Physical Therapy for Herniated Disc Pain

Each year, about 3 million people experience a herniated disc, according to a study published in the Journal of Orthopaedic Science. If you have this condition, you know how much it can impact your daily life. Fortunately, there are ways to manage herniated disc pain and help your back heal. Physical therapy for herniated disc pain is a great option to make you feel better.

“Herniated discs occur when the soft center of a spinal disc pushes out through a tear in the outer layer, causing inflammation and lower back pain. The herniated disc can sometimes press on nearby nerves and cause pain traveling down the leg,” explains Edward Wei, MD, a Mass General Brigham interventional physiatrist who cares for patients at Spaulding Rehabilitation. “Physical therapy can help relieve the pain and prevent future injuries.”

Dr. Wei specializes in nonsurgical treatment options for back pain and works with patients to develop personalized treatment plans. In this article, he shares his top three tips on how to manage herniated disc pain and get back to living your life.

Tip #1: Try physical therapy to manage herniated disc pain. 

For many people, physical therapy is the first treatment option doctors recommend for herniated discs. Physical therapy for a herniated disc focuses on relieving pain and strengthening the muscles that support your back. A physical therapist creates a plan that is right for you based on your pain level and other symptoms.

Common physical therapy exercises for herniated disc pain may include:

• Stretching: Gentle stretches can help improve flexibility and reduce stiffness. 
• Core strengthening: Strengthening the muscles in your abdomen, around your spine, pelvic floor, and diaphragm help take pressure off your spine.
• Posture exercises: Learning to stand and sit properly can reduce pressure on your discs and prevent future problems.
• Strength training: This helps you build back muscles to support your spine. 
• Endurance training: This improves overall strength and reduces your chance of reinjury.

"Physical therapy is personalized to your body’s needs and can help reduce pain and prevent further injury,” says Dr. Wei. “You’ll also have homework—your physical therapist will give you stretches and exercises to do at home to continue your recovery.”

Tip #2: Give your back a break to rest after injury.

While it’s important to stay active, it’s also essential to let your back rest for a few days after the initial injury. However, Dr. Wei recommends getting back to light activity soon afterward, as movement helps your discs heal and absorb nutrients. He advises avoiding heavy lifting and activities that involve bending or twisting until your back has improved.

Recovery time depends on your specific condition and how well you follow your physical therapy plan. Most people begin to see improvement within a few weeks of starting PT. Full recovery may take several months, especially if the herniated disc has caused severe pain or nerve damage. Back pain takes time to heal, and it’s important to remember that recovery is not a race. It may take up to 6 months to feel like yourself again.

While recovery may take time, many people can manage herniated disc pain successfully without surgery by sticking to their physical therapy plan.

Tip #3: Consider other therapies and treatments if needed.

Dr. Wei’s third tip is to consider additional therapies and treatments if physical therapy alone is not enough. He explains that while physical therapy is often the first step, other therapies and treatment also can help relieve herniated disc pain, these can often be done in conjunction with each other. These include:

• Over-the-counter anti-inflammatory medications like ibuprofen or naproxen
• Steroid injections for pain resistant to physical therapy and oral medications
• Acupuncture or massage therapy to help relax muscles and relieve pain
• Yoga to improve flexibility and strengthen your back
• Electrical stimulation and ultrasound to relieve pain and muscle spasms
• Weight loss to help reduce pressure on your spine over the long term

It's important to talk to your doctor about which therapies and treatments are right for you.

Home management strategies

In addition to physical therapy and other treatments, Dr. Wei recommends the following strategies to help relieve herniated disc pain at home:

• Reduce bending over or twisting your lower back. This will help reduce the stress on the discs in your lower back. Protect your spine by keeping your movements controlled and avoiding unnecessary strain while your pain is flared up.
• Avoid sitting too long. Sitting places increased stress on the discs in the lower back. Take breaks often to get up and move around, and when you sit, make sure not to slouch and try using lumbar support.
• Get out of activities that involve bending. Feel free to skip tasks like laundry, vacuuming, gardening, and shoveling, as they involve a lot of bending.

Dr. Wei says that as you progress with physical therapy and get stronger, you can return to some activities. The goal is to help you get back to your normal routine with better back health and strength.

When should you consider surgical treatment for herniated disc pain?

In some cases, medications, physical therapy, and spine injections for herniated disc pain might not be enough. If you don’t start feeling better after several weeks of treatment, or if you experience severe symptoms like leg weakness, severe numbness, or loss of bowel and bladder control, your doctor may recommend surgical treatment for herniated disc pain, which can help relieve pressure on the affected nerves.

There are different types of surgery that may be used for treating herniated discs, including:

• Microdiscectomy: This is a minimally invasive procedure where a small incision is made in your lower back to remove the herniated part of the disc and any loose fragments. It requires less disruption to the muscles and tissues around the spine.
• Lumbar fusion: This is a surgery that often involves connecting two or more bones in the lower back to reduce motion across these bones.

While surgery can be effective, it’s usually considered only after trying nonsurgical options like physical therapy, medications, and spine injections.

Managing herniated disc pain with the right treatment

Managing herniated disc pain often starts with physical therapy. By strengthening your muscles and learning how to protect your spine, you can reduce pain and prevent future problems. If your symptoms don’t improve with physical therapy, surgical treatment for herniated disc pain may be an option. Working together with your doctor, you can find the treatment that’s right for you.