Medical Edge Newspaper Column

Conservative Approach Usually Best
For Treating Herniated Disk

March 12, 2006
DEAR MAYO CLINIC:
Since being diagnosed with a herniated disk in my lower back, I have researched various treatment options on the Internet. I understand that physical therapy is necessary to prevent further injury or a recurrence, but I am wondering whether traditional physical therapy is a good treatment option or if I should seek out a facility that uses the VAX-D or Pneumex traction machines to stabilize the disk. I have consulted a spinal surgeon, a chiropractor and a physical therapist and have received different answers from each, so I'm more confused than ever. Are there any medical studies that show one treatment to be more effective than another? -- Chicago

ANSWER:
The traction methods you mention essentially immobilize the lower body and stretch the spine. They may provide transient benefits, relieving pain for a few hours or a day. But there are simpler and less expensive ways of treating a herniated disk or preventing its recurrence.

Disks cushion the vertebrae of the spine. When they herniate -- rupture -- as a result of some traumatic event or simply from aging, they bulge out, often without causing symptoms. If the disk substance extends enough to irritate a nearby nerve, however, it can cause pain or tingling in the back as well as the leg. It can also cause numbness or weakness in the leg.

Usually the body soon heals itself. In over 70 percent of cases, conservative approaches (including doing nothing) allow patients to recover without having to resort to complex and expensive options. These simpler methods include, for example, a day or two of bed rest, pain-relieving or anti-inflammatory drugs, cold or heat therapy, and electrical stimulation.

If simpler approaches fail and discomfort from the disk problem seriously intrudes on daily life, surgical alternatives are available. Though an established method like diskectomy -- removal of a part of the disk to relieve pressure on a nerve -- can have excellent results, it and other invasive methods are not necessarily the best options for every patient. Surgical evaluation is often indicated to select appropriate candidates and deter others.

It is important, however, to know when urgent care -- possibly requiring emergency surgery -- may be necessary. If you suffer significant or progressive muscle weakness, loss of bowel or bladder control or loss of sensation in the area that would touch a saddle, contact your doctor immediately or go to an emergency room.

The best approach for dealing with herniated disks is to prevent their occurrence in the first place. Here, traditional physical therapy, together with a regular exercise program at home, can strengthen muscles supporting the back and improve flexibility, making disk problems or other back problems less likely.

-- William E. Krauss, M.D., Neurosurgery, Mayo Clinic, Rochester, Minn.