Treating discogenic lower back pain is like treating many other musculoskeletal ailments; it's about reducing the inflammation from around the disc and also, importantly, about getting the muscles right to help take the pressure off the disc so that the same forces aren't going through it and we're not sitting back there having to think about how to reduce the inflammation again.

Physical therapy tends to be very helpful when addressing discogenic lower back pain. Physical therapy will often focus on an extension-biased lumbar strengthening program. So, essentially, strengthening the core, strengthening the lower abdominal muscles, integrating the pelvis, stretching the hip flexors, and also doing some stretches to basically put the lower back into extension. Think of — here's the lower back, right? Here are the discs and putting the back into extension tends to take the pressure off of the disc and allows the disc to start to heal itself, as well. It]s generally referred to as a McKenzie-based physical therapy program.

Oral medications can also be helpful to control the symptoms. They're not going to fix the underlying problem, but they can help to control the pain and some of the inflammation while one is going through physical therapy and addressing the biomechanics. Within physical therapy itself, there are also some passive modalities, such as ultrasound, some gentle spinal manipulation and traction, and electrical stimulation that can also help to control the pain and, ideally, also alleviate some of the inflammation.

When the pain is persistent despite physical therapy exercises or if the pain is limiting a person's ability to participate with physical therapy, we certainly have medications to help with the pain from discogenic lower back pain and sometimes what we do is we do an epidural steroid injection to put some medicine around the disc in order to lower the inflammation around the disc. Now, putting steroid next to a disc isn't going to change a tear in the disc, but it's not going to mask the pain either. What it does is it reduces the inflammation and it opens up this window of opportunity during which a person can, one, ideally participate more with physical therapy and do more of the stretching and strengthening and, two, often what it'll do is, if it reduces the inflammation, then sometimes while the exercises may not have been enough to alleviate the pain, often the exercises will be enough to keep the pain from coming back. Typically, if we are able to reduce the inflammation and address the mechanics by stretching and strengthening the muscles around the spine, we are able to take away the pain and keep the pain from coming back by doing a few exercises on a relatively daily basis to tweak the mechanics so the same forces aren't going through the disc.

When more conservative options aren't working - in those rare cases - there are surgical alternatives and that's a time when you start thinking about things like provocative disc stimulation and discography in order to have a more educated conversation about whether a surgical alternative may be appropriate.

Treatment for pain generated by the spinal discs in the lower back is focused on removing the inflammation from around the nerves. The long-term solution for this is building strength so there is less stress and pressure put on the discs so the problem does not recur.

Editorial Note: While discography is a fairly common procedure to diagnose disc pain, there is some controversy regarding the procedure's significance to an accurate diagnosis.


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