Conservative Management of a Lumbar Disc Herniation

By: Dani Dobson

Christmas Eve we are sitting laughing, eating, and opening gifts. My dad suddenly says his back hurts. This is not uncommon for him, so I gave him a pillow and we carried on. Half an hour later the pain is too much, and he must go lie down. We thought he overdid it the day before and he was sent to bed with painkillers and a hot water bottle. Christmas day he phones me super early almost in tears saying that his back is now so sore he can hardly move, there is pain running down his right leg and he can’t stand up as he can’t put weight on the leg. Now I’m thinking ok he may have a pinched nerve. I went to him and did a soft tissue release and lots of needling into the glutes… That seemed to help for a while. 

Now it’s boxing day, he has been in bed for almost 3 days, the pain is getting worse, and he is still unable to put weight on his leg. It’s now time to go to the hospital. He had an MRI, and it turns out he had a herniation of his disc between L4 and L5 which was putting pressure on the nerve running down to his leg.

Now what is interesting is disc herniations can heal spontaneously taking a few weeks to a few months. But in the meantime, if you aren’t going to have surgery what do you do? The Dr put him on medication to ease the nerve pain, but this is where physiotherapy plays a vital role. 

Conservative management (management without surgery) for this is where physio is vital.

We will teach you correct and safe sequences of movement i.e. how to get out of bed, sit to stand etc as well as identifying movements and postures that exacerbate your symptoms. We use heat, TENS, and ice to help alleviate acute muscle spasms and manage pain. Hands-on techniques such as soft tissue massage and manipulation and gentle mobilisation to reduce muscle tension and alleviate nerve irritation. 

Additionally, we create a tailored exercise program focusing on core stability, flexibility, and strengthening that is vital for improving spinal support and reducing the risk of recurrence.

Now 2 months later the good news is after following this and taking his medication diligently my dad does not need a spinal fusion. His disc is starting to heal, and he does not have pain running down his leg. 

This may not be the case with every person and surgery might be the only option, but physiotherapy has an important role in pre and post-operative care!