Herniated Discs: Symptoms, Treatment, and Recovery - Rehabilitation

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Herniated disc


Hello, at the beginning of the year, I suddenly started experiencing lower back pain, which is accompanied by pain in the back of my right thigh and buttock.
Initially, the pain was most severe in the morning, making it very difficult to get out of bed.
At night, I could only sleep for about four to five hours before waking up due to soreness.
I could only walk for about 10 minutes before the pain became unbearable.
When I looked at people, I felt like I was leaning to one side, with my right side appearing more prominent.
It would only ease after squatting or sitting for a while.

In early January, I went to a large hospital for X-rays and an MRI.
The doctor diagnosed me with a herniated disc and initially said there was a 90% chance of improvement with physical therapy.
I continued with physical therapy for a month, which included heat therapy, traction, and electrical stimulation.
I felt that my pain level improved compared to when it was at its worst.
However, during my follow-up appointment, the doctor changed his mind and said, "This is a bit serious; I recommend surgery!" Now I feel quite lost, so I am here to seek answers.
I apologize for the lengthy explanation.

X-ray front view: https://screenshot.net/tw/dw5zgfp
X-ray side view: https://screenshot.net/tw/d8l4gi5
MRI lumbar spine localization image: https://screenshot.net/tw/d1560az
MRI images: https://screenshot.net/tw/88q7zfn
MRI axial image 6/13: https://screenshot.net/tw/djqmesl
MRI axial image 6/18: https://screenshot.net/tw/dqjgof4
I would like to ask:
1.
Is this truly a herniated disc, or could it be something else?
2.
How severe is my condition, and what treatment do you recommend?
3.
Currently, I am undergoing traction at 29 kg, and after therapy, I experience a brief period of discomfort and restlessness in my lower back.
Is this normal?
4.
When I feel uncomfortable, I appear to be leaning, with my right side protruding more.
What could be the reason for this?
5.
Sometimes after therapy, I experience soreness on the left side, especially when I try to stand up straight.
The soreness extends from my lower back to my knee, but my right leg seems to be less uncomfortable.
What could be the reason for this?

Ms. Zhang, 20~29 year old female. Ask Date: 2019/03/13

Dr. Xu Zhenrong reply Rehabilitation


1.
The imaging you provided shows herniation of the intervertebral discs at the L4/L5 and L5/S1 levels, with the former being more severe.
In addition to obtaining more cross-sectional images, medical imaging must be correlated with clinical symptoms and physical examination findings to achieve an accurate diagnosis.

2.
You are experiencing intermittent claudication symptoms, which significantly affect your sleep, indicating possible severe nerve compression.
It is advisable to initially try physical therapy in conjunction with medication.
If there is no improvement or if you experience muscle weakness or bowel dysfunction, surgical decompression should be actively considered.
3.
The therapist will adjust the traction weight based on your body weight.
After rehabilitation, there may be a brief period of discomfort in the lower back due to various reasons, such as excessive traction weight, insufficient heat application prior to traction, improper positioning, or lumbar muscle spasms.
You can communicate any concerns to the on-site therapist or request an evaluation from your physician.
4.
The postural deviation while standing occurs because the body naturally shifts to alleviate nerve compression and prevent exacerbation of pain.
5.
The pain may be of neuropathic origin or related to joint and muscle issues, and it is essential to have your primary physician evaluate it.

Reply Date: 2019/03/13

More Info


Understanding herniated discs, also known as intervertebral disc herniation, is crucial for managing symptoms and determining appropriate treatment options. A herniated disc occurs when the soft inner gel-like material of the disc protrudes through a tear in the tougher exterior, potentially compressing nearby nerves. This condition can lead to a variety of symptoms, including pain, numbness, and weakness in the affected areas.


Symptoms of Herniated Discs
The symptoms of a herniated disc can vary depending on the location of the herniation and whether it is pressing on a nerve. Common symptoms include:
1. Localized Pain: Pain in the lower back or neck, depending on the location of the herniation.

2. Radiating Pain: Pain that radiates down the leg (sciatica) or arm, often following the path of the affected nerve.

3. Numbness or Tingling: Sensations of numbness or tingling in the limbs.

4. Muscle Weakness: Weakness in the muscles supplied by the affected nerve.

5. Difficulty with Movement: Limited range of motion or difficulty standing up straight.

In your case, the pain radiating down your right leg, particularly in the buttock and thigh, along with the discomfort when sitting or standing for extended periods, aligns with typical symptoms of a herniated disc.


Diagnosis
Diagnosis typically involves a physical examination and imaging studies such as X-rays or MRI scans. These tests help confirm the presence of a herniated disc and assess the severity of the condition. Based on your description, it seems that your healthcare provider has already conducted these assessments, leading to the diagnosis of a herniated disc.


Treatment Options
Treatment for a herniated disc often begins conservatively and may include:
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the spine, improve flexibility, and reduce pain. Techniques may include stretching, strengthening exercises, and modalities like heat or ice therapy.


2. Medications: Over-the-counter pain relievers such as NSAIDs (e.g., ibuprofen) can help manage pain and inflammation. In some cases, prescription medications may be necessary.

3. Epidural Steroid Injections: If pain persists, corticosteroid injections may be administered to reduce inflammation around the affected nerve.

4. Surgery: If conservative treatments fail to provide relief after a reasonable period (usually several weeks to months), surgical options may be considered. Surgery typically involves removing the portion of the disc that is pressing on the nerve.


Recovery and Prognosis
The recovery time for a herniated disc varies widely among individuals. Many people experience significant improvement with conservative treatments, while others may require surgery. Factors influencing recovery include the severity of the herniation, the presence of nerve compression, and individual health conditions.


Addressing Your Concerns
1. Severity of Your Condition: Based on your symptoms and the MRI findings, it appears you have a significant herniation that is affecting your daily activities. Your healthcare provider's recommendation for surgery suggests that they believe conservative treatments may not be sufficient for your situation.

2. Post-Treatment Discomfort: Experiencing discomfort after physical therapy or traction is not uncommon, especially if the treatment involves stretching or mobilizing tight muscles. However, if the discomfort is severe or persistent, it’s essential to communicate this to your therapist or physician.

3. Posture and Appearance: The asymmetry you notice, where one side appears more pronounced, can result from muscle spasms or imbalances caused by pain. This is often a protective mechanism where the body compensates for discomfort.

4. Left-Sided Discomfort: The sensation of pain or discomfort on the left side after therapy could be due to compensatory movements or muscle imbalances. As your body adjusts to the treatment and attempts to alleviate pain, it may lead to discomfort in other areas.


Conclusion
It’s crucial to maintain open communication with your healthcare team regarding your symptoms and treatment progress. If you feel uncertain about the recommended surgical intervention, seeking a second opinion from another specialist can provide additional insights. Remember, the goal of treatment is to alleviate pain, restore function, and improve your quality of life.

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