Medical and Natural approaches to the treatment of slipped disc (herniated disc).

Medical treatment of slipped disc (disc herniation or bulge)

Traditional (conventional) medicine concentrates their efforts on treating the symptoms of the slipped disc. In UK patients are prescribed pain-killers (often morphine/opiate based) and anti-inflammatory medication (ibuprofen, diclofenac (prescription) or voltarol (over the counter).

Doctors recommend heat treatments and physiotherapy (generally consisting of exercises).

If this approach doesn’t work, patients are offered an injection of strong anti-inflammatory/painkiller into the area of disc bulge, and if that fails to have a “pain-killing” effect, patients are offered a discectomy (an operation to remove a disc bulge surgically).

If the injection helps, patients are advised to come back for another one, when the effects of first injection are worn away.

Pros of medical approach to disc treatment :

1. Free on NHS in UK (paid from taxpayers money).

2. Patient active participation not needed. Patient understanding of the problem is not needed and patient responsibility is not required.

3. If it comes to surgery, the current techniques are very advanced and may offer a “laser” treatment with a minimal intrusion into sensitive network of muscles, ligaments blood vessels and nerves surrounding the spine.

4. The prescription of anti-infalammatory drugs often yelds good results, lessening inflammation around bulged disc, reducing the cause of pain to a minimum.

5. Surgical intervention maybe urgently needed if disc bulge/protrusion/extrusion is impacting on the spinal cord causing severe loss of function (un-controlled changes in bowel and bladder function, loss of feeling and control over limbs). Surgery may bring a constant relief to this patient and often is the only means of emergency treatment.

6. May not require multiple appointments, few injections and an operation (if successful) often is a management plan stretched over months or years from onset. This treatment is supported by repeated prescriptions of pain-killers and repeated courses of anti-inflammatory medication. Some other drugs for pain management may be offered. May render good results if supported by good rehabilitation treatment, counselling and attending pain clinics where patient is taught to “live with the pain”.

Cons of medical approach to disc treatment:

1. The main cause of disc bulge remains untreated where poor spinal mobility and lack of functional strength are not addressed appropriately and maybe exacerbated by surgery and injections which may further weaken the spine.

2. The prescription of drugs, often cause side-effects, mostly related to gastro-intestinal system, including bleeding from ulcers in the stomach and severe abdominal pain.

3. Widely recommended use of heat pads and other heat treatments exacerbates the symptoms where short pain relief is followed by worsening of symptoms due to increased inflammation.

4. The Failed Back Pain Surgery syndrome may follow the surgical intervention. Although the main cause of pain (disc bulge) maybe removed, the scarring in the affected area and possible surgical fusion of spinal joints may disable patient for life. According to one research 10-40% of back pain surgeries may fall into this category.

5. Success of surgical procedures is largely based on individually tailored rehabilitation plan which must be applied early in the post-operational recovery. There was good success reported with discectomy followed by rehabilitation. Fortunately the rehabilitation alone (without prior surgery) according to one research may bring the same quality outcome rendering surgery useless.

6. Diet and lifestyle advice which may improve the rate of recovery and speed up natural body healing are not routinely recommended.

7. As the cause of the problem may not be taken under control and the spinal joints may not be moving according to their design and the spinal stability musculature may still not be fully functional – the problem may keep re-occuring or even getting worse.

Our recommendations:

• Although anti-inflammatory drugs are often play major role in patient recovery, patient have to be monitored for side effects and advised on correct dosage and use of these dangerous drugs. Generally they have to be taken after food to avoid gastro-intestinal side-effects and as a course of treatment to achieve desirable results.

• Although surgery remains a first choice of treatment for “emergency spinal decompression” when patient experiencing severe loss of function as described above, use of surgery has to be limited to these cases and to the cases where all other treatments failed to work.
• When treatment and rehabilitation aimed at restoring the function, mobility and strength of spinal structures in order to naturally decompress the disc and restore sufficient blood flow and innervation of the spine which aids natural repair fails, surgery need to be considered.

