Should You Consider Rehabilitation for Herniated Discs?

Should I go for rehabilitation for a herniated disc?

Hello, Doctor: I apologize for the lengthy message and multiple questions, but I hope you can provide me with some advice.
In mid-October, I experienced severe lower back pain while exercising (the pain was so intense that I couldn't bend over or walk).
A rehabilitation physician diagnosed me with an L5-S1 herniated disc.
The doctor prescribed anti-inflammatory medication and arranged for an X-ray.
During my follow-up appointment the next day, I informed the doctor that I felt much better after taking the medication, and at that time, I had no symptoms of buttock or leg soreness, numbness, pain, or weakness.
The doctor instructed me to continue taking the anti-inflammatory medication until the pain subsided (he prescribed a seven-day supply) and said, "You probably don't need rehabilitation." I was relieved to avoid rehabilitation, thanked the doctor, and left.
After the lower back pain subsided, I occasionally felt a slight electric sensation on the inner side of my left hip, which was not very bothersome, just noticeable when I was still.
I thought that since the doctor said I didn't need rehabilitation, the symptoms would eventually disappear.
However, recently, during my midterm exams at school, I had to sit for long periods, and I began to feel more intense discomfort.
The main symptoms are: after sitting for a long time (initially, I could manage for over an hour, but later it was only 10 to 20 minutes), I experience soreness in my lower back (I'm unsure if it's due to intentional posture or nerve compression), numbness and pain in the inner sides of both buttocks, occasional numbness and pain at the junction of my thighs and buttocks, and sometimes a slight numb sensation in the entire back of my left thigh (very mild, so I'm not entirely sure).
When standing or walking normally, I don't feel much discomfort, but after standing for a long time, I might feel some soreness in my lower back, or if I walk too quickly without engaging my core, I might experience some pain.
Occasionally, I feel a slight electric sensation in my lower back or buttocks, but for the most part, I'm okay.
Now that the exams are over, I sit for shorter periods, usually managing over an hour before I can't tolerate it anymore.
After reading many online descriptions, I feel my symptoms are quite mild, but I'm concerned about whether they will resolve on their own or worsen.
I would like to ask you, Doctor: Do I need to go to the hospital for rehabilitation, or can I do rehabilitation exercises at home? Are there any recommended rehabilitation exercises? Is there a standard set by health insurance for when rehabilitation can be done? If I do go for rehabilitation, what types of treatments should I expect, and how long does each session typically last? (I actually live very close to the hospital.) If I undergo rehabilitation, what is the expected outcome? Are there any adverse effects, such as the possibility of increased pain? (I've seen some people mention this online.)
Should I strengthen my abdominal and back muscles? I currently go to the school gym to ride a stationary bike, and the gym has the following equipment; I'm unsure if it's suitable for me:
http://www.exrx.net/WeightExercises/ErectorSpinae/WtHyperextension.html
http://www.exrx.net/WeightExercises/Obliques/LVTwistGripless.html
I know that the hyperextension exercise can also be done on a bed, but I feel the effect is not very good.
I'm also unsure if using that equipment poses any risks for my herniated disc.
I've been sitting for about an hour now, and aside from some soreness in my lower back, I feel okay.
Just a moment ago, I felt some numbness in the inner side of my left hip and the back of my left thigh, but after standing for a few seconds, it went away, so it doesn't seem very serious.
However, it's morning now, and based on my experience, symptoms tend to become more pronounced in the evening, possibly due to accumulated stress throughout the day.
Finally, thank you for your patience in reading this, and I hope you can provide me with some advice.
Thank you!

kimm, 20~29 year old female. Ask Date: 2006/11/23

Dr. Pan Yingda reply Rehabilitation

Hello, I apologize for the late response as I've been quite busy recently.
Regarding your questions:
1.
You should go to a hospital for rehabilitation.
As for recommended exercises, forward bending movements are generally not suitable.
It's important to avoid maintaining the same posture for long periods.
Correct posture, stretching, and core muscle training are key principles.
It’s difficult to explain everything here, but I believe your rehabilitation physician and therapist will be able to assist you.
If they are not helpful, consider changing facilities.

