Herniated Disc Treatment Options

I'm writing in response to your last answer on herniated discs. Thanks for explaining what they are and what happens when they press on a nerve, but what can I do to get rid of a herniated disc and the pain? I have a herniated disc in my low back, so what are my treatment options?
-Reigate, England

You're not going to "get rid" of the herniated disc on your own—I just need to let you know that. The only way to permanently get rid of a herniated disc is surgery, but that's generally a last resort option to relieve your pain and other symptoms. It's a low percentage of herniated disc patients who need surgery; I'd say around 1-2%. For the other 98-99%, non-surgical treatments are very effective for herniated or bulging discs.

For my patients, the first thing I recommend is physical therapy. This can be combined with anti-inflammatory medications, commonly called NSAIDs (or non-steroidal anti-inflammatory drugs). The NSAIDs should take care of most of the pain component, and you can use over-the-counter NSAIDs, such as Aleve or Motrin. If needed, your doctor may prescribe a stronger NSAID.

It's the physical therapy, though, that may provide long-term pain relief as it strengthens and conditions your body. The physical therapist will work with you to develop a specialized treatment plan, one that takes into account your pain, other symptoms, goals, history, and physical fitness. For herniated discs, the physical therapist often teaches you some extension exercises. Exercises that arch your back (that's what extension means) have been shown to reduce pain from a herniated disc.

If my patient hasn't had satisfactory pain relief from physical therapy and NSAIDs, I usually recommend a nerve root injection or an epidural steroid injection. Both of those fall under pain management, so you may need to go see a specialist if your doctor suggests an injection.

You have other treatment options: massage, herbal remedies, and acupuncture to name a few. You may try those as well, but there really haven't been any good studies proving that they work effectively; that's a fact to take into consideration when thinking about your treatment options. In my experience, patients have found the most relief from those big three of physical therapy, NSAIDs, and spinal injections.

If none of these options help you, even though you tried them for three to six months, your doctor may say that you've failed non-surgical or conservative care. Don't get hung up on the word "failed." In this case, it means that you may be a surgical candidate. At that point, your doctor will recommend the best surgery for you. I tend to do microscopic minimally invasive discectomies, which remove the part of your intervertebral disc that's pushing on your nerve. It's called minimally invasive because it's done through a small incision; minimally invasive surgeries have a shorter recovery time than traditional surgeries that involve larger incisions.

Perhaps most important of all, give your herniated disc some time—the tincture of time, I like to call it. The herniation won't get smaller, but with time, it may not push on your nerves so much as your body adapts to the changes in the disc.