Conservative treatment for a
herniated nucleus pulposus (HNP) also known as a herniated disc, consists of:
1. A short period of bed rest with
analgesics, mild muscle relaxants and nonsteroidal anti‑inflammatory drugs
(NSAID's).
2. Physical therapy should focus on
strengthening and mobilization throughout the course of treatment. Contrary to
most patient desires, occasional modalities such as hot packs and massage are
used in the acute phase only, to enable the patient to perform the necessary
physical exercises.
3. Back-school education is also a very
important part of conservative treatment.
4. Transcutaneous electrical nerve
stimulation (TENS) can offer relief to many back‑pain sufferers. These
small battery‑powered machines deliver a mild electrical current to the
nerves that interrupts the body's pain signals.
5. Spinal nerve blocks, injection of
trigger points and epidural steroid injections are other options that are used
in some cases during the conservative treatment phase.
Length of
Conservative Care
for a patient that exhibits radiculopathy (a sharp, stabbing pain radiating
down the buttocks and leg) and a positive scan, is usually indicated for
approximately 2 months. This is dependent on many factors. If there is a lack
of hard physical findings, conservative therapy is usually initiated for 6‑8
weeks. If there is no improvement after this time, scans are indicated. Pain
can also occur from degenerative disc disease, annular strains and tears (The
annulus consists of the tough fibrous outer rings that surround the disc center
also known as the nucleus). This pain will have a burning quality whereas
sciatic pain is generally sharp and knifelike. Pain may be present in the
morning in the form of stiffness and is relieved by heat and bed rest and
increased with cold weather. Disc herniation of the L4‑5 and L5‑S1
disc comprise 98% of all disc problems of the spine. Symptoms include sciatic
irritation (pain radiating below the buttock into the leg), and pain is
increased with sitting, coughing, sneezing, and relieved when lying down.
Quality care means allowing the patient to undergo a conservative mode of
treatment including all regimens we have at our disposal. Surgery should be our
last resort.
Notes: