Herniated Disc and Conservative Treatment
Disc Herniations Are Common
One of the most common issues I treat is lower back pain, especially disc herniations. Lumbar herniated discs commonly occur in patients 20-40 years of age, and result in acute symptoms of shooting and intractable pain in the low back and/or lower extremities. However, the prognosis of these patients is considered to be very good.
Is Surgery Needed?
A lot of people ask if they need surgery for this. While there is a lot that goes into this question, two things I usually mention are that disc herniations are common in much of the asymptomatic population and that they can heal with time and conservative treatment.
Do I Need Physical Therapy?
Health Services Research study in May of 2018 showed that patients who sought PT for Low Back Pain were 89% LESS LIKELY to receive a prescription for opioids. Physical therapy should be focussed on regaining pain free movement and teach patients about pain, posture and how different activities affect their symptoms. Everyone moves different and so not one type of exercises is better than others.
What Does The Research Show?
Based on recent recent research (1) Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up. This was confirmed in another case study (2).Other research (3) has also shown that a combination of Manual Therapy, like manipulation, with Exercises is better than just exercises, or just manipulation by itself.
- Gugliotta M, da Costa BR, Dabis E, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open. 2016;6(12):e012938. Published 2016 Dec 21. doi:10.1136/bmjopen-2016-012938
- Hong J and Ball PA. Resolution of Lumbar Disk Herniation without Surgery. N Engl J Med. 2016.
- Pierre Balthazard,, Pierre de Goumoens, Gilles Rivier, Philippe Demeulenaere, Pierluigi Ballabeni and Olivier Dériaz. BMC Musculoskeletal Disorders 2012 13:162