DISC HERNIATION / SCIATICA

A Disc Herniation or bulging disc is a common problem that can occur in the lower back (Lumbar Spine). It can occur due to wear and tear (degeneration) of a disc. Quite often this herniation happens after an event such as a sports injury, lifting something heavy, excessive bending forward, fall, or motor vehicle collision. However, it can frequently happen without any identifiable cause.

When a disc herniates it can cause back pain or leg pain. The leg pain occurs due to compression of a nerve by the disc herniation and is often referred to as Sciatica. Sometimes the nerve compression can be severe enough to cause numbness, weakness, or even bowel/bladder control difficulties. While the severe symptoms are rare, if you do have significant weakness or bowel/bladder control problems you need to seek treatment urgently at a hospital.

Thankfully, with appropriate treatment more than 90% of people can experience improvement of their symptoms without needing surgery when they don’t have severe weakness or bowel/bladder control problems.

Non-operative Treatment Protocol:

Here is my protocol for patients with new onset of symptoms of disc herniation or sciatica:

  1. Avoid activities that involve lifting anything heavier than 10-15 lbs
  2. Avoid bending your lower back
  3. Avoid twisting of your lower back
  4. Rest for 2-3 days at home to take it easy. Try to get up and walk a little indoors every 2 hours
  5. Use Acetaminophen and ibuprofen regularly. Do not exceed maximum allowed daily dose and do not use if there are contraindications to their use. Avoid using narcotic pain medications for more than 2-3 days.
  6. Apply an ice pack over the back for 10 minutes every 2 hours to help decrease inflammation
  7. Try a short 6 day course of oral methylprednisolone to reduce inflammation. This has to be prescribed by a medical professional.
  8. As the extreme pain eases up, start exercises that focus on relieving pressure on the disc:
    1. Back extension or McKenzie exercises focusing on lumbar extension. avoid lumbar flexion
    2. Water therapy
  9. If symptoms continue for 3-4 weeks then the next step may be to try an epidural injection targeting the inflammation around the nerve and disc
  10. Start core strengthening exercises after 6 weeks to prevent future episodes once the current episode of pain improves

Using these steps more than 90% of patients can avoid surgical treatment and can expect to improve within 6 weeks to 3 months.

Surgical Treatment:

The small proportion of patients who do not improve with the above mentioned methods or those who have significant weakness or bowel/bladder control problems may require surgical treatment.

Thankfully, minimally invasive surgical methods can be used to treat this condition with a small incision as an outpatient surgery using microscopic techniques with a very high success rate