Herniated disc: physiatrist
viewpoint
Herniated disc symptoms
This patient has a classic presentation for a lumbar disc herniation causing
a lumbar radiculopathy. When a disc herniates and compresses a nerve, the
patient will experience pain in the leg, and frequently pain will be much
worse with sitting.
Treatment of a herniated disc
Initial treatments for the herniated disc should focus on decreasing inflammation
that is associated with a disc herniation and improving mobility to prevent
deconditioning. Prompt and aggressive treatment of disc herniations can help
decrease the chance for developing chronic pain.
Anti-inflammatory medication for a herniated
disc
For anti-inflammation, methylprednisolone, an oral cortisone, is commonly used
for six days. Side effects are rare when used for this short time period, but
nonetheless stomach ulcers, osteoporosis, avascular necrosis of the hips (which
can lead to arthritis and hip replacement), cataracts, and transient increase
in blood sugar and blood pressure can occur. The oral cortisone is then followed
with a NSAID, and I like to start with ibuprofen 800 mg three times daily.
This medication is taken with food to avoid stomach upset.
Physical therapy for a herniated disc
Physical therapy is appropriate at this time to teach the patient specific
exercises called McKenzie exercises. The goal is to centralize the pain to
the back where it is better tolerated and easier to treat. Four to six PT
sessions are prescribed, and then the patient is given a home program to
follow. Compliance with this program is imperative. Walking is also encouraged
to prevent the muscles from getting weak in the back, stomach, and legs.
The patient should always remember to use pain as a guide to activity level
as "no pain, no gain" does not apply to a person recovering from
a disc herniation.
The great majority of patients with a herniated
disc will recover with anti-inflammatories and
an appropriate exercise program. However, if
pain continues lumbar epidural steroid injections
would be recommended. Physical therapy would
continue with the injections as maintaining flexibility,
strength, and aerobic conditioning of the major
muscle groups of the legs, stomach, and back
improves recovery and decreases the risk for
reinjury.
When spine surgery is needed to correct a
herniated disc
After 4-6 weeks of the above regimen, I would refer to a surgeon for evaluation
if symptoms from the herniated disc persisted. It is important to monitor for
increasing pain, progressive numbness or weakness, or bowel and bladder dysfunction
as this would require more aggressive treatment and an earlier referral for
surgery.
By:
Richard A. Staehler, MD
September 14, 2000 |
