How to treat disc herniation?

How can I check if my pain is from the herniated disc or muscle injury

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

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 of the lower back, 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 the prolapsed disc size got bigger while sleeping in a 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.

What is the pain pattern of disc herniation?

1. Pain is radiating down to the one side (left or right) intermittently.

It is rare having both legs involved.

2. 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

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

The sensation you will experience can be variable. Sometimes you will feel knee or calf muscle tightness/ stiffness without any pain due to the lumbar disc herniation.

How do I know if I am getting better or worse?

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

Symptom is getting better since you feel pain is moving towards the spine (center) – the size of bulging disc decreased with less nerve tension)

What if a 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 the changed location is more distal – the size of bulging disc got bigger and it compresses nerve root more

* Centralization (pain is moving to the center of the spine) is one of the strongest indicators that you will have a good result.

Can we reverse the herniated disc to the original place?

Yes.

Most patients experience the phenomenon of centralization (Pain area is moving towards the center of the lower 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 the 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 the 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 for the main muscles in lower back

1. Hip flexor (Psoas muscle) stretching

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

2. Quadratus Lumborum (QL) stretching

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

3. Piriformis stretching

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