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The spine is made up of a series of connected bones called vertebrae. The disc is a combination of strong connective tissues which hold one vertebra to the next and act as a cushion between the vertebrae. The disc is made of a tough outer layer called the annulus fibrosus and a gel-like center called the nucleus pulposus. As you get older, the center of the disc may start to lose water content, making the disc less effective as a cushion. This may cause a displacement of the disc's center (called a herniated or ruptured disc) through a crack in the outer layer. Most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist. A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling or weakness of the leg called sciatica. Sciatica affects about 1-2% of all people, usually between the ages of 30 and 50. A herniated lumbar disc may also cause back pain, although back pain alone (without leg pain) can have many causes other than a herniated disc. Most (80-90%) patients with a new or recent acute disc herniation will improve without surgery. The doctor will usually try using non-surgical treatments for the first few weeks. If the pain still keeps you from your normal lifestyle after completing treatment, your doctor might recommend surgery. Although surgery may not return leg strength to normal, it can stop your leg from getting weaker and relieve leg pain. Surgery is usually recommended for relief of leg pain (>90% success); surgery is less effective in relieving back pain. Your doctor may prescribe non-surgical treatments including a short period of rest, anti-inflammatory medications to reduce swelling, analgesic drugs to control the pain, physical therapy, exercise or epidural steroid injection therapy. If you are told to rest, follow your doctor's directions on how long to stay in bed. Too much bed rest may give you stiff joints and weak muscles, which will make it harder to do activities that could help reduce the pain. Ask your doctor whether you should continue to work while you are being treated. Your doctor may start treatment and, with the help of a nurse or physical therapist, begin education and training about performing the activities of daily living without placing added stress on your lower back. The goals of non-surgical treatment are to reduce the irritation of the nerve and disc and to improve the physical condition of the patient to protect the spine and increase overall function. This can be accomplished in the majority of herniated disc patients with an organized care program that combines a number of treatment methods. Some of the first treatments your doctor may prescribe include therapies such as ultrasound, electric stimulation, hot packs, cold packs and manual ("hands on") therapy to reduce your pain and muscle spasms which will make it easier to start an exercise program. Traction may also provide limited pain relief for some patients. Occasionally, your doctor may ask you to wear a lumbar corset (a soft, flexible back brace) at the start of your treatment to relieve your back pain, although it does not help heal the herniated disc. Manipulation may provide short-term relief from non-specific low back pain but should be avoided in most cases of herniated disc. At first, the exercises you learn may be gentle stretches or posture changes to reduce back pain or leg symptoms. When you have less pain, more vigorous exercises will likely be used to improve flexibility, strength, endurance and the ability to return to a more normal lifestyle. Exercise instruction should start right away and be modified as recovery progresses. Learning and continuing a home exercise/stretching program are important parts of treatment. Medication and Pain Management Medications used to control pain are called analgesics. Most pain can be treated with non-prescription medications such as aspirin, ibuprofen, naproxen or acetaminophen. If you have severe, persistent pain, your doctor may prescribe narcotics for a short time. Sometimes, but not often, a doctor will prescribe muscle relaxants. However, you want to take only the medication you need because taking more does not help you recover faster, might cause unwanted side effects (such as constipation and drowsiness) and can result in dependency. All medication should be taken only as directed. Make sure you tell your doctor about any kind of medications you are taking - even over-the-counter drugs - and if he/she prescribes pain medication let him/her know how it is working for you. Nonsteroidal anti-inflammatory medications (NSAIDs) are analgesics and are also used to reduce swelling and inflammation that occurs as a result of disc herniation. These include aspirin, ibuprofen, naproxen and a variety of prescription drugs. If your doctor gives you anti-inflammatory medications, you should watch for side effects like stomach upset or bleeding. Chronic use of prescription or over-the-counter NSAIDs should be monitored by your physician for the development of potential problems. There
are other medications that also have an anti-inflammatory effect.
Corticosteroid medications - either orally or by injection - are
sometimes prescribed for more severe back and leg pain because of
their very powerful anti-inflammatory effects. Corticosteroids,
like NSAIDs, can have side effects. Risks and benefits of this medication
should be discussed with your physician. Trigger
point injections are injections of local anesthetics (sometimes
combined with corticosteroids) directly into painful soft tissue
or muscles along the spine or over the back of the pelvis. While
occasionally used for pain control, trigger point injections do
not help heal a herniated lumbar disc. |
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