Lumbar disc herniation
Lumbar disc herniation is a common cause of low back pain and sciatica and is known by many, especially your GP, as a slipped disc. It’s description as a slipped disc couldn’t be further from the truth. The discs don’t slip anywhere but the disc material can protrude or bulge putting pressure on spinal nerves or even the spinal cord.
As a chiropractor who has experienced a lumbar disc herniation myself I know the clinical presentation of a lumbar disc herniation can be wide and varied. Common symptoms of a disc herniation are: sciatica, low back pain, leg muscle weakness, inability to sit for long periods of time – to bowel and bladder function loss.
How do you find out if you have one?
Get to your chiropractor, one who understands the mechanics of a disc problem. Have them do a thorough neurological examination testing your reflexes, muscle strength and nerve stretch tests. Make sure they have an x-ray machine and assess the spaces between the lumbar discs. An x-ray is a cheaper (compared to an MRI) way to screen the condition of your lumbar spine. If you have changes present an MRI may be needed. An MRI is the only real way you can tell if you have a bulging disc and even when one is present it cannot be definitively known as the cause of the pain. I’ve worked with many cases of large lumbar disc herniations that have resolved without surgery – given a suitable healing environment. (i.e. no lifting/bending, rest and exercise and gentle chiropractic manipulation.) My story is among one of them.
What treatment do I need?
Conservative management (manual treatment) of mild cases is your best bet especially over the first 6 weeks. This would consist of gentle manipulation of the spine to work on the mechanical factors that are probably causing most of the pain. Surgical intervention should only be considered as a last resort or if you have severe neurological symptoms. (bowel/bladder loss or severe pain and muscle weakness). The only other option is a spinal injection – for example an epidural. So no mater what course of action you decide to take or is recommended by your health professional the soft tissue structures and discs still needs time to heal. With or without surgery the inflammatory healing response takes time to complete.
Surgery yes or no?
For those who are trying to decide whether or not to have surgery (because sometimes the choice is left up to you – based on how desperate you are) remember these points about the two paths. Non surgical – the disc herniation will resolve and become reabsorbed over a 3-12 month period depending on the healing environment that you are able to provide. Acute pain normally lasts 3 months and then rehabilitation can take up to 9 months to complete while the nerves take their time to heal. The surgical path can provide the instant pressure release but it still requires time to recover from the surgery and time for any damage to the nerve to settle down. This can also take 3-12 months to resolve. My advice is to take your time to decide an you may find that as the weeks go by you are improving naturally and don’t need the surgery after all.