Herniated Disc: Physiatrist Viewpoint
Herniated Disc Symptoms
This patient has a classic presentation for a lumbar disc herniation causing a lumbar radiculopathy. When a disc herniates and compresses a nerve, the patient will experience pain in the leg, and frequently pain will be much worse with sitting.
Herniated Disc Treatment
Initial treatments for the herniated disc should focus on decreasing inflammation that is associated with a disc herniation and improving mobility to prevent deconditioning. Prompt and aggressive treatment of disc herniations can help decrease the chance for developing chronic pain.
Anti-inflammatory Medication for a Herniated Disc
For anti-inflammation, methylprednisolone, an oral cortisone, is commonly used for six days. Side effects are rare when used for this short time period, but nonetheless stomach ulcers, osteoporosis, avascular necrosis of the hips (which can lead to arthritis and hip replacement), cataracts, and transient increase in blood sugar and blood pressure can occur. The oral cortisone is then followed with a NSAID, and I like to start with ibuprofen 800 mg three times daily. This medication is taken with food to avoid stomach upset.
Physical Therapy for a Herniated Disc
Physical therapy is appropriate at this time to teach the patient specific exercises called McKenzie exercises. The goal is to centralize the pain to the back where it is better tolerated and easier to treat. Four to six PT sessions are prescribed, and then the patient is given a home program to follow. Compliance with this program is imperative. Walking is also encouraged to prevent the muscles from getting weak in the back, stomach, and legs. The patient should always remember to use pain as a guide to activity level as "no pain, no gain" does not apply to a person recovering from a disc herniation.
The great majority of patients with a herniated disc will recover with anti-inflammatory medications (steroid or non-steroid) and an appropriate exercise program. However, if pain continues lumbar epidural steroid injections would be recommended. Physical therapy would continue with the injections as maintaining flexibility, strength, and aerobic conditioning of the major muscle groups of the legs, stomach, and back improves recovery and decreases the risk for reinjury.
When Spine Surgery is Needed to Correct a Herniated Disc
After 4-6 weeks of the above regimen, I would refer to a surgeon for evaluation if symptoms from the herniated disc persisted. It is important to monitor for increasing pain, progressive numbness or weakness, or bowel and bladder dysfunction as this would require more aggressive treatment and an earlier referral for surgery.
