- Go to physical therapy and ensure that you give it enough time (at least 6 months)
- If physical therapy doesn’t work and you have progressively worsening symptoms that are making your legs or arms go numb associated with muscle weakness then you may be a candidate for surgery or injections.
- Other methods like massage, acupuncture, etc, may be helpful to reduce symptoms and can be a nice complement to physical therapy.
In the remainder of this article, I will go into detail about what I would do if I had a herniated disc with pain that was still present after one year.
I hope that this will give you insight into how I make my clinical decisions with patients.
Will You Need Surgery For A Herniated Disc That Still Hurts After A Year?
It is possible that you could need surgery if you continue to have pain that is still related to the disc herniation.
This pain usually has this presentation:
- Sharp and shooting that goes down the leg
- Numbness and tingling
- Weakness (in more extreme cases)
- Bowel and bladder changes (in cauda equina syndrome)
If you notice that all of the symptoms above are getting worse you should see your doctor immediately.
The symptoms to look out for primarily are weakness and bowel and bladder changes. If those are worsening rapidly you likely have significant compression of nerves that you’ll want to get addressed immediately to prevent and longstanding or permanent damage.
If You Decide To Continue Treating It Without Surgery, What Should You Do?
If you aren’t experiencing any of the nerve-related symptoms and they aren’t worsening but rather it’s a dull and achy, sometimes sharp pain that is more centralized to your back, only on one side (or both), or goes into your glute, you can likely improve it without surgery.
Most people derive the best benefit from a combination of exercise and manual therapy.
Exercises could include many different types and it will just depend on what feels best for you. Nothing is off the table, even bending forward. In fact, I had one patient who did heavy deadlifts and bent forward a bunch for rehab with a herniated disc and he actually felt better!
Here are a few different exercises to try out that you can look up on youtube:
- Childs pose
- Bird dog
- Side plank
- Seated forward spinal flexion and reach
- Standing backward bend
- Etc etc
As you can see there are several different exercises you can try to get things moving in the right direction.
Not every herniated disc requires a bunch of exercises to heal, and also, not every disc requires manual therapy to heal.
Each person is going to be unique in their own recovery.
My personal bias is to start with one exercise at a time or one activity at a time, walking for example, test that for a few days or weeks, and then move on to the next thing if there is no change, or if things have gotten worse.
It’s also important to note that most people only start doing something about a problem once it’s become so bad they can no longer ignore it.
It’s of course better to address a problem before it becomes a massive issue however life is so complicated and busy already that people have a hard time focusing on things that are not on the immediate horizon.
Can The Herniated Disc Pain Last Forever?
It is possible for the pain to last “forever,” as in it never goes away. This is less likely to happen if you address it early and work with a physical therapist and your doctor to manage symptoms in the beginning.
As I shared above, too many people just wait for things to get worse and worse before dealing with it. Sometimes it’s best to address it early and prevent it from getting significantly worse (if possible).
It’s not always possible to prevent it from getting worse and some people will need to get a surgical procedure. The good news is that for most young, healthy people that I have worked with who had a disc herniation and then had surgery, they did very well after the surgery.
The key is making sure you are the proper candidate for surgery!
What Happens If A Herniated Disc Doesn’t Heal?
If the disc herniation doesn’t heal, it’s ok. In many cases where the herniation was symptomatic, the herniation may still be present on a subsequent MRI finding but, you may have no pain. This is a fairly common scenario.
Does A Larger Hernation Heal Better Than A Smaller One?
Yes, a larger herniation has been shown to resorb more readily than a smaller one. It’s not definitively known why this occurs however it is hypothesized that the larger herniation causes more inflammatory chemicals to surround the area. Macrophages and other cells in your body go to the site of the herniation and then begin “cleaning the area,” up. Since it’s a larger herniation it signals more of these and you have a more remarkable change in your imaging findings.
Is A Large Disc Herniation More Painful Than A Small Disc Herniation?
Usually, a larger disc herniation will be more painful than a small disc herniation. Much of this is just related to physics. If you have a larger herniation, more of the nerve will be compressed, if more of the nerve is compressed, theoretically you will have more symptoms.
It’s not known why some people can show severe nerve compression from a disc herniation and have no symptoms while others do not.
I suppose it’s possible that some people have nerves that are less responsive to compression than others, or that they’ve experienced some sort of adaption.
In any case, most people with significant compression due to a herniation will have pain. This is different than a disc bulge. Most humans have disc bulges and have no idea.
Also, having a disc bulge doesn’t mean you are at a higher risk of having a herniation.
Thank you for reading and if you have had a herniated disc for greater than 2 years, check out this article!