Is It Really a Herniated Disc? Your Back Pain

Is it really a herniated disc?

Doctor, I would like to ask you about something.
In April, when I woke up, I sneezed and ended up with such severe lower back pain that I couldn't stand up straight.
At the beginning of May, I went to the hospital to see an orthopedic specialist and had an X-ray done.
The doctor suspected I might have a herniated disc and advised me to undergo physical therapy for a week.
If there was no improvement, I would need to have further examinations.
Initially, I did notice some improvement with the therapy, and the doctor mentioned that I should continue for at least seven weeks for better results.
However, I have been doing this from May until now, and it is almost the end of July, yet I still have not improved.
Bending over, sneezing, or coughing still causes pain in my lower back.
I researched herniated disc patients and found that it can affect the lower limbs, but I do not experience that; my pain is only located near the bones beside my lumbar spine close to my buttocks and in the lumbar region itself.
Should I continue with the physical therapy? Will it really lead to improvement?

A Zhi, 20~29 year old female. Ask Date: 2014/07/21

Dr. Ding Xianwei reply Neurosurgery

Due to the inability to conduct a personal examination, I can only provide advice based on past experiences and existing information.
Generally, simple lower back pain should not last more than a month; therefore, if the pain persists beyond this period, other organic issues must be considered.
In your case, it could potentially be a herniated disc leading to spinal stenosis.
Of course, less common conditions such as ankylosing spondylitis or metastatic tumors cannot be ruled out.
However, it is most likely that your work and lifestyle habits have not changed, meaning that the underlying cause of your back pain has not been addressed, making recovery unlikely.

I recommend avoiding prolonged sitting or standing, refraining from lifting heavy objects, and reducing squatting or crouching positions.
If your pain persists despite these measures, an MRI may be necessary to check for other organic lesions.
Pain relievers and muscle relaxants are essential; many people believe that long-term use of pain medication is harmful, but if pain cannot be managed, how can the vicious cycle of pain be broken? Additionally, if you have not been taking pain medication for more than a month, it cannot be considered long-term use.
If taking pain medication leads to liver or kidney failure, it is likely because the patient was already on the brink of failure.

Regarding the use of pain medication for back pain, it can be stopped when you are not in pain, indicating that it is only temporarily needed.
If these measures do not resolve the issue, you may need to visit our clinic for a personal examination to clarify the underlying problem.

Reply Date: 2014/07/21

More Info

When it comes to understanding back pain, particularly in the context of a suspected herniated disc, it's essential to grasp the nuances of spinal health and the implications of various symptoms. Based on your description, it appears that you have been experiencing persistent lower back pain since an incident in April, which has not significantly improved despite undergoing rehabilitation for several weeks.

Understanding Herniated Discs
A herniated disc occurs when the soft inner gel of the disc bulges out through a tear in the tougher exterior. This can lead to compression of nearby nerves, which often results in pain, numbness, or weakness in the affected area. However, not all cases of back pain are due to a herniated disc. Other conditions, such as muscle strain, ligament sprain, or even degenerative disc disease, can also cause similar symptoms.

Symptoms and Diagnosis
You mentioned that your pain is localized near the lumbar region and does not radiate down your legs, which is somewhat atypical for a classic herniated disc scenario. Typically, a herniated disc might cause sciatica, where pain radiates down the leg due to nerve compression. The absence of such symptoms could suggest that your pain may not be solely due to a herniated disc.

The initial X-ray may not have provided a definitive diagnosis, as X-rays primarily show bone structures and may not reveal soft tissue issues like disc herniation. An MRI is often the preferred imaging method for diagnosing disc problems, as it provides a detailed view of the spinal discs and surrounding tissues.

Treatment Options
Continuing with rehabilitation is generally advisable, especially if you have seen some improvement. Physical therapy can help strengthen the muscles around the spine, improve flexibility, and alleviate pain. However, if you find that your condition is not improving after several weeks of therapy, it may be time to revisit your healthcare provider for further evaluation.

Here are some treatment options that may be considered:
1. Physical Therapy: As you are already undergoing this, ensure that your therapist is focusing on exercises that strengthen your core and back muscles, which can provide better support for your spine.

2. Medication: Over-the-counter pain relievers like NSAIDs (e.g., ibuprofen) can help manage pain and inflammation. If your pain is severe, your doctor may prescribe stronger medications.

3. Injections: Corticosteroid injections can reduce inflammation around the affected nerve roots and provide temporary relief.

4. Surgery: If conservative treatments fail and your pain persists or worsens, surgical options may be considered. This could involve a discectomy, where the herniated portion of the disc is removed.

5. Alternative Therapies: Some patients find relief through acupuncture, chiropractic adjustments, or massage therapy. These should be approached with caution and ideally under the guidance of a healthcare professional.

When to Seek Further Evaluation
If your symptoms persist despite ongoing rehabilitation, or if you experience new symptoms such as weakness in your legs, bowel or bladder dysfunction, or significant changes in sensation, it is crucial to seek further evaluation. An MRI or CT scan may be warranted to assess the condition of your discs and surrounding structures more accurately.

Conclusion
In summary, while your symptoms may suggest a herniated disc, the lack of radiating pain and the persistence of localized discomfort warrant further investigation. Continuing with physical therapy is beneficial, but if significant improvement is not observed, consider discussing additional imaging studies with your physician. Understanding the underlying cause of your pain is vital for effective treatment and recovery. Always communicate openly with your healthcare provider about your symptoms and any changes you experience.

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