A physical medicine doctor’s plan for non-surgical treatment of low back herniated disc pain. 

Before hastily deciding to have surgery for your newly diagnosed herniated disc, you should take a conservative approach.

The top three home treatments for a herniated disc in the lower back are rest for one day, then apply ice on the area for 15 minutes three times a day, and also take ibuprofen or naproxen, says Dr. Walter Roche.

He is a physical medicine and rehabilitation specialist in acute/chronic pain management, conservative spine care, musculoskeletal medicine, sports medicine and electrodiagnostic medicine.

What is the most effective nonsurgical treatment to date for lower back disc herniation?
Dr. Roche says, “Physical therapy in combination with oral steroids and activity modification for two weeks; no heavy lifting; no running or strenuous activity. Allow the inflammation to subside. Narcotics play a small role in pain control for people with herniated discs. I don’t offer them.  The best drugs are steroid medications, (methylprednisolone) oral steroids, prednisone, cortisone.”

The best two exercises that Dr. Roche recommends for herniated disc patients are walking and swimming.

Does pain during physical therapy for lumbar herniated disc mean the patient is damaging it? “Not necessarily … no,” says Dr. Roche. Physical therapy is intimidating to some people because they fear it will further damage their herniated disc.

“It’s important to communicate with the PT that if any activity is causing pain,” says Dr. Roche.  “The physical therapist is trained extensively and they would modify the therapy to minimize the amount of physical discomfort or pain. A good PT should not be doing anything that would exacerbate the pain.”

“Sitting makes the situation worse. That’s why walking is one of the best exercises you can do when you have lower back pain…. swimming, or laying down. Sitting is bad.”

Be sure that when you lie down (other than to go to sleep at night), this doesn’t become prolonged bed rest, but rather, a brief respite from being up and about to give the back some rest—perhaps about 20 minutes. Use a timer to make sure that you don’t overdo this.

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