The ultimate fear of having low back pain is finding out you have a disc herniation because this diagnosis carries such a reputation for pain and suffering and we ALWAYS think surgery is necessary for this. I am here to tell you this should NOT be the case for you.
Low back pain is the #1 disability in the world with a lifetime prevalence of 80%. 25% of individuals report having experienced low back pain in the last 3 months. Low back pain is the #1 cause of work-related disability and missed workdays.
Disc herniations have a high prevalence as well but are not always associated with low back pain. In fact, on average 30% of 20-year-olds have disc bulges, 40% of 30-year-olds have disc bulges, and 50% of 40-year-olds have disc bulges yet experience no pain at all! This would suggest that disc herniations are not always the cause of low back pain even if they are seen on MRI, and therefore would not always indicate the need for disc herniation surgery.
Is Surgery the Right Choice?!?!
Disc herniation surgery has become quite common. The failure rate of back surgeries is so high that there is actually a name for it referred to as "Failed Back Surgery Syndrome" due to how many people it affects. It is now considered that your chance of a successful back surgery is about the flip of a coin, yet many many people are still being advised surgery for their disc herniations. This may be explained by the high volume of asymptomatic (non-painful) disc herniations that are operated on due to inappropriate use of imaging and lack of conservative, rehabilitative care. One study in 2016 actually found that although surgery might provide faster immediate relief compared to conservative care, long term there was no difference between surgery and conservative care.
So what are the pro's and con's then? Your average lumbar disc herniation surgery (microdiscetomy) price ranges from $15,000 to $50,000. Your average chiropractic/physical therapy visit is around $60. This is a HUGE cost difference, and not only does surgery require a large sum of money but it doesn't teach you the things you could have done to build a stronger healthier back so that something like this doesn't happen in the future. The reason for developing low back issues is typically not fixed by a knife, but rather by finding out why the low back problem occurred in the first place and addressing it there with our lifestyles and movements. This is similar to someone that is trying to save more money, but instead of practicing financial responsibility they just try and work more or find a higher paying job. The problem is still there.
What Exercises will help my Disc without Surgery?
There is a wide array of exercises for disc herniation and rehabilitative approaches that may help with disc-related low back pain. Disc herniation exercises can be very simple and basic but guidance from a professional is key. The number 1 most important thing when seeking care for low back pain or a disc herniation is receiving a proper assessment. If the provider is not taking you through movements and assessing your function, then they are not the right provider for this problem. Many low back problems and disc herniations are sensitive to different movements and postures. Common disc herniation symptoms may increase when sitting for long periods in the same position, typically a slouched position. This may produce some extra pressure on the disc or nerve involved and can increase disc herniation pain. One simple approach is to try and focus on moving frequently, getting the back in a straighter position, and also moving the back the opposite direction as shown here....
Here at RehabFix we find many individuals respond well to this simple exercise, especially if you feel discomfort from sitting long periods or when bending over to touch your toes. Another good recommendation for sitting is to grab a t-shirt or towel and put it behind the low back to help prevent this excess pressure for long periods. We recommend taking the object in and out every 20 minutes or so for the spine to be frequently moving.
Simple methods like these can have a very positive effect on low back issues. Ultimately the best approach is scheduling an appointment so that you may get all the tools you need to find relief as quickly as possible and build a bulletproof back.
When Surgery is Actually Necessary...
Surgery is sometimes needed though, and it's important to understand when it is appropriate. One of the indications for additional tests is a failed trial of conservative care. If you have already sought out help from a provider that is proficient in low back or disc rehabilitation, and you have not received any benefit after 4-6 weeks it may be time to investigate further or get a second opinion. If rehabilitation is not working, and additional tests like imaging are showing things that may require surgery then you can begin having that conversation. Also, if you are experiencing significant weakness in one of your legs that is not going away with conservative care, this also may be an indication to investigate further or get a second opinion. Finally, if you are beginning to experience numbness in your groin, or issues with incontinence associated with an acute onset of low back pain then you must take action immediately and go to the emergency room.
Conclusion
Disc herniations and low back pain can be a very scary thing, but it doesn't have to be. Many people have normal disc herniations that are not painful, and are not always the source of pain. Rehab professionals help these individuals every day, and surgery is often not needed to make a fast and full recovery. Surgery can be a very costly procedure that may not set the individual up for success in the future since they have yet to change the function of their body. Find someone you trust to help you with your disc herniation or low back problems!
I help people with low back issues recover without drugs or surgery through 1:1 online coaching.
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