A herniated disk, often times called a slipped/ruptured disk or sciatica, usually occurs in the lower back. It is the one of the most common causes of low back pain. Though many people refer to their back pain or herniated disk as sciatica, this is technically incorrect as the sciatic nerve runs down into the hip. Where the disk herniates is not the sciatic nerve, but rather the disk root.
Between 60% and 80% of people will experience low back pain at some point in their lives and a large percentage of these are caused by a herniated disk.
The 24 bones that make up your spine are called vertebrae. The vertebrae are separated by disks that are the natural spacers and shock absorbers to your spine. Think of the disk like a jelly donut with a hard fibrous outer covering and a soft jelly like middle. A disk begins to herniate when it’s jelly-like middle pushes against the fibrous outer ring due to wear and tear or a sudden injury. This squeezing of the disk often causes lower back pain.
- stay as active as possible
- consider an epidural injection
- get physical therapy
- consider deep tissue massage therapy
- rush into surgery
- take oral steroids like Prednisone
- get hooked on over the counter (OTC) anti-inflammatories or narcotics
- forget to consider alternative instead of epidural steroid injections
Recovery is a balancing act between non-aggravating the nerve and making sure the small muscles that stabilize the back don’t atrophy, which means keeping your muscles from degeneration. Once the muscles atrophy, a chronic lifelong problem of back pain can ensue.
Do things that don’t aggravate the neck or make any arm/hand symptoms worse. For example, running could aggravate the back, while using an elliptical may be fine. Make sure you keep your range of motion good by slowly bending down and to the left and right several times a day.
Epidural injections involve placing medication around the aggravated nerve under imaging guidance. It is important to use caution here as recent studies have shown that injecting steroids can cause negative side effects. Consider using growth factors from your own blood platelets instead. Speak with your doctor about epidural injections and how they could help your condition.
Physical therapy can help you stay strong and make sure your muscles don’t degenerate while you are recovering.
Physical therapy should focus on getting rid of muscle trigger points and maintaining range of motion. When the low back is no longer painful, you can consider strengthening exercises. However, be careful, as a recent study showed that trying to strengthen when the back is still aggravated can be counterproductive.
Studies have shown that treating low back pain with deep tissue massage performs just as well as NSAID drugs such as Motrin, Aleve, and Advil without any of the nasty side effects.
Massage therapy can be performed by a licensed massage therapist. Focus on somebody who comes highly recommended. Make sure they have experience in therapeutic trigger point or myofascial massage therapy.
Research shows that patients who get surgery are no better than those who do nothing.
The only time to consider surgery is when there is muscle weakness that’s worsening. Other non-invasive therapies like having your own blood platelets injected to heal the injury may be helpful and much less invasive.
Oral steroids are associated with dramatic increases in serious bone disease like osteonecrosis. While this is a common recommendation in family practice clinics, natural alternatives like using high dose fish oil may be helpful and less risky.
OTC anti-inflammatories like Ibuprofen, Advil, Motrin, or Aleve can dramatically increase your risk for sudden death heart attack as well as stomach ulcers. Consider natural alternatives like high dose fish oils. Narcotics are addictive and can be very difficult to stop for some patients once they start down that road. Narcotics can also destroy your natural sleep cycles, your natural ability to control pain, and reduce testosterone and disrupt other important hormones.
Injecting steroids into the area where the disc is aggravating the nerve can be very helpful and help patients avoid the need for more invasive surgery. However, the recent New England compounding pharmacy tragedy involving tainted steroids has caused many physicians to revisit steroids. In addition, one recent study showed that for every epidural steroid shot a middle aged or older woman received, there was a 29% increase in fracture risk. Surprisingly, many studies now show that these helpful injections may work just as well with only anesthetic without any steroid. In addition, other physicians have been replacing the steroid with healing growth factors taken from the patient’s own blood platelets.
Herniated disks are a very common cause of chronic lower back pain. It is also not uncommon for patients to rush into surgery in order to find relief from their pain. However, it is important to realize that there are several non-surgical options available to patients that may relieve or completely resolve the pain caused by a herniated disk. Surgery should always be considered a last resort. Try using your own body and alternative methods to treat your lower back pain and in the long run you’ll be much happier and healthier.