Understanding Your Treatment Options When You Have a Herniated Disc
Herniated discs get a diagnosis and the next thing you know, patients are bombarded with word-of-mouth treatment options. Someone says to get surgery immediately. Someone else says that resting it away worked for them. Someone recommends a chiropractor; someone else says that there’s no solution without physical therapy. While it’s understandable to feel overwhelmed at all of these possibilities, the reality is, there are different options based on different conditions.
There’s no universally correct means of treatment for every patient. The answer essentially depends on the severity of pain, which disc is herniated and for how long and whether there are nerve implications in addition to back pain. Knowing the options presents a more educated selection approach instead of going with what the first person suggests.
The Conservative Route
It’s believed that with conservative treatment, most herniated discs resolve themselves naturally, which is why the initial recommendation from practitioners is noninvasive unless trauma or serious complication suggests otherwise. Conservative treatment means acknowledging the pain but not exacerbating the issue, allowing the body to heal itself.
Step one is anti-inflammatories to reduce swelling in the area where the disc and nerve protrude. Over-the-counter ibuprofen works for minor hernias but more advanced steroid versions assist with major concern. These aren’t simply a way to mask symptoms: reduced inflammation is a legitimate means of healing since it takes pressure off of stressed nerves.
Exercise modification as opposed to exercise restriction is recommended. Gone are the days of staying in bed for weeks on end; movement keeps muscles engaged so they don’t become stiff. However, during a herniation, it’s probably best to avoid heavy lifting, twisting and intense workouts. Instead, gentle movement like walking and stretching may be more appropriate.
This is where physical therapy comes in to play with guided treatment. Phsyical therapists teach patients well-meaning movements designed to strengthen and support muscles surrounding the spine. They also utilize heat/cold applications and hands-on work for pain management. Yet the long-term goal of strengthening the supporting muscles surrounding the injury help reduce strain in the first place.
Chiropractic Manipulation
Chiropractic care is suggested by many who find success in this arena post herniation as well. Spinal adjustments and similar hands-on approaches work to get everything back in alignment and relieve pressure from surrounding nerves as a means of facilitating normal movement and reduced stress on injured areas.
Spinal decompression techniques can also create negative pressure in the interior of the disc, drawing herniated material back toward the center or at least providing similar relief. Not every chiropractor offers this technique, nor does it work for everyone, but some people find a great deal of value in this after herniated disc treatment from someone dedicated to other parts of the body. Therefore, not all herniated disc experiences warrant the same combined treatment; they need to be looked at independently.
However, manual therapy isn’t appropriate for every herniated disc, namely depending on where they are located or how severe. Good practitioners assess this diagnosis and refer out to someone more knowledgeable if their methods won’t be effective.
Injections when Pain Persists
Should conservative care fail after several weeks of management, epidural steroid injections become an option where a practitioner injects a corticosteroid anti-inflammatory medication into the canal surrounding the aggravated nerve.
Steroid injections aren’t meant to heal the herniated disc; they’re designed to reduce inflammation and pain enough that physical therapy and natural healing can occur. While some people find one treatment sufficient, others need a series over subsequent months. Results generally occur over 2-4 weeks.
There are risks involved with injections though most people experience little adverse side effects apart from soreness at insertion sites or increases in pain, but these rarely occur after 24 hours post-injection. Infections and nerve damage are minimal, so weighing potential relief versus proposed risk is critical.
When Surgery Makes Sense
Only when conservative treatment fails after giving it an appropriate chance—or certain signs occur—should surgery be performed. Surgery should occur expediently should patients lose feeling or motor function progressively, lose bowel or bladder control or experience excruciating pain that prevents walking, as these are red flags.
Microdiscectomy surgery involves removing the portion of the disc that presses on the nerve but this is preferred over older methods that have led to hospitalization overnight—for same day discharge—and it works for leg pain caused by nerve compression.
Disc replacement fusion surgeries are reserved for more extreme cases which involve longer recovery time and intervention complications; therefore these shouldn’t be performed unless simpler surgery won’t work.
Surgery for leg pain caused by nerve compression works well but it’s less likely to resolve lower back pain itself, so those considering surgical intervention need to know what will and what won’t likely get better over time.
How Long Recovery Takes
Recover time depends on specific treatment acquired. For conservative efforts, 6-12 weeks is reasonable before another form of intervention is sought; for injections 2-4 weeks should provide insight if they’ve worked and physical therapy generally manifests results over a few months with gradual improvement.
Chiropractic care works practically in a few weeks but only if it responds well; otherwise it takes adjusted time to either see little success or significant recovery.
Surgical recovery takes 4-6 weeks for initial healing before progressive return to normal life over months (3-6). Some feel significantly better right away while others don’t but response over time is still feasible.
The reality is that two patients with identical problems may respond completely differently. Genetics, age, employment history, general wellness all play factors in how quickly someone heals.
Making The Choice
Patients need to advocate for their best treatment option through an open discussion with their practitioners. What’s actually wrong (what disc, how protruded, what symptoms), what are red flags for development? Start conservatively unless the situation suggests otherwise and then give it time since proactive intervention without giving simple attention a chance isn’t wise.
Most herniations heal over time without surgical intervention, especially if they’re given adequate time and appropriate adjustment. However, if a clear regime has failed after adequate time (not right away), then it’s time to figure out what’s next.
Second opinions make sense—if one practitioner suggests immediate surgical intervention but symptoms fail to include red flags that imply rapid response time is needed, consult someone else. Surgery could still be an appropriate path but finding it more acceptable thanks to confirmation makes sense for any life-changing decision.
Costs matter. Conservative care is cheaper than surgery upfront, but multiple months of treatment add up. Insurance covers different interventions at different rates, sometimes unfeasible if patients are uninsured. Therefore, knowing financial realities helps paint a complete picture alongside medical attributes.
At the end of the day, being educated about what’s best makes sense—realistic expectations from a reasonable practitioner who provides them options as opposed to one-size-fits-all applications create better images than what’s currently rendered about finding relief. Generally speaking people do with whatever combination they ultimately find works best through trial and error and patience.
