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Lumbar Disc Herniation

 

By: Dustin Steffan, DPT Seattle Physical Therapist 

The diagnosis of a lumbar disc injury can be both intimidating and confusing. The healing process is generally a long one, but there are a number of treatment options available. The first choice to be made is whether to pursue conservative management or surgical intervention. Timing of more invasive treatment is a subject debated in the medical literature and is generally considered a last resort. Presence of the following can be a more pressing issue that requires work up and possible referral for surgical consult:

    1. • Fatiguing weakness of the leg, foot, or hip muscles
    2. • Changes in bowel or bladder function
    3. • Intractable pain that interferes with daily activities
    4. • Constant and overt sensation loss in the lower leg or foot

      1. In the absence of these findings the general recommendation posed is to wait at least 6 months before committing to more invasive procedures. During this time, it is best to pursue conservative management. If you have only back pain, leg pain, and tingling down the leg without any major weakness of the muscles, you are a good candidate for this. Conservative management can consist of a variety of therapies with physical therapy being shown to be one of the most effective. One comforting fact is that there is not a lot of correlation between evidence of disc herniation with imaging and symptomatic pain. In other words, there are plenty of people walking around with mild to moderate disc bulges that have not and likely will not experience symptoms.

Transitioning from a symptomatic disc to an asymptomatic disc can be a long process. Staying active is very important. This can involve any light/low impact activity such as swimming or walking. Avoiding sitting for extended periods, especially in slumped positions, is a universal recommendation. If your work at a computer, consider investing in a sit to stand desk, or make changes to your work station to allow for frequent changes in position.

Managing disc hydration is another good self-care treatment means. Discs imbibe fluid when you are laying down, so you will have the most water content and disc pressure upon waking in the morning. If your pain is worst in the morning, this may be part of the reason. Over the course of the day, the disc desiccates and can be a pain generator towards the end of the day

 

        1. • To dehydrate your discs first thing in the morning, try one of the following gentle techniques:
        1. o Go for a short walk upon first waking
        1. o Lay on your stomach, propped up on your elbows if pain free
        1. o Perform pain free, small range back bends
            1. o Additionally, avoid bending and lifting for the first 2-3 hours of the day
      1. • To rehydrate your discs, try one of the following techniques prior to the onset of your afternoon pain, try to sustain the position for 10-15 minutes for maximal rehydration:
        1. o Lay down in a comfortable position (on stomach, on back with knees propped up, in child’s pose position)
        1. o Sit in a chair with knees pulled up to your chest
      1. o Slouch in a chair while maintaining a relatively straight back