The therapy for a herniated disc (disc hernia) must be adapted to the respective patient.
For patients who do not have unbearable pain and chances of recovery, a lengthy treatment period is acceptable (for example, 12 weeks).
For patients with high-grade sciatica who do not respond to conservative treatment, surgical intervention to relieve nerve pressure may be a reasonable solution to heal lumbar disc herniation.
If a patient suffers from progressive neurological deficits or sudden dysfunction of the bowel or bladder (urinary or faecal incontinence), he should contact a neurosurgeon immediately, as these disorders can constitute a surgical emergency. Fortunately, both situations are rare and most disc surgeries are a procedure of choice.
Medication for herniated
If the pain is mild to moderate, the doctor may recommend a pain-relieving, over-the-counter medication, such as ibuprofen (dolormin etc.), ketoprofen alrheumun, etc.), acetaminophen (ben-u-ron, etc.), or naproxen.
Many of these drugs carry a risk of gastrointestinal bleeding, in addition, a very high dose of acetaminophen can damage the liver.
If the pain does not improve with over-the-counter medications, the doctor may prescribe narcotics, such as codeine or a combination of medications with opioids.
Possible side effects of these drugs include somnolence, nausea, confusion and stool constipation.
Medication for nerve pain
Medications such as gabapentin (Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta), tramadol (Contramal, Amadol), and amitriptyline are often helpful for relieving pain of neurological origin.
Because these drugs have fewer side effects than narcotics, they are increasingly being used to treat people with herniated discs.
relaxants Muscle relaxants such as diazepam (Valium) or tetrazepam (Musaril) may be prescribed in case of muscle contractures to the legs or back.
Somnolence and dizziness are the most common side effects of these drugs.
Corticosteroids are anti-inflammatories that can be given as an intramuscular injection, especially in the first 3 days when the inflammation is in the acute phase.
They can be given in combination with muscle relaxants.
Cortisone and muscle relaxants are components of the first therapy after sciatica or cervicobrachialgia has occurred.
Ozone therapy is a minimally invasive treatment for lumbar disc hernia that exploits the biochemical properties of the gas mixture of oxygen and ozone.
You create a combination of oxygen and ozone, because the oxygen effect reduces the prolapse of the intervertebral disc, which reduces the pressure on the nerve.
There is no scientific evidence for the effectiveness of this therapy.
It is important to note that chiropractors can only achieve pain relief for a short time with these techniques.
Usually it is not possible to “push the toothpaste back into the tube” if a disc hernia or herniated disc has already developed.
In other words, the chiropractor cannot cure the patient by eliminating the cause of the disorder.
Description of chiropractic treatment
Chiropractic treatment is generally carried out as follows:
the specialist performs rapid manipulation on the vertebra with a very short movement.
You can feel a click caused by the release of gases (cavity formation of the joint).
The noise is caused by the release of oxygen, nitrogen and carbon dioxide, which reduces joint pressure.
Most often one feels a relief, even if it can be uncomfortable (usually only for a short moment) when the muscles of the spine are contracted or the patient remains tense during therapy.
Among the therapies, osteopathic treatment is the one that achieves better results in the long term.
The pain that comes from the lumbo-sacral zone and pulls down over the leg is not always caused by the pressure of a disc on the sciatic nerve.
There are other possible causes, for example:
- The nerve can be pushed through the piriformis muscle or pelvic ligaments.
- The pain may have its origin in a gluteal muscle contracture.
- Sciatica may be caused by nephroptosis (sinking kidney).
The osteopath contributes to:
- posture correction,
- contracture solution,
- restoration of body balance,
- Elimination of painful nerve stimuli.
In this way, the tension on the sciatica is reduced and the pain subsides or disappears.
The physiotherapist can point out postures and exercises to reduce the pain associated with a disc hernia.
How can a physiotherapist help?
The general goal of the physiotherapist is to enable the performance of everyday activities.
The therapist prepares a treatment program based on the results of the examination and personal goals.
The treatment program most likely insists on a combination of exercises.
The physiotherapist creates a program that includes:
- Exercises that involve special movements to relieve pressure on the nerve and relieve pain and other symptoms, especially in the first phase of treatment
These exercises include the McKenzie Method.
- Stretching exercises to improve the mobility of the joints and muscles of the spine, arms and legs.
The most commonly used method to achieve this goal is the “back school”.
Improving joint movement can be the key to pain relief.
- Strengthening exercises: when the core muscles are strong, they support the vertebral joints. In addition, muscular legs and arms relieve the back.
Postural gymnastics includes exercises to strengthen and stretch the entire spine and also the pelvic muscles.
