A herniated disc, also known as a slipped or ruptured disc, occurs when the soft tissue inside the spinal column pushes through a crack in the tougher outer layer of the disc. In a healthy spine, vertebral discs cushion your bones as you move, but an acute injury or age-related degeneration can weaken them and make them crack open. The gel material inside the disc starts to leak out, and the damaged disc compresses nerves along your spinal cord.
Herniated disc pain comes from nerve compression and inflammation in your spine. Common symptoms of a herniated disc are:
- Back pain
- Neck pain
- Numbness in arms or legs
- Muscle weakness
- Restricted mobility
The treatment of a herniated disc depends on the severity of the symptoms and the patient’s overall health. Some common treatments include:
- Rest and activity modification: Resting and avoiding activities that worsen the symptoms can help relieve pain and discomfort.
- Physical therapy: A physical therapist can design a program of exercises and stretches that can help reduce pain, improve flexibility and strengthen the muscles supporting the spine.
- Medications: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and reduce inflammation. In some cases, stronger prescription medications may be necessary.
- Epidural steroid injections: These injections deliver a powerful anti-inflammatory medication directly to the affected area, helping to relieve pain and reduce inflammation.
- Surgery: Surgery may be necessary if other treatments have failed or if there is significant nerve damage. A surgical procedure can remove the herniated portion of the disc and relieve pressure on the affected nerve.
We will discuss each treatment option in more detail.
Rest and Activity Modification
Rest and activity modification can help a herniated disc by reducing the load on their spine, allowing the injured tissue to heal and reducing the risk of further damage.
Activity modification can also help by reducing the amount of bending, twisting, and lifting that can aggravate the herniated disc. A healthcare provider may recommend avoiding activities that put excessive strain on the spine, such as heavy lifting, sports that involve twisting or impact, or activities that require prolonged sitting or standing.
Rest and activity modification can also help reduce inflammation in the affected area.
A physical therapist can design a program of exercises and stretches that can help reduce pain, improve flexibility, and strengthen the muscles supporting the spine. Here are some ways that physical therapy can help with a herniated disc:
- Pain relief: A physical therapist can use a variety of techniques to help relieve pain, including manual therapy, heat or ice therapy, and electrical stimulation.
- Flexibility: A physical therapist can design a stretching program to improve the flexibility of the muscles and joints surrounding the herniated disc. This can help reduce pressure on the disc and alleviate pain.
- Strengthening: Strengthening the muscles that support the spine can help reduce the load on the herniated disc and improve spinal stability. A physical therapist can design a program of exercises to target specific muscle groups.
- Posture and body mechanics: A physical therapist can teach the patient proper posture and body mechanics to help reduce pressure on the spine and prevent further injury.
- Education: A physical therapist can educate the patient about their condition and how to manage their symptoms, including strategies for pain relief and injury prevention.
It’s important to note that physical therapy is not a one-size-fits-all approach, and the specific exercises and techniques used will vary depending on the patient’s individual needs and condition. A healthcare provider can help determine if physical therapy is an appropriate treatment option for a herniated disc.
Several medications can help manage the pain and inflammation associated with a herniated disc. The choice of medication will depend on the severity of the symptoms, the patient’s medical history, and other factors. Some common medications used to treat a herniated disc include:
- Over-the-counter pain relievers: Medications such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve) can help relieve mild to moderate pain and reduce inflammation.
- Muscle relaxants: These medications can help reduce muscle spasms that can occur as a result of a herniated disc. Common muscle relaxants include cyclobenzaprine (Flexeril) and methocarbamol (Robaxin).
- Prescription pain relievers: In some cases, stronger prescription pain medications may be necessary to manage severe pain. Opioids such as oxycodone or hydrocodone may be prescribed, but they carry a risk of addiction and other side effects and are typically reserved for severe cases.
- Epidural steroid injections: These injections deliver a powerful anti-inflammatory medication directly to the affected area, which can help reduce pain and inflammation.
- Medical marijuana: Some studies have suggested that the cannabinoids in medical marijuana, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), may have pain-relieving and anti-inflammatory effects. These effects may help alleviate some of the symptoms associated with a herniated disc, such as pain and inflammation.
Epidural Steroid Injections
Epidural steroid injections can be used to help manage the pain and inflammation associated with a herniated disc. The injection involves delivering a corticosteroid medication directly to the affected area in the spine.
The corticosteroid medication used in the injection has anti-inflammatory properties and can help reduce inflammation and swelling in the area around the herniated disc. This can alleviate pressure on the nerves and reduce pain.
The injection is given directly into the epidural space, which is the space between the protective covering of the spinal cord and the vertebrae. The medication is then absorbed into the bloodstream and travels to the affected area, providing localized pain relief.
Epidural steroid injections are typically administered by a healthcare provider in an outpatient setting, such as a clinic or hospital. The procedure may be guided by imaging techniques such as X-rays or fluoroscopy to ensure that the medication is delivered to the correct location.
Most patients report a reduction in pain that lasts for several months.
Once all other conservative treatment options have been exhausted, your medical provider may recommend surgery to correct a herniated disc.
There are several surgical procedures that can be used to treat a herniated disc. The choice of surgery will depend on the location and severity of the herniation, as well as other factors such as the patient’s overall health and medical history. Some common surgical procedures used to treat a herniated disc include:
- Microdiscectomy: This procedure involves removing the portion of the disc that is pressing on the nerve root, using a small incision and specialized surgical instruments. This can relieve pressure on the nerve and alleviate pain.
- Laminectomy: In this procedure, a portion of the vertebra (the lamina) is removed to create more space in the spinal canal, which can relieve pressure on the nerve.
- Discectomy: This procedure involves removing the entire disc, rather than just the portion that is herniated. The disc is then replaced with an artificial disc or a bone graft.
- Spinal fusion: This procedure involves fusing two or more vertebrae together using bone grafts or metal implants. This can provide stability to the spine and prevent further herniation of the disc.
The choice of surgery will depend on several factors, including the location and severity of the herniation, the patient’s overall health, and their individual treatment goals. A healthcare provider can help determine which surgical option is most appropriate for each individual case. It’s important to note that surgery is typically only recommended for cases where other treatments, such as physical therapy or medication, have not been successful in managing the symptoms of a herniated disc.
If you have been diagnosed with, or suspect you may have a herniated disc, make an appointment with Dayton Orthopedic Surgery & Sports Medicine Center to discuss your treatment options. Call (937) 436-5763 to schedule an appointment.