion: the nucleus pulposus passes through the inner rings of the annulus fibrosus; it may encroach on the foramen or the nerve root
• Extrusion: the nucleus pulposus displaces into the spinal canal through disrupted fibers of the annulus fibrosus
• Sequestration: nuclear material from the nucleus pulposus emerges through the annular fibers and escapes into the spinal canal

The Thing About MRIs You Must Know

It is important to note that MRI findings must be correlated with the physical exam. Why?

MRI imaging findings will be positive for normal degenerative changes and will be found in over 90% of individuals at a certain point. This means that findings such as disc height loss, disc degeneration, and facet arthropathy will be present in over 90% of individuals at a certain point.

At the same time, many individuals who have positive MRI findings will be asymptomatic. This means that despite the MRI picking up on changes within the spine, it is common to find that these same people do not experience pain or other symptoms.

So what does this mean for me?

This means that your MRI findings must be correlated with your physical exam. The MRI findings have to match with what your physical examination shows. There are patterns commonly seen in individuals with certain diagnoses. Your symptoms have to match what the MRI shows. Just because an MRI shows you have a disc herniation does not mean that 1. you have pain, or 2. your pain is coming from the disc herniation itself.

Initial Steps in Treatment

When you first experience the discomfort that comes with a herniated disk, the route towards relief might seem daunting. Yet, the path often begins with simple, conservative steps. Most disc herniation cases resolve and heal themselves within a couple of weeks. Remember, the goal of the initial steps is to control pain and improve your quality of life. If your symptoms are not resolve, further treatment options become available.

During this time frame, NSAIDs can be helpful with reducing inflammation and alleviating pain. Other pain medications may be prescribed depending on the severity of your symptoms. Lifestyle changes and small adjustments may include postural adjustment, ergonomic modifications for work station setups, and engaging in low-impact exercises. Additionally, incorporating stress management techniques and ensuring adequate sleep are essential components of a comprehensive approach to reduce pain and facilitate healing.

Physical Therapy and Exercise

Physical therapy becomes the key for individuals needing herniated disc treatment. It will help address pain control and management, restore spinal mobility, patient education, and resumption of exercise and normal life practices.

Finding directional preference (the McKenzie approach) is often used first. The goal is to find which direction of movement helps reduce the pain and leads to centralization of radiating symptoms. The most common tends to be lumbar extension, however some individuals may find lumbar flexion to help more in the beginning stages.

Once pain levels are more managed, restoring spinal mobility is essential. Paying attention to symptoms is important when first attempting to introduce a new directional movement. For example, if an individual’s directional preference is lumbar extension and you start to introduce lumbar flexion, do so in small ranges first. Assess what happens. If peripheralization is present (the pain travel further down the leg), revert back to lumbar extension. The goal is that over time, you will be able to tolerate all directions without peripheralization.

Postural re-education, core stabilization, and a strengthening program will help with spinal health and provide a proactive path for reducing chances of future injury. Focusing on posture helps to minimize stress on the spine. Core stabilization and strengthening will help provide the lumbar spine with necessary support and alleviate added stresses to this region. Maintaining an active mobility and strength program is not only beneficial for your spine, but for general life!

Surgical Options

When chronic back and neck pain persist after failed attempts at conservative treatment, herniated disc treatment may change to surgical options. Consulting with a neurosurgeon will be beneficial and they can review your options. A procedure known as a discectomy is often considered. This surgical option involves the removal of the damaged portion of a herniated disk in the spine. This surgery aims at easing symptoms related to nerve compression, such as pain, numbness, or weakness. On occasion, nerve conduction studies and EMGs can offer precise location of nerve damage, facilitating a tailored surgical approach.

Surgery is often viewed as a last resort. If symptoms show no improvement after 6-12 weeks of comprehensive conservative treatment, a consultation with a neurosurgeon may be the next step.

What is a Discectomy?

A discectomy is a surgical intervention specifically targeting the symptoms caused by herniated discs that push against nerve roots. The portion of the disc that is causing pressure on the nerves is removed. The goal is to restore your ability to move without pain, emphasizing the importance of maintaining an active lifestyle, paying attention to posture, and adopting beneficial sleep and stress management practices post-surgery for a sustained recovery. Remember, herniated disc treatment should first consider conservative approaches. Surgery should only be an option if all other conservative approaches have failed.

The Role of Mattresses and Pillows

Your mattress and pillow may be playing a role in contributing to your pain, especially if you are waking up with pain every morning. While getting a new mattress may not be the first step in your pain management journey, making sure your body is supported and properly aligned when you sleep is crucial. Not just for disc herniations, but for overall spinal health and reducing stresses to certain parts of the body.

Every individual prefers a different type of mattress. This comes down to our anatomy, the makeup of our bodies, etc. Start with the pillow (especially if you are dealing with a cervical disc herniation). Make sure you have a pillow that is supportive to the neck. In other terms, you don’t want your head leaning too far to the right or left when sleeping on your sides. And you don’t want your head propped up too high if you are laying on your back.

When looking at your mattress, make sure it isn’t too soft where your body isn’t getting the support it needs. You also want to make sure it isn’t too firm where it can’t hug the natural curves of the body. If it is too firm, you may find it irritates the sides of your hips, ankles, or other body prominences.

If you tend to wake up in the morning with low back pain, check out this article here!

Lifestyle Adjustments for Better Management

When dealing with the pain from a disc herniation, it is common to see muscle spasms within the back muscles particularly around the spine. Embracing stress management techniques not only eases your mind but can reduce the tension that exacerbates back pain. Similarly, focusing on sleep management ensures your body gets the rest it desperately needs for recovery.

Moreover, integrating alternative medicine alongside conventional treatments offers a holistic approach to healing. From acupuncture to massage therapy, exploring these avenues can provide additional layers of relief. While it may not be enough to fix the problem at hand, it can be a handy way to help eases the stresses that come alongside dealing with the pain. Find something that eases your mind. It could be going for a walk, listening to music, or getting a massage. This should be personal to you. But find something outside of medical management (aka surgical options or physical therapy) to help relieve your mind of the stresses of dealing with pain. This offers a more holistic approach to your recovery.

Managing Pain Through Medication

Many individuals find relief through pain medication. However, it’s not just about taking pills and hoping for the best. Effective management of back pain and neck pain hinges on understanding how these medications work and using them responsibly. Medication also does not fix the problem. It is like a band-aid. It alleviates the pain coming from the disc herniation or related symptoms, but it does not correct them.

Pain medication serves as a tool in your toolbox to assist with herniated disc treatment. The goal here isn’t to mask your symptoms but to provide a window of comfort while your body heals. Think of these medications as part of a broader strategy. It helps with symptom relief, allowing you to further participate in physical therapy, which help you reach your goals over a longer term. This method must be balanced with conservative treatments and, when necessary, surgical options.

Always remember, a discussed and well-informed partnership with your medical team is paramount.

Other Articles Related to Back Pain

• 5 Best Exercises for a Pinched Nerve in the Back
• Pain From Your Back Down Your Leg? Sciatica Treatment Explained!
• Low Back Pain Upon Waking Up? Try These 3 Things!
• Core Strengthening Exercises to Reduce Back Pain
• Consistent Low Back Pain: How It’s Treated to Give You Peace of Mind

References

TL;DR

Herniated disc treatment most likely involves conservative treatment, with pain medication and/or physical therapy at the forefront. Surgical options may be necessary if conservative treatment fails. If you are dealing with a disc herniation, consider physical therapy as your first option to return back to doing the things you love pain free!