Should You Continue Rehab for Herniated Discs? Expert Insights

Q: Should You Continue Rehab for Herniated Discs? Expert Insights

Hello： I have reviewed your MRI images, and there is indeed a condition present. <br>Your questions are： 1. <br>Based on my MRI, what is the likelihood of recovery through rehabilitation? 2. <br>Why might my symptoms worsen after the first rehabilitation session? 3. <br>If I want

Should I continue rehabilitation for a herniated disc?

Hello, doctor.
I am 177 cm tall and weigh 70 kg.
In March of this year, I visited a neurologist.
Initially, the straight leg raise test, X-rays, and nerve conduction studies showed no issues.
On March 29, I had an MRI, and during my follow-up appointment, the doctor reviewed the images and indicated that there was a herniation at the fourth and fifth lumbar vertebrae compressing the nerve.
I have attached a few images here: https://imgur.com/x0KZwF4 https://imgur.com/JSZO2Y7.
I was then referred to the rehabilitation department for therapy.

I started my first rehabilitation session in early April.
Initially, my symptoms were limited to pain in the buttocks when bending forward past my knees and some pain in the buttocks for about 10 minutes after getting out of bed in the morning, after which I would return to normal.
I had no issues walking or even running.
However, after my first rehabilitation session, I suddenly felt worse the next day.
Upon waking, my buttocks would continue to hurt for several hours, and standing after getting out of bed was painful, leading to a waddling gait (though I still had strength in my left leg).
My ability to bend at the waist has worsened to the point where I can no longer touch my knees, and putting on socks has become very difficult.
I need to do some stretching and take pain relievers and muscle relaxants every few hours to walk normally.
Occasionally, I feel a very slight numbness in the sole of my left foot.

Currently, the main pain is in my left buttock and the groin area, while my lower back feels tight or sore occasionally but not painful.
Sitting is also uncomfortable for my buttocks.
I have been undergoing rehabilitation for two weeks, with a total of 9 sessions.
I am currently pulling 22 kg for my lower back exercises.
My condition has remained similar to what it was after the first rehabilitation session, with no significant improvement or worsening.
A colleague of mine had a similar situation and mentioned that it took him almost three months of therapy to see improvement.
I want to continue trying, but I have heard that prolonged nerve compression could lead to paralysis.

Doctor, based on my MRI, what is the likelihood of recovery through rehabilitation? Why might my symptoms have worsened after the first session? If I wish to continue rehabilitation, under what symptoms or after how long of ineffective therapy would you recommend immediate surgery? Thank you, doctor.

Nick, 30~39 year old female. Ask Date: 2018/04/18

Dr. Lai Zhaokang reply Neurosurgery

Hello: I have reviewed your MRI images, and there is indeed a condition present.
Your questions are: 1.
Based on my MRI, what is the likelihood of recovery through rehabilitation? 2.
Why might my symptoms worsen after the first rehabilitation session? 3.
If I want to continue rehabilitation, what symptoms should prompt my physician to recommend immediate surgery, or how long should I wait if rehabilitation is ineffective?
Response: 1.
Rehabilitation may improve your discomfort, but the underlying pathology causing compression will still be present; you may just feel more comfortable.
2.
The worsening of symptoms could be due to the angle and force of lumbar traction, as your lumbar spine may not be accustomed to it during your first exposure.
You can ask your rehabilitation therapist to make adjustments.
3.
You can certainly continue rehabilitation for 3 to 6 months, but be prepared for a long-term commitment.
However, if after 1 to 2 months there is no improvement, or if your symptoms continue to trouble you, worsen, or if you experience weakness, difficulty walking, or issues with bowel or bladder control, you should consult a neurosurgeon to discuss the details and planning for surgery.
Best wishes.
// Dr.
Lai Chao-Kang, Chief of Spine Neurosurgery, Changhua Hospital //

Reply Date: 2018/04/18

More Info

When dealing with a herniated disc, particularly after surgery, the decision to continue rehabilitation can be complex and should be approached with careful consideration of your symptoms and overall condition. Based on your description, it seems that you have experienced a worsening of symptoms following your initial rehabilitation sessions, which can be disheartening. However, it is important to understand the potential reasons for this and the options available to you.

Firstly, it is not uncommon for patients to experience an increase in pain or discomfort after starting rehabilitation exercises, especially if the exercises are not tailored to their specific condition or if they are too aggressive. This phenomenon can occur due to several factors, including muscle fatigue, inflammation, or even irritation of the nerve root due to the movements involved in rehabilitation. It is crucial to communicate these changes to your rehabilitation team so they can adjust your treatment plan accordingly.

Regarding your MRI findings, it indicates that there is a herniation at the L4-L5 level that is compressing the nerve root. This compression can lead to symptoms such as pain, numbness, or weakness in the legs. The fact that you are experiencing significant discomfort, especially in the left buttock and thigh, suggests that the nerve may still be under pressure, which could explain the exacerbation of your symptoms post-rehabilitation.

In terms of rehabilitation, it is essential to have a comprehensive approach that includes not only physical therapy but also pain management strategies. If you find that your symptoms are not improving after a reasonable period of rehabilitation (typically 4-6 weeks), or if they worsen significantly, it may be time to reassess your treatment plan. This could involve further imaging studies, such as a follow-up MRI, to evaluate the status of the herniation and the surrounding structures.

If conservative measures, including physical therapy and medication, do not yield satisfactory results, surgical intervention may be considered. The criteria for surgical intervention typically include persistent pain that significantly affects your quality of life, neurological deficits (such as weakness or loss of sensation), or if there is evidence of progressive neurological deterioration. It is crucial to have an open dialogue with your healthcare providers, including your neurologist and orthopedic surgeon, to discuss your symptoms and the potential need for surgery.

In summary, continuing rehabilitation for a herniated disc can be beneficial, but it should be closely monitored. If your symptoms worsen or do not improve after a few weeks of therapy, it is essential to consult with your healthcare team to explore further options, including potential surgical intervention. Remember that every patient's situation is unique, and treatment plans should be individualized based on your specific needs and responses to therapy.

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