July 1, 2017|
Issue: July/Aug 2017
RVT, BS, CCRP, VTS (Neurology) | University of Missouri Veterinary Health Center
Stephanie received her associate of applied science degree in veterinary technology from Jefferson College in Hillsboro, Missouri, in 2005. She began working at the University of Missouri Veterinary Health Center as the neurology/neurosurgery technician in 2007 and received her certification in canine rehabilitation from the University of Tennessee in 2008. She received her bachelor’s degree in veterinary technology from St. Petersburg College in 2011 and her Veterinary Technician Specialist credential in neurology in June 2013.
Stephanie is a deputy member with the proposed Academy of Physical Rehabilitation Veterinary Technicians as well as an adjunct clinical instructor with the Biomedical Sciences Online Program at the University of Missouri. She is pursuing her master’s degree in biomedical sciences with an emphasis in veterinary sciences.
Read Articles Written by Stephanie Gilliam
Intervertebral disc herniation (IVDH) is the most common spinal disease in dogs. This painful and debilitating disease occurs in about 2% of canine patients seen at teaching hospitals but is rarely seen in cats, horses, and food animals.1 Hansen first classified intervertebral disc (IVD) disease as type I and type II in 1951. Type I IVDH is an extrusion of the nucleus pulposus, and type II IVDH is a protrusion of the annulus fibrosis. Management of IVDH by a combination of medical and surgical methods is now well established, with high success rates reported (up to 95%).2 Veterinary technicians can play an important role in management of these cases.
Intervertebral discs separate the vertebral bodies along the entire length of the spinal column, with the exception of the atlanto-axial joint, and between the bones of the sacrum.3 These discs permit motion of the spine while providing support under movement. The annulus fibrosis is the ligament that makes up the periphery of the disc and attaches to the vertebral end plates. The nucleus pulposus is the highly hydrated central portion of the disc (FIGURE 1). A common aging process known as fibroid metaplasia can result in degenerative changes in the disc. In this process, a decrease in proteoglycans, due to pathologic or age-related changes, results in decreased water content within the nucleus and annulus. These degenerative changes are accelerated in chondrodystrophic dogs, which predisposes them to early IVD degeneration.
As noted above, 2 types of disc degeneration have been described. Hansen type I IVD degeneration occurs commonly in chondrodystrophic breeds, such as the dachshund and beagle. However, it may also be seen in large breeds. This type of degeneration leads to an extrusion of the nucleus pulposus into the vertebral canal. Type I IVD degeneration affects young animals, with clinical signs developing between ages 3 and 6 years. Calcification of the degenerative disc is radiographically apparent in dachshunds by 6 to 18 months of age.1 The degenerative process leads to a weakened annulus that cannot confine the calcified nucleus pulposus. Normal movements of the spinal column are enough to cause an acute disc herniation. This extrusion of nucleus pulposus leads to an acute onset of clinical signs.
Hansen type II IVD degeneration is most common in large nonchondrodystrophic breeds, such as the German shepherd and Labrador retriever. Fibroid metaplasia leads to a slow protrusion of the disc into the spinal canal. Both the annulus and the nucleus can protrude, but the annulus remains intact. Hansen type II degeneration develops more slowly than type I, and clinical signs become apparent between 5 and 12 years of age. Spinal cord compression from Hansen type II IVDH results in a slowly progressive myelopathy. German shepherds and Labrador retrievers may present with Hansen type I or type II IVD degeneration.
Traumatic IVDH is an acute, noncompressive nucleus pulposus extrusion. It is less common than Hansen types I and II but has been documented with magnetic resonance imaging (MRI). This type of IVDH usually results from heavy exercise that exerts excessive force on the disc. The result is expulsion of the nucleus pulposus through the annulus into the spinal canal. It is a low-volume/high-velocity herniation. The gelatinous nucleus pulposus then disperses along the floor of the canal and does not cause spinal cord compression.1
Clinical signs of IVDH can range from spinal hyperesthesia (back pain) only to paraplegia without pain sensation. Spinal hyperesthesia is caused by compression of the nerve roots and meninges. Animals may have a hunchback appearance (kyphosis) and tense abdominal muscles if they are in pain. Paresis (weakness) or plegia (paralysis) may affect any limb depending on where the disc herniation is along the spine. When describing the extent of clinical signs, mono refers to one limb; hemi, to limbs on one side (eg, right thoracic and pelvic); para, to pelvic limbs; and tetra, to all 4 limbs.
