How is a herniated disc treated?
Most herniated discs resolve on their own or with conservative treatment, which includes rest, anti-inflammatories, and physical therapy. Some people find that ice packs or moist heat applied to the affected area provides some symptomatic relief of the pain and muscle spasms in the back. In cases that do not improve with conservative treatment, spinal injections or surgery might be needed.
- Medicine — Nonsteroidal anti-inflammatory drugs (NSAIDs) help to relieve pain, inflammation, and stiffness, allowing for increased mobility and exercise.
Common over-the-counter NSAIDs include aspirin, ibuprofen (Motrin®, Advil®), and naproxen (Naprosyn®, Aleve®). You may take medicines with food to avoid stomach irritation.
Muscle relaxants and various analgesics might be prescribed to relieve the discomfort associated with severe pain or muscle spasms in the initial treatment periods.
- Physical therapy — The goal of physical therapy is to improve core strength, flexibility and endurance to enable you to engage in your normal activities.
The exercises prescribed by your physical therapist can also help relieve pressure on your nerves, reducing the symptoms of pain and weakness. The exercise program often includes stretching exercises to improve flexibility of tight muscles and aerobic exercise — such as walking or using a stationary bike — to build endurance and improve circulation.
Other exercises might help to strengthen the muscles of your back, abdomen, and legs.
- Spinal injections — An injection of a cortisone-like medicine into the lower back might help reduce swelling and inflammation of the nerve roots, allowing for increased mobility. These injections are referred to as epidurals or nerve blocks.
- Surgery — Surgery might be needed for people who do not respond to conservative treatment, whose symptoms get progressively worse, or who experience progressive neurologic decline. Rarely, a large disc herniation might injure nerves to the bladder or bowel, which requires emergency surgery. The most common surgical options include microdiscectomy, laminectomy, or foraminotomy.
- Microdiscectomy — Microdiscectomy is a procedure used to remove fragments of a herniated disc, often using an operating microscope.
- Laminectomy — The part of the bone that curves around and covers the spinal cord (lamina) and the tissue that is causing pressure on the nerve or spinal cord are removed. This procedure is performed under general anesthesia. The hospital stay is one to two days. Complete recovery takes about six weeks.