How does a disc herniation present?
- Patients present with low back pain that radiates down the leg. Most often in only involves one leg as the disc usually budges or herniates in a posterior, lateral direction as the PLL (posterior longitudinal ligament) prevents it from bulging straight posterior. Many times, initial presentation involves only pain symptoms following a specific dermatome and does not include any sensory motor dysfunction. If left alone, tingling, numbness, muscle weakness and even bowl and bladder dysfunction can occur.
- SLR is almost ALWAYS positive
- Severe pain on palpation lateral to spinous process of involved level
- Pain is WORSE while sitting. This is because there are more compressive forces on the lumbar spine in a seated position
- Often, patients will have a hard time describing the pain in their back and leg. Many times, patients will say it’s like nothing they have ever felt before.
- Severity will fluctuate day to day from a 1/10 to a 10/10 in pain intensity. Also, how far the symptoms travel will fluctuate as well.
Physical Therapy Treatment
Conservative treatment (physical therapy) will be tried for 3-4 weeks. Most often, the patient reports feeling better for a small period of time after the treatments but the symptoms return. The time frame for symptoms to return after PT ranges from 30 min to 1 day after treatment depending on the patient’s condition. At PT, patients are given exercises and stretches to perform in the office. Sometimes, the exercises are performed under supervision. Often though, and depending on how busy the office is, the patient recieves instructions and performs the activities on their own.
If PT is ineffective, patient will be instructed to return to their primary care physician and will most likely get referred for an MRI. The MRI will be able to see a disc herniation unlike an X-ray. X-rays only see high density structures or the lack of high-density structures. It can’t soft tissue as the disc is basically a fluid filled pillow. MRI will confirm the herniation / disc budge diagnosis. It will also see if there is any other fluids / soft tissues pushing or irritating the spinal nerve roots.
There are many options for surgery: Laser spinal treatment, a surgical discectomy, laminectomy, artificial disc surgery. These are often the final option for people once they have exhausted all conservative treatments. When considering these options for which one is best for you, it is best to discuss with your prescribing surgeon as each surgeon has different preferences and skills. DO NOT TRUST GOOGLE.