Therapy
Therapeutically, there are many possibilities to treat a herniated disc of the lumbar spine. Basically, a distinction is made between conservative and surgical therapy. About 90% of herniated discs can be successfully treated without surgery.
Over time, the herniated disc recedes and the symptoms improve. The conservative therapy is in turn divided into different sub-areas, which can help the patient during recovery. Heat improves the blood circulation in the muscles.
A hot water bottle in the back or heat patches, such as ThermaCare®, help soften the muscles and relieve tension. Pain is often caused by cramps and poor posture in the musculoskeletal system. Patients with herniated disks often report relief of their symptoms when they apply heat regularly.
Back-friendly postures are very important in order to get the disc herniation symptoms under control. In addition, this is also intended to prevent new herniated discs. The so-called step positioning is considered to be particularly relieving for the spine and is usually very comfortable for patients with herniated discs.
For this purpose, the patient lies on his back and puts his legs up at right angles. Patients with a herniated disc of the lumbar spine should start with physiotherapy at an early stage and not keep physically still. Lack of movement stiffens the muscles, the pain leads to a relieving posture, which in turn increases the pain even more.
If you only lie down for a long time with a herniated disc, your clinical picture is likely to become even worse. By means of physiotherapy this vicious circle can be counteracted. The patients perform specific exercises to strengthen the back muscles.
This improves the stability of the spine and prevents further slipped discs. In addition, the spinal column is relieved by a strengthened musculature. Sports that are easy on the spine can also be used to treat a herniated disc – such as water gymnastics.
Sports that strain the back and lifting heavy objects should be avoided at all costs. Manual therapy is a procedure that serves to mobilize the patient’s spine in the event of a herniated disc and is intended to eliminate tension. This includes massages, osteopathy and chiropractic.
In principle, manual therapy can be used sensibly as a complementary measure in treatment, but it is not suitable for every patient with a herniated disc. It is therefore essential to consult a doctor in advance. In the drug therapy of a herniated disc of the lumbar spine, the adequate pain therapy is crucial.
Here, the so-called WHO step-by-step scheme is applied. Depending on the severity of the symptoms, different painkillers are used. In the first stage, non-opioid painkillers are administered, for example paracetamol or ibuprofen.
Stage II uses weak opioids such as tramadol and tilidine, which are combined with the painkillers of stage one. If this does not bring any improvement either, stage III follows, in which strong opioids are used, for example morphine or fentanyl. Finally, the painful nerves can also be anaesthetized locally.
For this purpose, painkillers can be injected directly at the spinal joints, the neuroforamen or directly at the herniated disc. This procedure is called periradicular therapy. Surgery for a herniated disc in the lumbar spine is only performed for certain indications, for example severe paralysis and loss of bladder and bowel control.
The complication rate of the operation is relatively high, which is why conservative therapeutic measures should be exhausted first. During the operation, the surgeon gains access to the damaged intervertebral disc and removes the leaked gelatinous mass. If the intervertebral disc is severely affected, it may have to be completely removed and replaced by an artificial disc. This is followed by a follow-up of about six weeks, the aim of which is to strengthen the back muscles, mobilize the spine and learn back-friendly postures and movements.