2.
Your condition qualifies for rehabilitation under health insurance.
3.
Typically, treatment includes heat therapy, electrical stimulation, and pelvic traction (which usually takes about 30-40 minutes), along with some exercises.
4.
Generally, rehabilitation should not worsen your condition.
Any deterioration usually occurs because the initial problem has not yet reached its peak severity, which can lead to misunderstandings that the condition is worsening with treatment.
Additionally, if there are certain precautions that are not being followed, the problem may worsen.
If you feel discomfort after treatment, you should immediately inform your therapist.
Discomfort often arises from improper posture during treatment, especially if maintained for a period of time.
Should I strengthen my abdominal and back muscles? It is not advisable at this stage.
You should first adjust your movements and strengthen your core muscles (to provide stable support for the pelvis and lumbar spine), followed by stretching, and only then focus on abdominal and back muscle training.
The principle of hyperextension is correct, but currently, you should not engage in such high-intensity exercises.
Our recommendation is to lie on your stomach on a bed, prop up your upper body with your hands, and perform passive hyperextensions, doing 24 repetitions every hour.

Reply Date: 2006/11/23

More Info

When considering rehabilitation for herniated discs, particularly in the context of your recent experiences with lower back pain and associated symptoms, it is essential to evaluate both the current state of your condition and the potential benefits of rehabilitation therapy.

Based on your description, it seems that you initially experienced acute pain from an L5-S1 herniated disc, which has since improved with anti-inflammatory medication. However, the emergence of new symptoms, such as occasional tingling or discomfort in the left inner thigh and buttocks, suggests that your condition may still require attention. While it’s encouraging that your pain has decreased, the persistence of these symptoms, especially after prolonged sitting, indicates that your spine may still be under stress.

Rehabilitation can be beneficial for several reasons. First, it can help strengthen the muscles surrounding the spine, which provides better support and stability. This is particularly important for individuals with herniated discs, as strengthening the core and back muscles can alleviate pressure on the spinal structures. Exercises that focus on the abdominal and back muscles can be particularly effective. However, it is crucial to approach these exercises cautiously and under professional guidance, especially in the early stages of recovery.

Regarding your concerns about whether to pursue rehabilitation, it is advisable to consult with a healthcare professional, such as a physical therapist, who can assess your condition more thoroughly. They can provide a tailored rehabilitation program that considers your symptoms, activity level, and overall health. Rehabilitation does not necessarily require a specific threshold of pain or disability; rather, it is often recommended when symptoms persist or interfere with daily activities.

In terms of rehabilitation modalities, physical therapists may employ a combination of manual therapy, therapeutic exercises, and modalities such as heat or electrical stimulation to manage pain and promote healing. The duration and frequency of rehabilitation sessions can vary based on individual needs, but typically, sessions may last from 30 to 60 minutes and occur one to three times a week.

As for the exercises you mentioned, such as hyperextensions and oblique twists, these can be beneficial but should be approached with caution. Hyperextensions, for example, can strengthen the lower back but may also exacerbate pain if performed incorrectly or too soon in the recovery process. It is advisable to start with low-impact exercises and gradually progress as tolerated. Always prioritize form over intensity to avoid further injury.

Additionally, it is essential to listen to your body. If you experience increased pain during or after exercises, it may be a sign to modify your approach or consult with a professional. Rehabilitation should not lead to worsening symptoms; if it does, adjustments are necessary.

In summary, considering rehabilitation for your herniated disc is a prudent choice, especially given your ongoing symptoms. Engaging with a physical therapist can provide you with a structured approach to recovery, focusing on strengthening and stabilizing your spine while managing pain. Remember that recovery is a gradual process, and maintaining open communication with your healthcare providers will be key to achieving the best outcomes.

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