Herniated Discs: Rehabilitation Insights and Pain Management

Q: Herniated Discs: Rehabilitation Insights and Pain Management

Hello： When a herniated disc occurs, it can compress the spinal nerves, leading to symptoms of nerve compression. <br>If this occurs in the lumbar spine, it can result in lower back pain, as well as pain in the buttocks and lower limbs. <br>Mild lumbar disc herniation can improve

I have a herniated disc!

Since April 2005, I initially experienced lower back pain and discomfort.
After three months, I sought medical attention, but no specific examinations were performed; I only underwent rehabilitation (shortwave therapy and electrical stimulation, without lumbar traction) six times.
The lower back pain and discomfort inexplicably improved, but shortly after, I developed pain on the outer side of my right thigh, which prevented me from fully extending my leg, and there were noticeable tender points, while my lower back felt completely fine! In mid-December 2005, I switched hospitals for a definitive examination (MRI), which diagnosed me with herniated intervertebral discs at lumbar levels L4-L5 and L5-S1, with L4-L5 being more severe and compressing the nerve (I have seen the MRI images), and there was also some involvement at L5-S1.
I started rehabilitation again in late December, undergoing two sessions with the same shortwave and electrical stimulation, and added lumbar traction!
My questions are:
1.
After my first traction session, I experienced extreme pain from my right buttock to my right calf, unlike anything I had felt before, but it improved the next day! During the second traction session, I reduced the weight, and while the pain was less intense than the first time, it still persisted, though not as long.
Is it appropriate for me to continue with lumbar traction? If not, since traction is considered one of the most effective conservative treatments for herniated discs, does that mean I have to resort to surgery? My weight is 100 kg, and I used 60 pounds for the first traction and 50 pounds for the second; I felt no pain during the traction, but it was extremely painful afterward!
2.
Currently, I only have discomfort in my right leg, and my lower back feels slightly tight.
Since electrical stimulation and shortwave therapy are aimed at the lower back, will they also be effective for my leg? It has been over six months since I first experienced lower back discomfort; is there a chance of recovery through rehabilitation? Have I missed the optimal treatment window? How long should I undergo treatment before I might notice significant improvement?
3.
I can clearly feel that sitting for long periods causes discomfort in my lower back and leg.
Should I alternate between sitting and standing? (How long should I sit before getting up?) (I also feel uncomfortable when standing for long periods!) Can I use assistive devices? (e.g., lumbar support, backrest...)
4.
Recently (July 2005), I started swimming almost every day, increasing my distance from 500 meters to 2000 meters.
However, I have been feeling more pain while swimming! Initially, I alternated between breaststroke and freestyle, but later I noticed the pain in the back of my thigh becoming more pronounced, so I stopped breaststroke, halved my swimming distance, and switched to freestyle only! However, there has been no significant improvement in the pain points; instead, my lower back feels very tight, and I have started to feel pain in my buttocks! Is my condition related to swimming? I have heard some doctors say that swimming is fine...
even a very good rehabilitation exercise!
5.
My daily sensations vary; sometimes I experience inexplicable severe pain, while other times I feel no pain or discomfort.
Would you consider my condition severe? Thank you for your response, doctor!

dreammaker12, 20~29 year old female. Ask Date: 2005/12/21

Dr. Xu Zhenrong reply Rehabilitation

Hello: When a herniated disc occurs, it can compress the spinal nerves, leading to symptoms of nerve compression.
If this occurs in the lumbar spine, it can result in lower back pain, as well as pain in the buttocks and lower limbs.
Mild lumbar disc herniation can improve with rest, medication, and rehabilitation therapy.
During the acute phase, it is essential to lie flat and rest, avoiding bending or vigorous activities.
It is important to maintain proper posture to prevent recurrence, using chairs with back support, and ideally using a lumbar cushion for added support, especially when driving or traveling long distances.
Rehabilitation therapy primarily includes heat therapy and lumbar traction, and it is crucial to commit to several weeks of treatment to potentially alleviate nerve compression.
Generally, if there is weakness in the lower limbs, reduced deep tendon reflexes, or if pain symptoms do not improve after a period of conservative treatment and significantly affect the quality of daily life, surgical intervention may be considered.
Young and middle-aged patients who need to work but experience recurrent symptoms often require surgical treatment.
Approximately 85% of patients prioritize rehabilitation; surgery is only considered if rehabilitation is ineffective.

