Herniated Disc: Non-Surgical Solutions

About 80% of people will have back pain at some point in their life. These odds suggest you are probably one of them. Back pain with or without leg pain is commonly due to a herniated disc in the low back. Discs are the cushions in between each of the individual bones, or vertebrae, of the spine. They are strong structures that allow our spines to move and handle loads during our everyday lives. The outer part of the disc is a durable structure with multiple layers. The inner aspect of the disc resembles more of a thick fluid. A herniated disc occurs when a small tear in the outer part of the disc results in the inner material leaking out.  Thankfully, disc herniations can be treated without surgery.

Physical therapy for disc herniation

Disc herniation is the most common cause of sciatica, in adults. Put simply, sciatica is pain that originates in the low back and travels down the leg. However, not all disc herniations cause pain in the back or down the leg. Many adults older than 30 have evidence of a disc herniation on MRI but never experience pain. I am one of them. One study showed 30% of people in their 30’s and 60% of people in their 60’s have evidence of a disc injury but experience no pain. There are many factors that determine whether or not a person will experience pain. Possible contributors include the location of the herniation, the person’s physical health, and psychological factors.

Recovery from Disc Herniation without Treatment

Disc herniations can spontaneously heal without treatment. In these instances, resorption of the displaced inner material occurs spontaneously. This can occur within a few weeks of injury or it may not be seen for several years. One recent study showed spontaneous recovery occurs in approximately 2 out of every 3 lumbar disc herniations.  Because so many disc herniations spontaneously resolve, conservative treatments are usually recommended before considering surgery. Conservative treatments include those offered by your acupuncturist, massage therapist, and physical therapist.

Evidence for Conservative Treatments

Half of the people who access the services of a physical therapist do so for low back pain. More than half of these people have conditions related to the disc. Your physical therapist will first conduct a comprehensive examination to rule out the presence of any serious problems such as an injury to the nerves or spinal cord. Whenever pain is present in the legs, the first objective of treatment is to decrease these symptoms. Disc problems are much easier to manage once the pain is localized to only the low back.

Exercise for Disc Herniations

Research shows that exercise is one of the most beneficial forms of treatment for people with lumbar disc herniations. Exercises are designed to improve the strength, endurance, and coordination of the muscles which support the spine. Also, exercises can be extremely effective at reducing pain in the legs. Very often, exercises that promote extension of the spine, also known as “McKenzie exercises” are effective at resolving pain in the legs. However, an individualized examination must always be performed in order to determine the exercise approach which is best for you.

Manual Physical Therapy for Disc Herniations

Manual therapy performed by a physical therapist is also an evidence-based and effective treatment for people with a disc herniation. Joint mobilization techniques are useful to improve mobility, promote extension of the spine, and resolve symptoms in the legs. Joint manipulation techniques may also be used to alleviate stubborn pain or stiffness from a herniated disc. It is important that these techniques are delivered by a licensed and specially-trained healthcare professional. Doctors of Physical Therapy with advanced residency and fellowship training have expertise and skill with these techniques.

What Steps Can You Take

I recently rehabilitated a 40-year old landscaper with an L4-L5 disc herniation and pain radiating from his low back to his calf.  Surgery and injections were being considered. However, after 5 weeks of physical therapy he was back to work and nearly pain free. Today he feels like a new person! Physical therapy takes patience and a commitment. There is no magic pill for resolving back pain.  However, excellent results often occur. Your physical therapist will guide you through the recovery process. Contact us today if you are suffering or simply have questions about which treatments are right for you.


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