For example, if the disc herniation is in the cervical spine, the animal may be tetraparetic (weak in all 4 limbs). However, if the disc herniation is in the caudal thoracic spine, the animal may be paraparetic (weak in the pelvic limbs). If the animal has lost all movement to the affected limbs, the correct term is plegia. If an animal is paraplegic, it is important to check the affected limbs for nociception (the ability to feel pain) because lack of nociception does affect prognosis. The disc herniation may be lateralized and compress one side of the spinal cord more than the other, which may produce asymmetric clinical signs.
A presumptive diagnosis may be made on the basis of signalment, history, clinical signs, and neurologic examination findings. However, a definitive diagnosis can be based only on further diagnostic testing, such as myelography, computed tomography (CT), or MRI.
Spinal radiography may show evidence of a degenerative disc and may also rule out other diagnostic differentials, such as neoplasia, discospondylitis, or spinal fracture. To obtain proper positioning for spinal radiography, the patient should be heavily sedated or under general anesthesia. Radiographic changes suggestive of IVDH include narrowing of the IVD space, narrowing of the space between the articular processes, and a small intervertebral foramen. Mineralized discs may sometimes be seen in the vertebral canal (FIGURE 2).1
FIGURE 2. Radiograph showing mineralized intervertebral discs.
Myelography used to be the standard diagnostic modality for spinal cord compression. This technique used contrast material injected into the subarachnoid space and review of a series of radiographs. After the contrast material outlined the spinal cord, attenuation of the contrast agent identified the site of spinal cord compression (FIGURE 3). Injection of contrast material was associated with possible complications, including seizures. With myelography, clinical signs could also be exacerbated because of iatrogenic trauma or hemorrhage caused by spinal injections.1
Cross-sectional imaging, such as CT or MRI, is required to determine the active region of spinal cord compression, and is now considered the standard modality for evaluation of IVDH. CT may be used in conjunction with myelography to better delineate lateralization of the IVDH but may also be used as the sole diagnostic modality. It is noninvasive and fast, with images acquired in minutes. Diagnosis of spinal cord compression by using CT is similar to diagnosis via radiography in that it is based on identifying the anatomic landmarks where attenuation of the spinal cord is visible, but compared with radiography, it offers enhanced soft tissue contrast and visualization (FIGURE 4). CT does have some advantages over MRI in the evaluation of bony lesions. In cases such as vertebral fractures or luxations, CT may provide more useful information than does MRI.
FIGURE 4. CT scan with arrow pointing to herniated disc within the spinal canal causing compression of the spinal cord.
Magnetic Resonance Imaging
MRI is the gold standard imaging modality for almost all neurologic disease processes. It provides superior soft tissue contrast, which allows further differentiation of anatomic structures. Like CT, images may be viewed in many different planes (sagittal, transverse, dorsal), which allows close scrutiny of anatomic regions (FIGURE 5). In patients with multiple affected sites, MRI is best for differentiating the inciting cause of the current clinical signs.
FIGURE 5. Sagittal MRI image with arrow pointing to herniated disc material within the spinal canal causing compression of the spinal cord.
MRI is based on the properties of hydrogen atoms, which are numerous in tissues with a high water content. When placed in a magnetic field, the hydrogen atoms line up. A radiofrequency pulse knocks the atoms out of alignment. When that pulse is removed, the atoms bounce back to their previous orientation and release energy in the form of another radiofrequency pulse. This second radiofrequency pulse is captured to form the resultant image.
The typical MRI finding with disc protrusion or extrusion is focal extradural spinal cord compression centered over a disc space.3 MRI has few contraindications other than anesthetic risks (the patient requires general anesthesia to undergo MRI). Metallic implants or foreign bodies, such as gunshot, can cause artifacts in the images or can move during the procedure and harm the patient.
Treatment recommendations for IVDH vary from case to case. There are no straightforward guidelines on which treatment option is best; rather, guidelines are based on whether surgery should be included as part of the treatment. There are pros and cons to surgery for IVDH. Clients should be informed of the benefits and risks of each treatment option before they make a decision.
