Treatment for a Lumbar Herniated Disc

The primary goals of treatment for a lumbar (low back) herniated disc are to:

• Alleviate pain and other symptoms such as numbness and/or weakness
• Prevent the symptoms from worsening
• Provide a better healing environment for the herniated disc

Most treatment approaches include exercise-based therapies and lifestyle changes to improve healing and minimize the chance of recurrence. 

Non-Surgical Treatments for a Lumbar Disc Herniation

Treating pain from a lumbar herniated disc usually involves reducing the inflammation and swelling around the disc to take pressure off the affected spinal nerve root. Usually, a combination of the non-surgical strategies listed below is recommended.

• Medications. Pain-relieving medications are sometimes used to treat herniated disc pain and may include one or more of the following¹Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382^,2Zhang AS, Xu A, Ansari K, et al. Lumbar Disc Herniation: Diagnosis and Management. Am J Med. 2023;136(7):645-651. doi:10.1016/j.amjmed.2023.03.024^,3Capsicum. Natural Medicines. Therapeutic Research Center; 2023. Updated October 11, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=945
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil): usually recommended for initial treatment and are available over the counter or by prescription (if a higher dosage is needed)
  • Topical creams and gels, such as Aspercreme: available over the counter and used for temporary pain relief after strenuous activities or in case of a pain flare-up
  • Oral corticosteroids, such as prednisone: available by prescription only and recommended for severe inflammation and/or pain
  • Opioids, such as tramadol: available by prescription only and recommended in rare cases of severe, debilitating pain
• Physical therapy. Targeted physical therapy and exercises improve pain and mobility. Exercises are typically focused on extension (backward bending) movements and lumbar stabilization to reduce nerve compression.
• Injection treatments. Several types of injection treatments are used for relieving pain and/or improving healing in the herniated disc. Common examples include:
  • Epidural steroid injections and selective nerve root blocks, which may help reduce inflammation and pain¹Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382^,3Capsicum. Natural Medicines. Therapeutic Research Center; 2023. Updated October 11, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=945^,4Singh S, Kumar S, Chahal G, Verma R. Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc - A prospective randomized study. J Clin Orthop Trauma. 2016;8(2):142–147. doi:10.1016/j.jcot.2016.02.001
  • Plasma-rich platelet (PRP) therapy, which promotes healing in the injured disc⁵Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM&R. 2015;8(1):1-10. doi:https://doi.org/10.1016/j.pmrj.2015.08.010
  • Tumor necrosis factor-alpha inhibitor (TNFi) injections, which treat inflammation by blocking specific inflammatory proteins (TNF)⁶Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-516. doi:10.1007/s12178-017-9441-4
• Massage therapy. Massage therapy, such as deep tissue massage and neuromuscular massage therapy, loosens and relaxes tight muscles, relieves muscle spasms, promotes healing, and releases pain-relieving endorphins.⁷Koren Y, Kalichman L. Deep tissue massage: What are we talking about? Journal of Bodywork and Movement Therapies. 2018;22(2):247-251. doi:10.1016/j.jbmt.2017.05.006
• Spinal manipulation. Spinal manipulation, has been shown to moderately improve lower back and/or leg pain (sciatica) in patients with a herniated disc.⁸Erwin WM. Should you adjust that herniated disc? Thoughts from a chiropractor/molecular scientist. J Can Chiropr Assoc. 2023;67(1):7-18.
• Heat and cold therapy. Heat relaxes tight muscles, reduces spasms, increases blood flow, and improves the flexibility of connective tissue. The application of ice or cold packs reduces inflammation and has a pain-relieving effect.⁹Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65. doi:10.1080/00325481.2015.992719
• Acupuncture. Stimulation of the affected nerve by inserting hair-thin needles into specific areas of the skin is thought to relieve nerve tension and reduce sciatica symptoms.¹⁰Deng R, Huang Z, Li X, Pei X, Li C, Zhao J. The effectiveness and safety of acupuncture in the treatment of lumbar disc herniation: Protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(12):e18930. doi:10.1097/MD.0000000000018930
• Cognitive behavioral therapy (CBT). CBT is beneficial for managing negative thoughts and behaviors that often contribute to and/or worsen the experience of pain.¹¹Hanscom DA, Brox JI, Bunnage R. Defining the Role of Cognitive Behavioral Therapy in Treating Chronic Low Back Pain: An Overview. Global Spine J. 2015;5(6):496-504. doi:10.1055/s-0035-1567836
• Dietary supplements. Some research supports the potential effectiveness of certain herbal and dietary supplements with anti-inflammatory, pain-relieving, and/or healing properties, such as¹²Glucosamine. Natural Medicines. Therapeutic Research Center; 2023. Updated July 19, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=807#background^,13Alpha-linoleic acid. Natural Medicines. Therapeutic Research Center; 2023. Updated October 13, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1035^,14Devil’s claw. Natural Medicines. Therapeutic Research Center; 2023. Updated June 12, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=984:
  • Glucosamine
  • Devil’s claw
  • Omega-3 fatty acids

Surgical Treatments for a Lumbar Disc Herniation

Surgery for a herniated disc is performed to relieve pressure on a mechanically compressed nerve and to prevent the worsening of neurologic deficits. 

Indications for surgery

In most cases, surgery for a lumbar herniated disc is elective, meaning that it is the patient's decision whether or not to have surgery. Surgical intervention is considered in the following scenarios¹Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382: 

• Symptoms have continued for 3 to 6 months or worsened despite non-surgical treatment 
• Development of progressive neurologic dysfunction, including loss of motor function 
• Debilitating pain and functional disability interfering with daily activities, such as standing, sitting, or walking
• Imaging findings confirm that a herniated disc is the source of pain and/or neurologic symptoms

Herniated discs that cause medical emergencies, such as cauda equina syndrome, require urgent surgery.¹Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382

Microdiscectomy 

The gold standard surgery for a herniated disc is microdiscectomy, also called microdecompression, which involves removing a small portion of the herniated spinal disc to relieve pressure on the nerve root while leaving the rest of the disc intact.¹⁵Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

Watch Lumbar Microdiscectomy Surgery Video

Spinal fusion and artificial disc replacement 

In some cases of recurrent lumbar disc herniations with spinal instability, the entire spinal disc is removed, and a bone graft is inserted in the disc space. The bone graft restores the disc height, relieves nerve compression, and facilitates bone growth for the fusion of the entire motion segment. This procedure is called lumbar spinal fusion surgery. 

See Spine Fusion Risks and Complications

An alternative option is to replace the painful spinal disc with an artificial disc – a device designed to mimic the disc’s natural movement. This procedure is called lumbar artificial disc replacement.

Pain relief and functional improvement after surgery are largely dependent on the quality of rehabilitation after surgery, the overall health of a patient, and the skill and experience of the surgeon.

See Rehabilitation Following Lumbar Fusion

Patients should discuss the surgical risks, benefits, and full range of treatment options with the physician before considering surgery for a lumbar herniated disc.