Disc herniation is a common injury suffered during lifting activities. If you have suffered a disc herniation, the soft cartilage, or disc, in between your vertebrae has slipped out of place. Because your spinal cord slides through the center of the disc, any displacement of the disc causes pressure to your spinal cord and can cause permanent nerve damage. Understanding the outcomes associated with physical therapy versus conservative or surgical interventions will guide you in making your decision after a herniation injury.
Conservative Managment
The Journal of American Academy of Family Physicians reports that 90 percent of lumbar disc herniation patients with sciatic symptoms report decreased severe symptoms after six weeks, with total resolution of symptoms after twelve weeks. Conservative management includes decreased activity, muscle relaxants and over the counter pain management. The Academy recommends repeat primary care physician visit after one or two weeks. If severe pain persists thereafter, physical therapy should then be initiated for pain management.
Physical Therapy Outcomes
Although the research regarding the outcomes for physical therapy for a herniated disc is varied, there are advantages to receiving physical therapy as opposed to surgery. Because some patients are not medically stable enough to undergo surgery, physical therapy provides a nonsurgical option that is associated with 86 percent symptom resolution in a study completed by the Orthopedic Technology Review. The modalities such as electrical stimulation, infrared heat and ultrasound can provide symptom reduction, they are not correlated with herniation repair. Thus, long term affects can only be achieved with herniation resolution.
Indications for Therapy
Many considerations exist when considering surgical intervention after disc herniation. Studies show varying outcomes based on a multitude of factors. For those with severe symptoms such as fecal or urinal incontinence and paralysis, surgery is emergent and imperative because avoiding surgery will likely result in permanence of symptoms. The "Journal of Sports Physical Therapy" reports that those under worker's compensation report approximately equal outcomes of function and pain two years after injury whether or not they received therapy. However, Spine reported a study of over 1,200 patients who reported maintenance of superior outcomes four years after injury if surgical intervention was used.
Surgical Candidate Personality
Because many herniation injuries occur while the patient is working, worker's compensation can factor into the decision to receive surgery, as the patient's medical costs are usually completely covered by the worker's compensation. Furthermore, the desire to return to the occupation can motivate some patients to pursue a more aggressive, surgical approach. Spine notes that out of approximately 1,200 patients studied, patients that sought surgical intervention reported increased incidence of sciatic pain, suffered L4 to S1 injuries, were younger, less likely to be currently working and more likely to be receiving compensation.
References
- Journal of Orthopedic Sports Therapy: Physical Therapy Outcomes for Patients Receiving Worker's Compensation Following Treatment for Herniated Lumbar Disc and Mechanical Low Back Pain Syndrome
- American Academy of Family Physicians: Acute Lumbar Disk Pain: Navigating Evaluation and Treatment Choices
- Spine Universe: Physical Therapy for Herniated Discs
- Spine: Surgical versus Non-Operative Treatment for Lumbar Disc Herniation: Four-Year Results for the Spine Patient Outcomes Research Trial (SPORT)
- Quinte Decompression and Pain Clinic: Independent Scientific Research