Conservative therapy is indicated for animals that have one episode with mild clinical signs, those whose owners have financial constraints, or those with other medical problems that preclude anesthesia and surgery. Hansen type II IVDH is more commonly treated with conservative therapy. These patients may be treated successfully for long periods with conservative management consisting of pain control and cage confinement; the more important of these is confinement. Strict cage rest is recommended for 4 to 6 weeks. The kennel should be big enough for patients to stand up and turn around in but not big enough for them to walk around in. The patient is let out of the kennel only to go on short-leash walks to urinate and defecate. If improvement is seen, exercise is restricted to a leash for another 3 weeks.
Analgesics and anti-inflammatory drugs should be used only if the client agrees to cooperate with the confinement instructions. Anti-inflammatory drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs), alleviate pain and thus allow most dogs to be more active. This activity may cause more pressure to be placed on the disc, thereby leading to extrusion of more disc material into the vertebral canal. NSAIDs, gabapentin, or tramadol may be used for pain control. Some clinicians prefer an anti-inflammatory dose of prednisone in a decreasing regimen. However, steroids and NSAIDs should never be administered concurrently because doing so may cause severe gastrointestinal complications.3 Physical rehabilitation, weight control, and prevention of jumping may help to reduce the risk for recurrence.1
The following scenarios would require surgical management:
- Hansen type I cervical or thoracolumbar IVDH that is associated with minimal neurologic deficits but is refractory to conservative therapy.
- Hansen type I cervical IVDH with moderate to severe neurologic deficits (nonambulatory tetraparesis or tetraplegia). An acute onset of tetraplegia is a surgical emergency.
- Hansen type I thoracolumbar IVDH resulting in nonambulatory paraparesis to paraplegia. Dogs presenting with lack of nociception (or deep pain perception) should ideally have immediate decompressive surgery within 24 hours of onset of clinical signs. Prolonged loss of pain perception carries a poor prognosis.
- Hansen type I cervical or thoracolumbar IVDH causing deteriorating neurologic status, regardless of the severity of neurologic deficits.3
Many decompressive surgeries are used to treat IVDH, including hemilaminectomy, dorsal laminectomy, ventral slot (for cervical IVDH), and pediculectomy. Hemilaminectomy improves retrieval of herniated disc with minimal spinal cord manipulation (FIGURE 6). Pediculectomy can be used as an adjunct technique in cases of a bilateral approach.1 If surgery is required for Hansen type II IVDH, a hemilaminectomy, corpectomy, or pediculectomy is usually performed.3
Many dogs treated conservatively demonstrate initial improvement. Approximately 50% to 100% of patients recover with medical management, with a 30% to 50% relapse rate.3 The recovery rate in nonambulatory patients treated conservatively is lower; deep pain–negative dogs treated conservatively have a recovery rate of 5% to 10%.3 Among patients with Hansen type I IVDH that have intact pain perception, functional recovery is expected in 80% to 95%.
In patients with Hansen type I IVDH, the average time to ambulation is about 2 weeks. In nonambulatory tetraparetic or tetraplegic dogs with Hansen type I IVDH, it is reportedly about 1 week.
The absence of deep pain perception is associated with a poor prognosis. A recovery rate of about 50% is reported for dogs with absent pain perception. These dogs may have a better outcome if they undergo surgery within 12 to 24 hours of losing deep pain perception.3 The prognosis after surgical treatment of Hansen type II IVDH is guarded compared with that for Hansen type I IVDH, especially for thoracolumbar lesions. Neurologic deterioration after surgery is more common with Hansen type II IVDH, but the reason is unknown.3
A condition known as myelomalacia is a concern for dogs without deep pain perception. Myelomalacia is liquefaction of the spinal cord parenchyma. It may be focal or diffuse. Myelomalacia affects 10% of dogs lacking deep pain perception.3 Therefore, if a dog does not have deep pain perception, the surgeon may elect to perform a durotomy during surgery to visualize the spinal cord. Diffuse myelomalacia carries a grave prognosis. Recovery in dogs with focal myelomalacia is rare.
Nursing Care and Rehabilitation
Supportive care of nonambulatory animals should include prevention of decubital ulcers, urinary tract infections, and muscle atrophy. To prevent decubital ulcers, the animal should be kept on a well-padded bed and rotated from side to side every 4 to 6 hours (FIGURE 7). The skin over bony prominences should be checked daily for reddening. The patient should be kept clean and dry at all times.