Chiropractic treatment of slipped disc

Chiropractic approach is aimed at restoring natural function of the spine (as mentioned above). Chiropractic approach traditionally consists of chiropractic treatment and a series of daily exercises (stretches and strengthening).

Chiropractic treatment is a joint manipulation traditionally termed a “chiropractic adjustment” which is aimed at restoring natural and functionally normal movement in the spinal joints. That is followed by exercises individually selected by your chiropractor according to your diagnosis and the phase of care.

Exercises are aimed at keeping your spinal joints mobile and supple thus restoring the function of the spine and re-distributing the pressure at different levels.

Further treatment followed by strengthening exercises to ensure constant functional support and realignment of the spinal joints.

Pros of chiropractic approach to disc treatment:

1. Natural treatment based on the body’s natural ability to heal and restore the natural functions.

2. Side-effects are very rare if you are treated by a qualified, trained, certified and insured chiropractor. Post-treatment soreness may occasionally be reported.

3. Because full-spine is being treated and all restrictions of spinal movement are being addressed – all body systems dependant on brain-organ communication through the spine may be improved. General health benefits.

4. Non-invasive treatment which is usually painless.

5. Chiropractors generally recommend ice-packs to be used on the sore and inflamed spine to naturaly reduce inflammation and pain.

6. Chiropractors may advise on diet and life-style to boost your body’s ability to heal and repair.

7. Chiropractors offer inexpensive maintainnce treatments to compensate for modern life-style and avoid reoccurence and offer constant support and advice.

Cons of chiropractic approach to disc treatment:

1. It’s not free but maybe covered by your private medical insurance and rarely available on NHS.

2. May require a course of treatments as human body needs time to heal and respond to the positive changes of treatment.

3. Needs full patient understanding of the problem and require full patients participation in the process of repair. Patient has to be prepared to take responsibility for their health.

3. Chiropractic treatment may not work and may still need surgery if the damage is too severe or if patient is not compliant with the course of treatment and exercises.

4. Slipped disc may sometimes take longer to repair if treated by natural means, but side effects of injections and surgery may be avoided and effects are long lasting if patient is compliant to recommendations.

Combination of medical and chiropractic treatments can work together

1. Chiropractors may advise patient to ask for doctors prescription of anti-inflammatory medication and pain-killers to spped up the repair and reduce the pain.

2. Some doctors may refer patient to a chiropractor for treatments of mechanical back pain and “pinched nerve”.

3. Chiropractors will triage (determine severity and possible cause of the problem in order to offer best possible and most appropriate help) and refer patients who they can not help to doctors, orthopedic surgeons or other medical practitioners.

4. Chiropractors may assist the patients before the surgery and help them to rehabilitate after the surgery to reduce the risc of reoccurence.

Use of other professions and tools for treatment of slipped disc.

1. Use of supporting belts and neck braces only recommended when injury is severe, otherwise they tend to weaken spinal stabilising system with the exception of traction belts (Disk Dr available in UK through Orthomedical Ltd). We have seen good results in patients with slipped disks who used these air belts. This type of traction belt is known to have good results in combination with core-stability exercises.

2. Different treatments maybe offered by your doctor, including osteopathy and physiotherapy and it is up to you to question and research all available options and recommendations. Just remember few basic rules: don’t exercise in pain, dont apply heat, don’t believe in magic cure treatments.

3. Remember, that disc bulge is often caused by long-standing spinal decay, which may build up totally un-noticed, therefore treatment plan has to be offered including all factors mentioned in this article.

4. Don’t let anybody treat you if they didn’t see your MRI or an X-ray, they may not understand the nature and severity of your problem.

5. If you ever had an MRI or an X-ray, keep the copy for future reference. In UK you have a legal right to full access to your health records including copies of the images of your spine. If they have lost it, they have to provide you with new MRI or X-ray procedure.