- Water rehabilitation can be a good way to stay physically active when gym exercises are causing pain.
Bodybuilding should be done when no pain is felt and appropriate movements are used to avoid stress on the back and neck.
- Aerobic exercise, according to some studies, is useful for relieving pain, maintaining adequate body weight, and improving strength and overall mobility. All these factors are important in the treatment of a disc hernia.
This may seem like too much of an exercise program, but you can rest assured, because research shows that the more exercises you do, the faster pain and other symptoms pass.
If the patient is overweight, the exercises help to reduce weight and thus reduce the pressure on the intervertebral disc.
Physical and postural therapy
The correction of posture in back pain and the education to proper movement are fundamental.
The expert will point out small changes on how to sit, stand, bend, pick up objects and sleep.
These guidelines help to relieve pain and deal with the disease independently.
The mattress is a possible source of back pain, but one should only consider replacement if the pain is more intense in the morning after awakening.
A hard mattress is not necessarily better than a soft one, personal preference plays a role here.
There are other apparative therapies such as traction and TENS that are outdated and only provide temporary relief.
Traction and inversion bank reduce the pressure on the intervertebral discs only during therapy, but do not cause the disc to slide back.
Electrostimulation with TENS can only interrupt the pain signal for a maximum of 1-2 hours.
Surgery is required for a disc hernia in about 1 in 100 cases.
When do I have to operate?
- There is severe compression of the nerve.
- Symptoms do not improve with conventional therapy, such as physiotherapy and epidural infiltration.
- There are serious difficulties when walking or standing.
- There are serious symptoms, such as progressive muscle weakness or urinary incontinence. In this case, an operation must be carried out as soon as possible.
Over time, the disc hernia dries out, but it can take up to 10 years for it to be fully absorbed. So you shouldn’t wait too long.
The aim of surgery is to remove the leaked disc part.
This surgical procedure is called a discectomy and can be done in several ways.
An open discectomy is the removal of part or all of the disc.
This procedure is performed under anesthesia.
It is carried out through an incision in the spine and the removal of the intervertebral disc.
Surgery of a lumbar disc prosthesis
The prosthetic replacement of the intervertebral disc provides for the insertion of a disc prosthesis (artificially) instead of the damaged intervertebral disc.
There is an incision over the spine and the damaged disc is completely or partially removed. After that, a disc replacement is inserted into the intervertebral space.
A study has shown that 87% of those affected experienced a significant improvement in their quality of life three months after the replacement of the intervertebral disc.
endoscopic discectomy In endoscopic surgery with laser, the surgeon makes a small incision to get to the spine. An endoscope is used to visualize the intervertebral disc. An endoscope is a long, thin and flexible tube with light and a telephoto camera at the end.
The procedure is performed under local or general anesthesia, depending on where the intervertebral disc is located.
After the incision is made, the surgeon frees the compressed nerve causing the pain and removes the part of the disc with the laser.
One study showed that 67% of people were able to move more easily six months after laser endoscopic surgery, and about 30% needed a lower dose of medication for pain relief.
About 2-4% of affected persons require further surgery.
Another study showed that after endoscopic laser surgery, people returned to work after an average of seven weeks.
For most people with severe symptoms of a disc hernia, surgery helps relieve symptoms.
After five to six weeks of rehabilitation, they can usually return to work.
Nevertheless, the operation does not work for everyone and further operations and therapies may be required if the first procedure has not been successful.
Possible complications from surgery include:
- nerve damage,
- temporary dysesthesia (sensory disturbances).
Before a surgical procedure, one should ask the surgeon what the risk of a complication is and how long it will take to recover.
The surgeon can set up a rehabilitation program.
A review of a number of studies has shown that the exercise programs that begin four to six weeks after lumbar spine surgery have helped reduce pain and improve spinal function.
The most common problem after intervertebral disc surgery is recurrence.
Often the operated patient feels pain again and the formation of another herniated disc at a different height is possible.
For example, after a procedure at the level of L5-S1, a higher herniated disc may occur, namely in L4-L5.
How long does it take to recover? Prognosis
The prognosis of the disc hernia is very difficult, because there are various circumstances that can influence it.
As a result of the treatment, most people feel an improvement.
Nevertheless, pain can still occur after the therapies.
It can take several months before you can return to normal activities without pain or only with mild discomfort.
People who have to perform heavy work and lift heavy loads should change their work to avoid further back damage.
With a herniated disc that causes back pain and pain in the leg, running is contraindicated because of the constant strain on the spine.
Cycling and motorcycling always cause bumps due to uneven ground, but if the asphalt is smooth, you can practice them without worries.
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