Straight, No Chaser: Management of Herniated Disks


Approximately 40 million Americans have low back pain. Odds are the presence of low back pain is not associated with a herniated disk. Truthfully, herniated disks are more commonly the result of degenerative changes in your spine due to aging and the wear and tear associated with how we live. So, if you really want to decrease your risks, adjust your lifestyle. However, it is important that you appreciate the circumstances under which medical attention is indicated and may make a difference to you.
Today’s post is not a prompt for you to ask your family physician, emergency department or orthopedist for surgery. In fact, the overwhelming majority (approximately nine of 10 patients) of patients who actually have herniated disks are treated conservatively, meaning without surgery. This post is meant to empower you with information about prevention and treatment as well as an overview of medical management principles.
The best approaches to limiting pain associated with herniated disks (or any low back pain for that matter) are prevention in the first place, then prevention of worsening of the situation.


  • Posture. Posture is important because normal alignment of the spine and back keeps everything working as designed. Good posture limits pressure and reduces the occurrence of injuries. Focus on keeping your back straight. This is so important. Do this when sitting, standing and lifting. Use your legs when lifting and not your back. Find something on which to prop one of your legs when standing.
  • Exercise. Exercise is all about strengthening your core. You don’t want extra belly girth pulling against your spine. Furthermore, strengthening the abdominal/trunk muscles stabilizes and supports the spine. All those times you slip and don’t injure your back are largely due to this stability.
  • Weight. Being overweight places excess pressure on the spine and disks and predisposes you to misalignment of your spine. This places you more at risk for herniation.

I’d imagine that most of you with low back pain have sought medical attention at some point. However, there are basic considerations that you can address prior to seeking medical attention. If you haven’t, it’s likely that your first doctor interaction on the subject will simply consist of instructions to perform some of the following steps:

  • Identify and reduce causes. If you have knowledge of what causes your pain, often the first course of action is to reduce or avoid those triggers. Of course this isn’t always easy when the discomfort is caused by work-related activities.
  • Reduce your stress. It’s true. Stress does intensify pain. Practice relaxation techniques such as deep breathing, mediation, massage, etc. when your stress level rises.
  • Consider professional help. The idea here is to change the way you feel about your pain even if you can’t eliminate it or while you’re taking steps to eliminate it. As mentioned, stress increases physical pain. Mental health professionals do wonderful work in this regard and can help you set realistic expectations.
  • Heat or ice.
  • Try over-the-counter pain medicines. Acetaminophen, aspirin and anti-inflammatory medicines such as ibuprofen and naproxen have worked for millions. This is an appropriate first step.

There’s a difference between when your pain requires medical attention and when it requires emergency medical attention. Your desire for an explanation, worsening of pain, radiation of your pain from your neck or back to your arm or leg, or the development of weakness, numbness and tingling are generally accepted prompts to seek an evaluation for your pain.
There are also prompts for you to get immediately evaluated because your pain could be life threatening. Such prompts include these symptoms.

  • Worsening symptoms. “Worsening pain” refers to that pain this renders you unable to work or perform your regular daily activities.
  • Bladder or bowel dysfunction. If you become unable to control your bladder (either holding your urine or being able to urinate), this needs to be immediately evaluated.
  • Loss of sensation in certain areas. Loss of sensation in the areas that would touch a saddle (i.e., the back of your legs, your inner thighs, and the areas surrounding your rectum) indicates the possible presence of a specific type of emergency that requires immediate evaluation.

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