7 Most Common Questions about Herniated Discs in the Lumbar Spine
Struggling with herniated discs is a very common problem that can occur in any part of the spine, but it most often appears in the lower back—the lumbar spine. When you hear this diagnosis, it may trigger some fear. You might imagine surgery, screws in your spine, and a long recovery. However, there is no need for panic; in the vast majority of cases, this condition can be managed conservatively with rehabilitation.
Successful Treatment Usually Requires an Active Approach from the Patient
There are dozens of causes for back pain associated with a herniated disc, so treatment can vary from person to person. Unfortunately, there is no magic pill. Successful management typically requires an active approach. The rule is simple: as long as you take care of your back, the pain is under control, and your body can handle more strain. However, if you stop taking care of your back because the pain subsides and your motivation to exercise fades, the herniated disc is likely to catch up with you during a weak moment—such as after a serious illness, in times of higher stress, or following intense physical exertion. Often, the pain returns with more intensity and less willingness to subside, even under the hands of an experienced physiotherapist. Recurrences are not a good sign for the health of your spine, so we aim to prevent them as much as possible through lifestyle changes and exercises. This is why your long-term commitment to therapy is so crucial.
7 Most Common Questions about Herniated Discs in the Lumbar Spine
My back hurts. How can I tell if I have a herniated disc or not?
The first step in making the correct diagnosis is a detailed medical history. This conversation allows the doctor or physiotherapist to understand the circumstances that led to your discomfort, its progression, the current state, positions and movements that relieve or aggravate the pain. Next, the function and mobility of the spine and other body joints must be examined, and a neurological assessment will evaluate potential nerve compression and check reflexes. If necessary, the doctor will refer you for specific tests such as X-rays, MRI, or CT scans. These steps are essential for accurately differentiating whether the pain is due to nerve root compression or another cause. Therefore, this diagnosis cannot be confirmed or ruled out without a thorough assessment and examination.
My MRI shows a herniated disc, do I need surgery?
You may find comfort in knowing that herniated discs can be found in 20-30% of healthy individuals on CT or MRI scans. Therefore, the presence of a herniated disc does not necessarily mean surgery is required. If confirmed, treatment usually begins conservatively with physiotherapy, exercise, medication, and physical therapies (such as laser, shockwave, or electrotherapy). Surgery is generally considered only when conservative treatments fail, and the patient continues to experience significant pain or develops numbness or muscle weakness. If there is muscle weakness in the limb due to nerve damage, surgery may be expedited to avoid further damage to the compressed nerve root. Ultimately, the decision is based on a discussion between the doctor and the patient, considering symptoms, their duration, and the patient’s preferences.
How should I exercise during the acute phase of a herniated disc?
If the pain is severe, it’s important that your exercises are gentle and respect your pain levels. We don’t want to worsen the pain or irritate the symptoms by spreading it from the spine to the foot. Conversely, any reduction in pain from the lower limb or relief from painful symptoms signals that we are on the right therapeutic path. A physiotherapist, who has the right knowledge and experience, can help you choose appropriate exercises.
Typically, abdominal breathing needs to be supported, the diaphragm engaged, and the chest relaxed. In the acute phase, it’s essential to follow a few principles to avoid worsening the condition:
- Rest in a relief position, sometimes a few days of rest can significantly alleviate symptoms.
- Try dry heat, such as using a buckwheat pillow or simply wrapping yourself in a blanket.
- Don’t be afraid to use common analgesics like paracetamol or NSAIDs. While they don’t address the underlying cause, they can provide pain relief, allowing you to rest and promote healing.
- Try abdominal breathing if your body allows. Here’s how: Lie on your back with your head aligned with the spine. Your spine and pelvis should be in contact with the surface. Place one hand on your chest and the other on your abdomen. Focus on ensuring that your chest doesn’t rise with inhalation; only the abdomen should rise. The breath should be gentle and slow. Gradually try to extend the inhalation to three counts and the exhalation to three counts. Slowly increase the inhalation to four counts and the exhalation to six counts. Ideally, you should feel the pressure of the breath in the lower abdomen. Practice for at least 10 minutes, with breaks. If the pain decreases, numbness subsides, or pain retreats from the leg, this exercise is suitable and can be done three times a day. However, if the exercises worsen your symptoms, stop and schedule an appointment for further evaluation.
I feel tingling in my leg, and the pain shoots into my buttocks. Should I seek immediate help? Could something happen to me?
Immediate medical attention should be sought if you experience worsening symptoms such as pain, numbness, or weakness that interfere with daily activities, as well as issues with bladder function or difficulty urinating despite a full bladder. A loss of sensation on the inner thighs, the back of the legs, or around the anus should also prompt urgent medical consultation.
In these cases, you may be dealing with cauda equina syndrome, which is nerve root compression in the spinal canal. This condition is typically caused by trauma or a massive herniated disc between the 4th and 5th lumbar vertebrae. It’s a medical emergency that requires immediate surgery to prevent permanent damage.
How long does treatment for a herniated disc take?
In up to 80% of cases, the problem resolves naturally within six weeks of the onset of pain. However, a positive attitude, light physical activity that doesn’t trigger pain, and learning proper lifting techniques and body posture while sitting, standing, moving, and sleeping are crucial. Preventing recurrence and worsening of the condition requires preventive measures, such as finding a suitable exercise program or an experienced physiotherapist to strengthen weakened muscles and activate new movement patterns. If surgery is necessary, recovery typically takes at least 12 weeks, though rehabilitation is still recommended to avoid a recurrence. Without rehabilitation, the forces on the spine remain unchanged, and poor movement habits can persist. Simply put, if you don’t change your movement habits, the problem is likely to return quickly. Over time, it may even manifest in segments above or below the surgical site.
How many therapy sessions will it take to resolve the problem?
It depends on the condition of the patient, the cause of the pain, and the severity of the issue. In some cases, noticeable improvement can be seen after just the first session, while in others, long-term care is necessary, particularly to adjust posture and improve movement quality. A more accurate estimate will be provided after the initial assessment by a physiotherapist.
What does rehabilitation for a herniated disc involve? What can I expect, and how should I prepare?
The goal of physiotherapy at Fyzio Svět is to help you return to full activity as soon as possible and prevent re-injury or recurrence. We aim to release tension, reduce pain, and optimize movement. We will work on functional strengthening and teach you how to recover after exertion, stretch, and improve spinal flexibility. Our clinic also uses advanced technology such as high-performance lasers, which have proven effective in healing herniated discs. Exercise, strengthening, regeneration, and relaxation are key components of the treatment.