Nonambulatory dogs with thoracolumbar IVDH are often unable to voluntarily urinate. If this is the case, the bladder will need to be manually expressed by applying gentle pressure to the caudal abdomen, or the patient will need intermittent or indwelling urinary catheter placement. Animals that cannot voluntarily empty their bladder completely are at risk for urinary tract infections. The urine should be monitored for foul odor and change in color so that treatment may be instituted if a urinary tract infection does develop.
Physical rehabilitation can help to shorten the recovery time for return to ambulation.1 Before a physical rehabilitation plan is developed for any patient with IVDH, it is important to consider the various stages of healing so that treatments may be better customized. Postoperative patients will need to be kept strictly rested for 6 to 8 weeks. These patients are allowed out of the kennel for only a few minutes 3 times daily to urinate and defecate and to perform controlled physical rehabilitation exercises. When out of the kennel, they should be kept controlled while on a short leash.
Postoperative pain from inflammation may be relieved by cryotherapy. A cold pack should be applied to the incision for 10 to 15 minutes every 4 hours for the first 48 hours after surgery.4 After the acute inflammatory period of healing is over, heat therapy may be instituted. This can be accomplished by using a commercially available gel pack. The heat pack can be applied to the incision for 10 to 15 minutes every 4 to 6 hours before other exercises are begun. The patient should be closely monitored during these treatments.
Passive range of motion (PROM) is intentional movement of a joint that is performed without muscle contraction. It is used when a patient is unable to move joints on its own or when active movement may be deleterious to the patient. PROM can be performed immediately after surgery and before active weight-bearing and is used to help prevent joint contracture, maintain mobility of soft tissue, reduce pain, enhance blood and lymphatic flow, and improve synovial fluid production. PROM will help maintain joint health; however, it will not improve strength or prevent muscle atrophy. Proper technique for PROM is important. The patient should be relaxed in lateral recumbency and the limb should be supported. The upper limbs are put through a comfortable flexion and extension for 15 to 20 cycles. The limb is then moved through a “bicycle” pattern another 15 to 20 times. This is repeated on each limb and is performed 3 to 4 times a day until the patient is ambulatory.
Standing exercises should begin as soon as physical rehabilitation exercises are initiated. Support is provided as needed while the patient is placed in a standing position to ensure loading/weight-bearing of the pelvic limbs and correct positioning of the feet. This is performed for 2 to 5 minutes 3 times daily. After the patient is able to maintain a standing position and the confinement period is over, exercises to challenge balance, such as weight shifting and wobble board exercises, may be instituted.5
Ambulation is allowed at slow paces in patients with voluntary motor function. Assisted sling walking or underwater treadmill hydrotherapy is used to unload weight while allowing ambulation. An underwater treadmill can facilitate active movements while supporting the dog’s body weight through buoyancy (FIGURE 8). For example, a dog bears 91% of its body weight with the water at the level of the hock. Increasing the water level to the height of the stifle decreases weight bearing to 85%, while adjusting the water to the level of the hip decreases it to 38%.
Furthermore, the resistance of the water helps to improve or build muscle strength. Water is much more resistant than air, making water exercise a better strengthening exercise than land walks. Hydrostatic pressure of the water has been shown to reduce edema and swelling, which may be of benefit in nonambulatory patients. Walking or swimming in water also improves general circulation. The water should be kept warm to provide the beneficial effects of heat to body tissues. Heat increases the elasticity and blood flow of tissue and also helps to relax the patient.
Strengthening exercises can be added when ambulation improves and after the kennel rest period. Strengthening exercises may consist of walking up and down inclines, weaving around obstacles, walking on varying textures (eg, sand, tall grass), stepping over objects of varying size (for proprioceptive awareness), and sit-to-stand exercises (FIGURE 9).5
Neuromuscular electrical stimulation may be beneficial to increase tissue perfusion, decrease pain, and delay the onset of muscle atrophy. It can be used to delay the onset of neurogenic muscle atrophy in patients with lower motor neuron disease. It is contraindicated over the incision following a hemilaminectomy. Neuromuscular electrical stimulation should be applied to affected muscle groups once daily for 15 minutes until the patient is ambulatory (FIGURE 10).4
A minimum of 3 weeks of physical rehabilitation is recommended. However, the degree of success with physical rehabilitation varies greatly, and a successful outcome may take several months.5
IVDH is one of the most common diseases causing paresis in dogs. It may result in a variety of clinical signs, ranging from spinal hyperesthesia to paraplegia. Many dogs recover if given the proper treatment and nursing care. The skilled veterinary technician is an essential part of the veterinary team and may possess the nursing skills needed to get these patients back on their feet again.
