Treatment and Prevention
The treatment plan you and your doctor decide on for a herniated disc will depend on several factors including the severity of your symptoms, your activity level, and how your lifestyle is affected.
The treatment of a herniated disc can include non-surgical and surgical options. In most cases treatment starts conservatively with non-surgical options, which are effective for more than 90% of people. (3) If non-surgical options are not effective, then surgical options are considered. For people whose symptoms are progressively worsening or who experience loss of bladder and bowel control, surgical options will be considered much earlier.
Non-surgical options for a herniated disc include trying to stay active, unless pain is severe. If you do need bed rest, your doctor will likely suggest that you limit this to 1 or 2 days. Anything longer than this may cause muscles to weaken and worsen your symptoms. Avoid activities that aggravate your symptoms, such as bending, lifting, or sitting for long periods of time. Using a firm mattress while sleeping may help. It may also help to put a pillow under the waist and another under the shoulder if sleeping on your side, or putting a pillow under your knees if sleeping on your back.
Your doctor may suggest medications such as acetaminophen* or nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen) to help relieve pain. If the pain is severe, your doctor may prescribe opioid (also called narcotic) pain medications such as codeine or oxycodone, muscle relaxants, or other medications that help with nerve pain (e.g., amitriptyline, gabapentin). Corticosteroids by mouth or by injection may be prescribed for severe and persistent pain.
Cold compresses or ice can help with pain when applied several times a day for no more than 20 minutes. Heat application may help, but should only be used a few days after the injury since heat may initially add to inflammation and swelling.
Your doctor may also suggest physiotherapy and exercises to help strengthen the spine muscles and help reduce the risk of injury to the disc and spinal nerves. Your doctor or physiotherapist will show you exercises that are suitable for you. Some exercises they may suggest include flattening the curve in the neck and lower back to release the pressure on the discs and provide more space for the spinal nerves, or lying on the back and pulling each knee to the chest.
Changing sitting position can also help. Put the feet up on a low stool to flatten the back against the back of the chair, or adjust the chair so it tilts forward.
Surgery isn't usually considered unless you develop severe pain or nerve damage that gets steadily worse. If you have loss of bladder or bowel control, you may need surgery right away. Surgery to remove the ruptured disc is done through a very small incision under a general anesthetic. Traction and a supportive neck collar can help a herniated disk in the cervical spine. During traction, a machine gently pulls the spine to relieve the pressure on it. A doctor or physiotherapist needs to show the person how to safely use the traction equipment. Traction therapy may be recommended for use at home.
The following may help prevent a recurrence of a herniated disc:
- exercises that strengthen the abdominal and back muscles
- good posture (standing up straight, sitting straight, lifting things with the back straight)
- bending the knees and hips when lifting something and keeping the back straight
- holding an object close to the body when carrying it
- avoiding wearing high-heeled shoes
- avoiding sleeping on the stomach
- keep at a healthy weight
- reduce or avoid smoking
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.