Herniation describes an abnormality of the intervertebral disc that is also known as a “slipped,” “ruptured” or “bulging” disc. This process occurs when the inner core (nucleus pulposus) of the intervertebral disc bulges out through the outer, more fibrous layer of the disc (annulus fibrosis).
Although a herniated disk can sometimes be very painful, most patients are free of symptoms by 3 to 4 months. However, some patients do experience episodes of pain during their recovery.
Conservative treatment is the first choice for treating a lumbar herniated disc unless the person exhibits certain serious symptoms like difficulty in walking, muscle weakness, loss of bowel and bladder control.
The Conservative treatment includes:
A couple of days of bedrest helps with pain relief but it is advised not to prolong it. It is important to stay active to speed up the recovery process. However, do not overstrain. Avoid doing any activities that cause pain especially anything involves bending or lifting something heavy.
An ice pack for 10 to 15 minutes every 2 to 3 hours or a heating pad on a low or medium setting for 15 to 20 minutes every 2 to 3 hours might help in relieving pain.
Anti-inflammatories and Analgesics that are available over the counter help bring the inflammation down and relieve pain.
Exercise is an important part of the treatment plan. A physiotherapist can help chart out a customised exercise plan that will help you with recovery to your daily routine.
At first, gentle stretches or posture changes are taught to reduce the back or leg pain. When pain eases, a more vigorous exercise plan will likely be used to improve flexibility & strengthen the spine. Continuing to exercise and stretch at home is important to prevent and recurrence.
Alternative therapies like, Yoga, Ayurveda, Acupuncture are also believed to help relieve the pain.
The Ayurvedic treatment involves Detoxification and rejuvenation through different forms of massages like Podikkizhi (Herbal powder massage), Ilakkaizhi (Herbal leaves massage), kativasthi (Pooling medicated oil in the back), Pizhichil (Pouring medicated oils as a stream), Nhavarakkizhi (Massage with rice boiled in medicated milk) and administration of internal medicines. These therapies help in relieving the inflammatory changes, releasing the spasms and nerve compressions in the affected area, strengthening the supportive tissues holding the spine, nourishing the joints through improving the circulation.
Yogic management of slipped disk is based on using certain postures which strengthens the spinal muscles and ligaments that hold the spine together. They are practiced along with other asanas that give rest to the spine. Constant practice of these asanas are believed to slowly reverse the bulge in the spine.
Acupuncture is focused on stimulating healing and rejuvenation of the area and reduction of pain is a side effect. Modern diagnostic techniques are now able to find the exact location of the disc protrusion which has led to modern acupuncture physicians using another treatment known as moxibustion. This is where a special herb called mugwort is heated and held directly over the location of the disc involved. In traditional Chinese medical terms this increases energy and blood circulation to the area to stimulate a healing response.
If the conservative treatment does not help in the first 3-4 weeks, traction or Epidural injections might be recommended by the physician. Surgery is usually the last choice that is only opted when the patient does not respond to any of the treatment used earlier and is severely incapacitated due to the pain. The aim of surgery is to cut away the piece of the disc that bulges out. This is known as a discectomy and it can be done in several ways.