- Lorenz MD, Coates JR, Kent M. Handbook of Veterinary Neurology. 5th ed. Philadelphia: Elsevier Saunders; 2011.
- Platt SR, Olby NJ. BSAVA Manual of Canine and Feline Neurology. 3rd ed. Gloucester, UK: British Small Animal Veterinary Association; 2004.
- Dewey CW, da Costa RC. Practical Guide to Canine and Feline Neurology. 3rd ed. Oxford: Wiley Blackwell; 2016.
- Olby N, Halling KB, Glick TR. Rehabilitation for the neurologic patient. Vet Clin North Am Small Anim Pract 2005;35(6):1389-1409.
- Millis DL, Levine D, Taylor RA. Canine Rehabilitation and Physical Therapy. Philadelphia: Saunders; 2004.
A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain.Is intervertebral disk herniation serious? ›
Rarely, disk herniation can compress the entire spinal canal, including all the nerves of the cauda equina. In rare instances, emergency surgery might be required to avoid permanent weakness or paralysis. Seek emergency medical attention if you have: Worsening symptoms.What causes a herniated intervertebral disc? ›
A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as one ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.How do you fix herniated disc? ›
In nearly all cases, surgeons can remove just the protruding portion of the disk. Rarely, the entire disk must be removed. In these cases, the vertebrae might need to be fused with a bone graft. To allow the process of bone fusion, which takes months, metal hardware is placed in the spine to provide spinal stability.What are the 4 stages of disc herniation? ›
- Stage 1: Disc Compression. ...
- Stage 2: Bulging Disc. ...
- Stage 3: Disc Protrusion. ...
- Stage 4: Herniated Disc.
For one thing, leaving a herniated disc untreated can result in nerve damage associated with your bladder or bowels, and this could mean permanent urinary or fecal incontinence. You could also be at risk for saddle bag anesthesia.Can a chiropractor fix a herniated disc? ›
According to Spine Universe, chiropractic care is a non-surgical option for herniated disc treatment. This makes choosing a chiropractor to address problems with a herniated disc a viable option if you want to avoid undergoing any surgical procedures.Is walking good for a herniated disc? ›
Low-impact exercises, such as walking, swimming, and cycling, may be safe and beneficial for people with a herniated disc, as they can help to improve overall fitness and strengthen the muscles that support the spine.What percentage of herniated discs require surgery? ›
Herniated spinal discs are fairly common. Fortunately, surgery is not typically required for a herniated disc. In fact, only about 10 percent of herniated disc patients end up needing surgery, according to research cited by Harvard Health.What is the fastest way to heal a herniated disc? ›
Treatment with rest, pain medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be recommended.
Herniated disks get better on their own over time or with nonsurgical treatment for 9 out of 10 people. If other treatments don't relieve your symptoms, your healthcare provider may recommend surgery.Is L4 L5 disc bulge serious? ›
A L4–L5 disc bulge (or slip-disc) in the L4-L5 region can cause severe health issues such as impotence and reproduction issues. It can also lead to infertility, loss or control of the bowel or bladder, paralysis in one or both of your legs, and even death.What are the red flags for herniated disc? ›
Common warning signs of a herniated disc
Following are some of the most common symptoms of a herniated disc: Radiating pain in your arms or legs. Loss of reflexes or weakness in your arms or legs. Numbness or abnormal tingling sensations in your arms or legs.
