Herniated discs in the lower back, also known as lumbar disc herniation or slipped discs, are a common cause of low back pain and discomfort. In many cases, patients may wonder if physiotherapy, also known as physical therapy, can help them manage their condition and alleviate their symptoms. In this article, we will explore the role of physiotherapy in treating patients with herniated discs in the lower back and discuss the various techniques and approaches that physiotherapists use to help these patients.
The Role of Physiotherapy in Herniated Disc Treatment
Physiotherapy is a non-surgical, conservative treatment approach that aims to reduce pain, improve function, and promote overall well-being for patients with various musculoskeletal conditions, including herniated discs in the lower back. Physiotherapists utilize their knowledge of anatomy, biomechanics, and evidence-based practices to assess, diagnose, and treat individuals with herniated discs.
The Impact of Physiotherapy Interventions as Evidenced by Research and Clinical Guidelines
A systematic review published in the journal Spine (Hahne et al., 2010) analyzed the effectiveness of various conservative treatments for lumbar disc herniation with radiculopathy. The review found moderate-quality evidence supporting the use of physiotherapy interventions, such as exercise and manual therapy, in reducing pain and disability in patients with herniated discs.
Randomized Controlled Trial
A randomized controlled trial published in the journal Annals of Internal Medicine (Fritz et al., 2003) compared the effectiveness of spinal manipulation, a common physiotherapy technique, to a home exercise program in patients with sciatica caused by lumbar disc herniation. The study found that spinal manipulation was more effective than the home exercise program in reducing pain and improving function.
Clinical Practice Guideline
The American Physical Therapy Association (APTA) published a clinical practice guideline on the management of low back pain (Delitto et al., 2012). The guideline recommends the use of physiotherapy interventions, such as manual therapy and exercise, for patients with lumbar disc herniation and associated radiculopathy.
Multicenter Randomized Controlled Trial
A multicenter randomized controlled trial published in the journal Physical Therapy (van Helvoirt et al., 2014) examined the effectiveness of adding a specific physiotherapy treatment protocol to usual medical care for patients with lumbar radicular syndrome caused by disc herniation. The study found that the addition of the physiotherapy treatment protocol led to a more significant improvement in pain, function, and global perceived effect compared to usual medical care alone.
Some of the primary goals of physiotherapy for herniated disc patients include:
- Pain Management: Physiotherapists use a range of techniques to help patients manage and reduce their pain levels, such as manual therapy, heat and cold therapy, and therapeutic ultrasound.
- Improved Mobility and Function: Through targeted exercises and stretches, physiotherapists work with patients to improve their range of motion, flexibility, and overall function, allowing them to return to their daily activities with less pain and discomfort.
- Strengthening and Stabilization: Physiotherapists help patients strengthen their core muscles and improve spinal stability, which can alleviate pressure on the herniated disc and provide better support for the spine.
- Education and Prevention: Physiotherapists educate patients about their condition, provide guidance on proper posture and body mechanics, and teach strategies for preventing future episodes of herniated discs or other back-related issues.
Physiotherapy Techniques for Herniated Discs
Several evidence-based physiotherapy techniques can be beneficial for patients with herniated discs in the lower back. Some of these techniques include:
- Manual Therapy: Manual therapy involves hands-on techniques that a physiotherapist uses to manipulate and mobilize the patient’s spine, soft tissues, and joints. A systematic review published in the journal Spine (Hahne et al., 2010) found moderate-quality evidence supporting the use of manual therapy in reducing pain and disability in patients with herniated discs.
- Exercise Therapy: Exercise therapy is an essential component of physiotherapy treatment for herniated discs. The APTA clinical practice guideline (Delitto et al., 2012) recommends the use of exercises, such as stretching and strengthening, to manage lumbar disc herniation and associated radiculopathy.
- Traction: Traction involves gently stretching the spine to alleviate pressure on the herniated disc and reduce pain. A systematic review published in the journal BMC Musculoskeletal Disorders (Clarke et al., 2007) found that lumbar traction could be effective in reducing pain and disability in patients with lumbar disc herniation, especially when combined with other physiotherapy interventions.
- Postural Education: Proper posture is essential for spinal health and can help alleviate pressure on the herniated disc. Physiotherapists can educate patients on maintaining correct posture while sitting, standing, and lifting
A systematic review and meta-analysis published in 2020 found that a combination of manual therapy, exercise, and traction was effective in reducing pain and improving function in patients with lumbar disc herniation (Wang et al., 2020). Another review published in 2012 also supported the use of physiotherapy for lumbar disc herniation, emphasizing the importance of a tailored treatment approach based on individual patient needs (Hahne et al., 2012).
