We get this question a lot in Physical Therapy. Sometimes it is from someone who suspects they might have a herniated disc in their neck or back. Sometimes it is from someone who was just diagnosed on MRI with a herniated disc. So, do you need surgery for a disc herniation? This is a great question.
In general, the answer is...No. It is well documented that disc herniations can and will regress and resolve on their own. It can take a while, think 6 months or more. But it does happen, and surgery can be avoided. There are exceptions, when surgery is necessary, such as in cases when someone loses complete nerve function and sensation, has alterations in their bladder and bowel control, or are having severe foot drop and leg weakness. Of course, you shouldn't take your medical advice just from a blog either, so if you're unsure if you're in this camp, please consult with both your Orthopedic specialist and your Physical Therapist.
Physical Therapy can further help you prevent the need for surgery and have a safe, full recovery by providing patient education, activity modification, manual therapy techniques, modalities as needed, and specific therapeutic exercises. Also, High Intensity Laser Therapy (Class IV laser) can be an effective modality for treating disc herniations, and this treatment is also provided at some Physical Therapy offices.
A herniated disc when accompanied by symptoms such as back pain, sciatica, altered mobility and gait, weakness, and disturbed sleep can be very debilitating and painful. You may feel that you have no option but surgery. But in many situations, this isn't the case, and if surgery can be avoided, you are better off as surgery isn't a guaranteed fix and comes with its own potential side-effects (and long term scar tissue). Though, do remember there are red flags above that would put you in the surgical candidate category.
If you have been diagnosed with a disc herniation and are wondering where to begin, have a conversation with your Physical Therapist first. A surgeon knows only surgery, so many of them are likely to recommend this as a first line of treatment (though many are coming around now to conservative measures). And if you don't have a PT, feel free to set up a free in-person or phone consultation with our office. Fill out your Contact information on our Events and Offers page, or send an email requesting your free consultation to thegreenroompt@outlook.com.
In good health,
Dr. Ashley Bertorelli, Physical Therapist and Founder, The Green Room Physical Therapy
References:
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation. The Spine Patient Outcomes Research Trial (sport): a randomized trial. JAMA 2006;296:2441–50
Chou R, Loeser JD, Owens DK, et al. ; for the American Pain Society Low Back Pain Guideline Panel Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine 2009;34:1066–77
Chou R, Qaseem A, Snow V, et al. ;for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American Pain Society Low Back Pain Guidelines Panel Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478–91
Komori H, Shinomiya K, Nakai O, et al. The natural history of herniated nucleus pulposus with radiculopathy. Spine (Phila Pa 1976) 1996;21:225–9
Fager CA. Observations on spontaneous recovery from intervertebral disc herniation. Surg Neurol 1994;42:282–6
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