The optimal sleeping position for a herniated disc is on your back. Lying on your back keeps your spine in a neutral position so you have less chance of pinching the nerve. For added comfort, nestle a small pillow or rolled-up towel under your knees and lower back.Is a herniated disc a major injury? ›
Herniated discs, also known as ruptured discs, are a serious back injury common in motor vehicle accidents. In many cases, these injuries can have long-term or permanent consequences for your health. These injuries could lead to restricted movement, chronic pain, and numbness in severe cases.How painful is a L4 L5 herniated disc? ›
Tingling, numbness (pins and needles), and an aching or burning sensation in the leg and on top of the foot are widespread. In severe cases, an L4-L5 slipped disc leads to weakness in the legs or feet. Some may even have an inability to walk, leading to an inability to stand.How permanent is a herniated disc? ›
Most of the time, pain associated with a herniated disc goes away on its own over a period of weeks or months and does not cause permanent damage to the spine or nerves. A herniated disc can occur in any part of the spine, but it is most common in the lower back (the lumbar spine) and the neck (the cervical spine).Is a herniated disc life long? ›
As for whether or not a herniated disc is permanent, there are a few ways to answer this question, which we explore in more detail below. Harvard Health reports approximately 90 percent of the time, herniated disc symptoms go away within six months with little or no significant intervention.Is a herniated disc a disability? ›
Is Herniated Disc a Permanent Disability? A severe herniated disc can be considered a disability and make you eligible for Social Security disability benefits if it meets the requirements in the Social Security Administration's Blue Book.How do chiropractors treat herniated discs? ›
They will lightly apply force onto the affected area with a pumping rhythm. Flexion-distraction is a gentle and pain-free procedure, making it a great option for patients who suffer from severe pain. It can move the herniated disc away from the affected nerve, alleviating your symptoms.
The good news is that the vast majority of herniated discs can be treated without surgery using manual therapy and exercise or with IDD Therapy disc treatment. It is only a small percentage of cases which go on to have surgery.What kind of doctor treats herniated disc in back? ›
Herniated discs are quite common and do not always need treatment. Most of the time they can be healed by rest; however, if symptoms persist, you may need to see an orthopedic surgeon near you specializing in spine surgery.Can you massage a bulging disc back into place? ›
Massaging these muscles can restore proper balance and symmetry to the posture, which can allow the bulging disc to migrate back to its normal position in the spinal column. The pressure against the spinal nerves often subsides, and very likely, the pain associated with it to goes away.What painkillers are good for herniated discs? ›
Narcotics such as codeine or oxycodone-acetaminophen (Percocet) are also short-term options that your doctor may prescribe if over-the-counter meds don't work. Your doctor might also prescribe muscle relaxants to ease muscle spasms in your back.What is the best position to sit with a herniated disc? ›
Sit with the Right Posture
It is proper to sit up straight without slouching. When you slump, you put extra pressure on the discs in the spine and can aggravate your herniated disc. Additionally, you want to ensure your knees are level with your hips. Your hips should be slightly above your knees if you sit at a desk.
Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area. Unfortunately, the injection does not make a herniated disc smaller; it only works on the spinal nerves by flushing away the proteins that cause swelling.What are the worst activities for herniated disc? ›
- High impact aerobics.
- Flexion-based movements.
- Leg lifts.
- Twisting movements.
- High-level core strength exercises.
- Overhead weightlifting.
- Repetitive forward bending at the waist.
It may take up to 8 weeks to get back to doing your usual activities. Your doctor may advise you to work with a physiotherapist to strengthen the muscles around your spine and trunk. You will need to learn how to lift, twist, and bend so you don't put too much strain on your back.What percentage of disability is herniated disc? ›
VA Disability Ratings for Herniated Discs
20% – Veterans who have had episodes that last for at least 2 weeks, but less than 4 weeks, in the past 12 months, may be able to qualify for this rating. 40% – Having episodes that last for at least 4 weeks but less than 6 weeks in the past 12 months.
Most herniated discs do not require surgery and typically improve with time. Surgery is therefore a last resort treatment after other options like oral steroids, anti-inflammatories, physical therapy, and even corticosteroid injections may have proven ineffective.
Eventually, it can lead to pain and swelling and even a bulging disc or herniated disc. Drinking water to adequately replenish the discs with the amount water needed to work properly can reduce the likelihood of developing back pain.Can physical therapy fix a herniated disc? ›
Physical therapy can reduce the inflammation and dysfunction that occurs with a herniated disc, and once the inflammation is reduce enough, healing can take place. When the inflammation is removed the disc can heal and pain will resolve.Is heat or ice better for a herniated disc? ›
Heat or Ice for Herniated Disc Pain Treatment
Heat and ice can be used to treat the symptoms of pain associated with the muscle spasm from a cervical herniated disc. As a general rule, use ice for the first 24 hours after this injury and then use whichever feels better after that.
