Herniated Discs: Pain Relief and Physical Therapy Insights

Intervertebral disc herniation issues?

I apologize for the interruption, but I would like to ask everyone a question.
I am a 33-year-old male, and on July 21, I experienced nerve pain in my buttocks and thighs for the first time in my life.
The sensation felt similar to stretching or doing the splits, and it persisted for 24 hours without relief.
Sitting, lying down, or being prone all caused severe pain, and I had difficulty bending.
On July 23, I quickly went to an orthopedic clinic and the rehabilitation department at Mackay Memorial Hospital.
I had an X-ray taken, and the diagnosis was a herniated lumbar disc, with slight narrowing of the intervertebral space (considered mild by the physician).
The current pain is attributed to the acute phase.
That night, I took anti-inflammatory pain medication, and when I woke up on July 24 (about 12 hours after taking the medication), I felt no pain at all.
The pain gradually returned by the afternoon, but there was significant improvement.
Since then, I have been visiting the clinic six times a week for traction, heat therapy, and electrical stimulation (currently eight sessions).
Overall, my pain has improved by about 80-90%, and my lower back no longer feels sore.
Currently, I experience intermittent "numbness or tingling in the soles of my feet" after walking for a while, and my thighs feel a bit sore after sitting for extended periods.
Occasionally, the muscles in my thighs feel tight.
1.
I would like to ask about the relationship between pain improvement and physical therapy.
I only underwent physical therapy on July 23 and took one anti-inflammatory medication that evening, yet I experienced significant improvement by July 24.
Is such rapid improvement possible, or could it be that the acute phase has passed and the symptoms have naturally diminished?
2.
I found information online stating that about 80-90% of patients with herniated discs improve with physical therapy, with only 10% requiring surgery.
Is this consistent with clinical practice?
3.
Is there a need for an MRI or similar imaging at this point?

Sam, 30~39 year old female. Ask Date: 2016/08/05

Dr. Shi Guozheng reply Orthopedics

1.
You are absolutely right.

2.
The rate of patients requiring surgical treatment is indeed low; most cases improve with conservative treatment.

3.
It is unnecessary.

Reply Date: 2016/08/05

More Info

Understanding herniated discs and their treatment options is crucial for anyone experiencing related symptoms. A herniated disc occurs when the soft inner material of a spinal disc protrudes through the tougher exterior, potentially pressing on nearby nerves. This can lead to pain, numbness, or weakness in the affected areas, often radiating down the legs or arms, depending on the location of the herniation.

1. Pain Improvement and Physical Therapy Relationship: The rapid improvement you experienced after starting physical therapy and taking anti-inflammatory medication can be attributed to several factors. Initially, the acute phase of your condition may have involved significant inflammation and muscle spasm, which can exacerbate pain. Anti-inflammatory medications help reduce this inflammation, providing relief. Physical therapy, including traction, heat therapy, and electrical stimulation, aims to alleviate pain, improve mobility, and strengthen the surrounding muscles. The combination of medication and therapy can lead to a significant reduction in symptoms, especially if the herniation is not severe. Additionally, it’s possible that the acute phase of your condition was short-lived, and your body began to heal naturally, contributing to the improvement you noticed.

2. Efficacy of Physical Therapy: Research indicates that approximately 80-90% of patients with herniated discs respond well to conservative treatments, including physical therapy. Surgery is typically reserved for cases where conservative management fails, or if there are severe neurological deficits. The goal of physical therapy is to strengthen the muscles supporting the spine, improve flexibility, and promote proper posture, which can help prevent future episodes of pain. Your experience aligns with clinical findings, suggesting that many individuals can achieve significant improvement without the need for surgical intervention.

3. Need for MRI: Whether or not you need an MRI depends on your ongoing symptoms and the clinical judgment of your healthcare provider. An MRI can provide detailed images of the spine and help assess the extent of the herniation, any nerve compression, and other potential issues. If your symptoms persist or worsen, or if new symptoms develop (such as significant weakness or loss of bowel or bladder control), an MRI may be warranted to guide further treatment decisions. However, if your symptoms continue to improve and you are able to manage your pain effectively with physical therapy and medication, your healthcare provider may suggest continuing with your current treatment plan without additional imaging.

In summary, herniated discs can often be managed effectively with conservative treatments, including physical therapy and medication. The relationship between pain relief and physical therapy is significant, as these interventions can address both the symptoms and underlying issues contributing to the herniation. Regular follow-ups with your healthcare provider are essential to monitor your progress and make any necessary adjustments to your treatment plan. If you have concerns about your symptoms or the need for further imaging, discussing these with your provider will help ensure you receive the most appropriate care for your condition.

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