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What is the best self exam and treatment for low back herniated disc pain?

By BruceBlaus. When using this image in external sources it can be cited as:  Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. (Own work) [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

Herniated disc treatment: Self Checking and Management

How can I check if my pain is from disc or muscle origin by myself?

1. You can check it through 4 simple movements below.

* Second and third pictures – dragging your hip towards one side with spine straight

While doing those 4 movements below (flexion, trunk shift to right/left, extension), if you feel pain/dull/achy sensation (more than stretching) in one side or both side of low back (usually one side), you can suspect the same side disc prolapse.

Flexion movement is usually limited with increased pain in the affected area.

2. Morning Stiffness in your back or leg

Low back or lower leg (Usually one side) feels stiff and tighter as prolapsed disc size got bigger while sleeping in non-gravity position.

3. Increased pain when standing up from prolonged sitting position

When standing up from sitting, movement is obstructed by something in your back!

4. Stretching doesn’t work well.

If tight low back, buttocks, hamstring, or calf muscle is not getting better or irritated with regular stretching, it is worth suspecting low back disc herniation.

5. Sneezing and coughing increase pain on back or leg

If you feel increased pain on your back or shooting pain to leg with coughing or sneezing, it means you have pressure on your nerve due to possible disc herniation.

Does disc pain have any pattern when it is radiating down to the leg?

1. Pain pattern is variable

Sometimes you feel in left low back and later you feel in left lateral hip area, and the day after you may feel in right low back area

2. You can feel either as pain, tingling sensation, numbness or muscle stiffness

Radiating pain to hip/leg – usually radiates to one side intermittently

How to check if he/she is getting better or worse in disc symptom?

[Concept of Centralization/Peripheralization]

After doing exercise/stretching/manual therapy/etc, if you feel pain is more towards the center of spine (Centralization):

Symptom is getting better – You may have smaller size of herniated disc that causes less stress on the nerve root)

What if patient says “I don’t feel much on my back, but I started to feel on my thigh/toes? (Peripheralization):

Symptom is getting worse because changed location is more towards distal area– indicating more bulged disc size stressing more on nerve root

* Centralization phenomenon is the one of the strongest indicator you will have a good result.

Can we reverse herniated disc to the original place?

Yes.

Most of patients experience the phenomenon of centralization (Pain area is moving towards the center of low back) and eventually pain is diminished within 2 to 4 weeks with proper guidance and treatment.

But, at least for 1 month, bending forward movement should be minimized. This is the time to give your disc and ligament structures to heal.

Then, how to reverse prolapsed disc to the original location?

Initially, most effective way of treatment is lying on your stomach with putting ice on low back

As time goes on, you can increase low back arch with several pillows underneath your chest.

You can increase more extension movement with progression of exercise: prone on elbow, prone press up and low back extension in standing exercise as time passes as below. (Perform it only if you can tolerate movement without increased pain)

* If you still see peripheralization (Pain moves to distal area of leg or foot) after exercise, stop the exercise and consult with your physical therapist or physician.

Helpful stretching associated with main muscles causing low back pain


[Psoas muscle stretching]

Hold this position for 15 secs and relax, repeat 5 repetitions each side

[Quadratus Lumborum (QL) stretching]

Hold this position for 15 secs and relax, repeat 5 repetitions each side

[Piriformis stretching]

Hold this position for 15 secs and relax, repeat 5 repetitions each side

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