An MRI scan can also show evidence of previous injuries that may have healed and other details in the spine that can't normally be seen on an x-ray. Myelogram: This special x-ray uses dye, which is injected into the spinal fluid.When should you have back surgery for a herniated disc? ›
Your doctor might recommend surgery as an option for your herniated disc if: Your symptoms have lasted at least 6 weeks and make it hard to do your normal activities, and other treatments haven't helped. You need to get better quickly because of your job or to get back to your other activities as soon as possible.How long do herniated disc flare ups last? ›
In general, a flare-up can last anywhere from a few days to several weeks.What does L4-L5 pain feel like? ›
Referred pain from L4-L5 usually stays within the lower back and is typically felt as a dull ache. The back may also feel stiff. Depending on the type and severity of the underlying cause, the L4-L5 motion segment may cause lumbar radicular pain of the L4 and/or L5 spinal nerves, also called sciatica.What medication is used for L4-L5 disc bulge? ›
Medication. Both prescription and over-the-counter (OTC) medications are used to help relieve pain from L4-L5. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first. For more severe pain, opioids, tramadol, and/or corticosteroids may be used.How long does it take to recover from L4-L5 disc herniation? ›
As a result, herniated discs can take a long time to heal. of the time, pain caused by a herniated disc will go away on its own within six months without surgery. However, it commonly takes up to six weeks for lumbar discs to recover from herniation.How do I know if my herniated disc is severe? ›
Seek emergency medical attention if you have: Worsening symptoms. Pain, numbness or weakness can increase to the point that they hamper your daily activities. Bladder or bowel dysfunction.
Progressive loss of sensation in the back of your legs, inner thighs and areas around the rectum (saddle anesthesia) Worsening symptoms to the point where you can't do your normal activities.Is it better to sit or lay down with lower back pain? ›
If you're experiencing back pain when sitting, your impulse may be to lie down and then try to slowly progress back to sitting, says Dr. Atlas. But this is the wrong approach. You should lie down to relieve the pain, but the goal should be not to return to sitting, but rather to regain your ability to stand and move.How do you sit in a car with a herniated disc? ›
Sit up straight with your knees slightly higher than your hips, and keep your chin pulled in so that your head sits straight on top of your spine. Sit a comfortable distance from the steering wheel.Why is herniated disc worse at night? ›
The recommended sleeping position with a lumbar herniated disc is on your back. This maintains neutral spinal alignment, which reduces the risk of related nerve issues. But if you are a side or stomach sleeper, the shifts in your spinal alignment could be why your disc pain is more noticeable at night.When should I be worried about a herniated disc? ›
If you still have pain or numbness after 4 to 6 weeks, or if you feel worse, talk with your doctor. Sometimes it takes surgery to relieve pain. Call your doctor right away if you have any of the following symptoms: Trouble going to the bathroom.Can you recover from intervertebral disk herniation? ›
For most patients, a herniated lumbar disk will slowly improve over a period of several days to weeks. Typically, most patients are free of symptoms by 3 to 4 months. However, some patients do experience episodes of pain during their recovery.How long does it take for intervertebral disk herniation to heal? ›
Self care: In most cases, the pain from a herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks. Restricting your activity, ice/heat therapy, and taking over the counter medications will help your recovery.Is herniated disc a disability? ›
Is Herniated Disc a Permanent Disability? A severe herniated disc can be considered a disability and make you eligible for Social Security disability benefits if it meets the requirements in the Social Security Administration's Blue Book.Can a chiropractor fix a bulging disc? ›
Chiropractic is a preferred treatment option for many people with bulging and herniated discs because it is a non-invasive process and does not require drugs or injections. Once you have reached your diagnosis, you and your chiropractor can work hand in hand to look for the best way to treat your condition.Is a herniated disc a lifelong injury? ›
Once a healthy disc herniates, it will never return to its normal anatomical state—the disease or injury is permanent in nature.
In cases where a herniated disc has been untreated for too long, this type of damage can be permanent. Patients may also permanently lose feeling in their legs and lower back.