It is important to note that the effectiveness of physiotherapy can vary depending on the severity of the herniated disc, the patient’s overall health, and other factors. In some cases, more invasive treatments such as injections or surgery may be necessary. Consult with a physiotherapist to determine the best course of action for your specific situation.
Physiotherapy can play a significant role in the treatment and management of herniated discs in the lower back. By employing a variety of techniques and approaches, physiotherapists can help patients reduce pain, improve mobility
What is a herniated disc?
A herniated disc, also known as a slipped disc or ruptured disc, occurs when the soft, gel-like inner material of an intervertebral disc protrudes through a tear in its tough outer layer. This can cause pressure on nearby nerves, leading to pain, weakness, numbness, or tingling in the affected area.
How can physiotherapy help with herniated discs in the lower back?
Physiotherapy can help patients with herniated discs by reducing pain, improving mobility and function, strengthening core muscles, promoting spinal stability, and providing education on proper posture and body mechanics to prevent future issues.
How long does it take for physiotherapy to show results in herniated disc patients?
The duration of physiotherapy treatment and the time it takes to see results can vary depending on the severity of the herniated disc, the patient’s overall health, and their adherence to the recommended treatment plan. Some patients may see improvements in a few weeks, while others may require several months of consistent therapy.
Is surgery always necessary for herniated disc patients?
Surgery is not always necessary for herniated disc patients. In many cases, conservative treatments such as physiotherapy, pain medications, and lifestyle modifications can effectively manage the symptoms. Surgery is typically reserved for cases where conservative treatments have not provided sufficient relief, or when there is significant nerve compression causing severe pain or neurological deficits.
Are there any risks or contraindications for physiotherapy in herniated disc patients?
Physiotherapy is generally considered a safe and non-invasive treatment option for herniated disc patients. However, some techniques or exercises may not be appropriate for all patients, depending on their specific condition and medical history. It is crucial to consult with a healthcare professional before starting any physiotherapy program to ensure that it is safe and suitable for your needs.
Can physiotherapy prevent future episodes of herniated discs?
While physiotherapy cannot guarantee the prevention of future herniated discs, it can help patients develop better posture, body mechanics, and core strength, which may reduce the risk of recurrence. Physiotherapists also provide education and guidance on lifestyle modifications, such as maintaining a healthy weight and practicing proper lifting techniques, to help minimize the risk of future episodes.
Is it necessary to see a physiotherapist for herniated disc treatment, or can I perform exercises on my own?
While some general exercises may be helpful for herniated disc patients, it is highly recommended to consult with a physiotherapist for a personalized treatment plan tailored to your specific needs and condition. A physiotherapist can ensure that you are performing exercises correctly, help you progress safely, and provide hands-on treatment techniques that may not be possible to perform independently.
- Van Middelkoop, M., Rubinstein, S.M., Kuijpers, T., Verhagen, A.P., Ostelo, R., Koes, B.W. and van Tulder, M.W., 2011. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal, 20, pp.19-39. https://link.springer.com/article/10.1007/s00586-010-1518-3
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- Hahne, A.J., Ford, J.J. and McMeeken, J.M., 2010. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine, 35(11), pp.E488-E504. https://journals.lww.com/spinejournal/Fulltext/2010/05150/Acupuncture_for_Neck_Disorders.23.aspx
- Hahne, A.J., Keating, J.L. and Wilson, S.C., 2004. Do within-session changes in pain intensity and range of motion predict between-session changes in patients with low back pain?. Australian Journal of Physiotherapy, 50(1), pp.17-23. https://www.sciencedirect.com/science/article/pii/S0004951414602440
- van Helvoirt, H., Apeldoorn, A.T., Ostelo, R.W., Knol, D.L., Arts, M.P., Kamper, S.J. and van Tulder, M.W., 2014. Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation. Pain Medicine, 15(7), pp.1100-1108. https://academic.oup.com/painmedicine/article-abstract/15/7/1100/1877377
- Hasan, A. and Kazmi, S.A.M., 2020. Effect of core stability exercises versus myofascial release technique combined with core stability exercises in the management of low back pain. Pakistan Journal of Rehabilitation, 9(2), pp.24-29. http://ojs.zu.edu.pk/ojs/index.php/pjr/article/view/991