In addition to receiving treatment, it is vital to maintain appropriate posture (including standing, sitting, and walking), avoid improper postures and exertion, especially bending to lift heavy objects and maintaining fixed abnormal postures for prolonged periods.
Reducing unnecessary walking or carrying heavy loads, particularly prolonged walking or standing, or sudden twisting of the lumbar spine is also important.
The bed should not be too soft, and engaging in flexibility exercises or appropriate training for the abdominal and back muscles can help prevent or alleviate existing symptoms.
During the acute phase, if symptoms are severe, complete bed rest is necessary until symptoms subside, after which limited activity can begin, often requiring the use of a soft back brace.
Physical therapy treatments such as heat application, traction, and electrical therapy will vary in duration based on individual conditions, so a specific timeframe cannot be provided.
Immediate results may not be seen; symptoms typically improve gradually over time.
The weight used in traction should start at one-quarter of the body weight and gradually increase to one-half, but this is just a guideline; adjustments should be made based on individual circumstances.
If pain persists for more than four hours after traction, the weight should be reduced.

It is recommended to be patient with rehabilitation and to continue treatment until symptoms are completely resolved.
During the treatment period, it is advisable to have more frequent sessions; if time permits, at least three sessions per week are recommended for optimal results.
Additionally, swimming is an excellent full-body rehabilitation exercise, but patients with disc herniation should avoid the frog kick.
Each individual may have different postural differences or physical loads during exercise, which can affect their original condition.
Therefore, it is essential to perform warm-up exercises, such as flexibility routines, before engaging in any physical activity, and to stop exercising immediately if any discomfort arises.
It is crucial not to rush, as this could lead to adverse effects, undermining the purpose of exercising for health.

Director of the Rehabilitation Department, Taipei Hospital, Department of Health, Hsu Chen-Jung.

Reply Date: 2005/12/21

More Info

Understanding herniated discs and their management, particularly through rehabilitation, is crucial for individuals experiencing pain and discomfort. Based on your detailed history, it appears that you have been dealing with significant issues related to herniated intervertebral discs (HIVD) for an extended period. Let's address your questions systematically.

1. Continued Use of Traction Therapy: Traction can be an effective conservative treatment for herniated discs, as it aims to relieve pressure on the affected nerve roots. However, your experience of increased pain following the first session suggests that your body may be reacting to the treatment. It's not uncommon for patients to experience temporary discomfort after traction, especially if the herniation is significant. If the pain subsides after a day or two, it may indicate that the treatment is beneficial, but if the pain persists or worsens, it may be wise to reconsider this approach. Consulting your physical therapist or physician about adjusting the weight or frequency of traction could provide insights tailored to your condition.

2. Effectiveness of Electrical Stimulation and Shortwave Therapy: These modalities are primarily aimed at reducing pain and inflammation in the lumbar region. While they may not directly address the discomfort in your leg, they can help alleviate overall tension in the lumbar area, potentially leading to some relief in radiating symptoms. Rehabilitation can indeed lead to improvement, but the timeline varies significantly among individuals. The "golden period" for treatment is often considered to be within the first few months post-injury, but many patients continue to see benefits from rehabilitation even beyond this timeframe. Regular follow-ups with your healthcare provider will help assess your progress and adjust your treatment plan accordingly.

3. Posture and Activity Recommendations: It’s essential to find a balance between sitting and standing. Prolonged sitting can exacerbate lumbar pain, especially if your posture is poor. Standing for long periods can also lead to discomfort. A good rule of thumb is to change positions every 30-60 minutes. Using supportive devices like lumbar rolls or ergonomic chairs can help maintain proper posture. If you find that certain positions or activities aggravate your symptoms, it’s best to avoid them and consult with a physical therapist for personalized advice.

4. Swimming and Its Impact: Swimming is generally considered a low-impact exercise that can be beneficial for back pain. However, if you are experiencing increased pain while swimming, it may be related to your technique or the specific strokes you are using. The frog stroke, for example, can place additional strain on the lower back and hamstrings. Transitioning to freestyle is a good choice, but if pain persists, it may be worth consulting a swim coach or physical therapist to ensure your technique is not contributing to your discomfort.

5. Variability of Pain: Fluctuating pain levels are common in conditions involving nerve irritation or compression. Factors such as activity level, posture, and even stress can influence your pain perception. Keeping a pain diary may help identify patterns or triggers, which can be useful for your healthcare provider in tailoring your treatment plan.

In summary, while you are experiencing significant challenges with your herniated discs, there are various avenues for management and rehabilitation. It’s crucial to maintain open communication with your healthcare providers, adjust your treatment plan as needed, and remain proactive in your rehabilitation efforts. With time, patience, and the right approach, many individuals see substantial improvements in their symptoms and quality of life.

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