Treatment for Herniated Disc & Sciatica: The Holistic Approach

Managing pain from a herniated disc and sciatica involves identifying the most effective treatment options.

While 70% to 80% of people will experience lower back pain at some point in their lives¹, most can avoid surgery though the use of non-surgical methods such as physical therapy, medications, or heat and cold therapy.

This article explores various treatments for herniated discs and sciatica pain, offering a holistic approach that addresses both the psychological and physical aspects of the conditions.

What causes a herniated disc?

Over time, the outer layer of a spinal disc can weaken and tear. This allows the inner gel-like core to push out and press on or irritate nearby spinal nerves. Factors like weakening ligaments, injuries, and disc degeneration can contribute to this condition.

As we age, our intervertebral discs naturally wear down. This makes them more likely to get damaged even during regular activities. There is also evidence that some people are genetically more likely to develop herniated discs.

Many times, a herniated disc does not cause any symptoms and can heal on its own without surgery. However, in some cases, the disc can press on spinal nerves. If the gel center of the disc touches these nerves, it can cause irritation and pain.

What are the causes of sciatica?

Sciatica is pain that travels down the sciatic nerve. The nerve starts in the back goes through your hips and buttocks, and down the backs of the legs to the knees. This pain is often caused by a herniated disc.

Chronic sciatica often involves a secondary condition called central sensitization. This is when your central nervous system – your brain and spinal cord – has become more sensitive to stimuli, and causes you to experience heighten pain, including pain in situations that wouldn't normally hurt. This can make even simple activities difficult².

Sciatica can cause various symptoms, including:

• leg pain
• loss of sensation
• prickling sensations
• discomfort that starts in the buttock and travels down the leg, sometimes reaching the foot.

When herniated discs occur in the lower back, they can cause sciatic nerve pain. This pain is often sharp, like an electric shock. It can get worse when you stand up, walk, or sit down.

How to treat herniated disc & sciatica pain

Treating pain caused by a herniated disc and sciatica requires a comprehensive approach. You need to address both the physical and psychological aspects of your condition. This can be done through exercise, hot and cold therapy, and retraining your pain response with techniques like cognitive behavioral therapy.

Physical therapy

Physical therapy is a key treatment for herniated discs and sciatica. It involves special exercises and hands-on techniques. These methods help reduce pain and improve movement. They also protect the herniated disc from further damage.

Exercise and therapy can reduce stiffness in your back and help maintain flexibility. Working with an experienced physical therapist can greatly help your recovery. They provide expert guidance and support throughout your healing process.

Medication

To manage the pain in the short-term, simple pain relief can be very effective. Anti-inflammatory drugs, like ibuprofen, help reduce swelling and inflammation around the nerve roots. Analgesics, such as paracetamol, can help control pain levels. Muscle relaxants may also be used to ease any muscle spasms. However, over time medications tend to lose their effectiveness, so it's important to focus on long-term recovery methods, such as exercise.

Hot & cold therapy

Applying ice packs to the affected area can greatly reduce pain and swelling. Cold therapy works by numbing the nerve sensation and reducing inflammation. This is particularly helpful in the first few days after an injury or flare-up.

After a few days, you can switch to heat therapy. One study from 2021 found that using heat wraps can significantly lower pain levels in patients with lower back pain³.

Exercises

Engaging in exercises that boost your cardiovascular health, strengthen your body, and improve your flexibility can significantly alleviate your discomfort. The good news is that any form of movement is beneficial, so choose activities that you find enjoyable.

Stretching can be particularly effective in easing sciatica pain.

To target this discomfort effectively, consider incorporating the following stretches:

• hamstring stretches (the back of the thigh)
• piriformis muscle stretches (deep in the buttocks)
• knee-to-chest movements
• Child’s pose stretch
• Cat-Cow movement
• Cobra pose.

Additionally, some people find that therapeutic exercises based on the McKenzie method can help reduce their sciatica pain by relieving pressure on the sciatic nerve⁴. However, evidence for this method is weak, and it mostly seems to address back pain in the short term, but be less effective for long-term pain relief.

Nerve mobilization techniques

Exercises designed for nerve mobilization, including those known as nerve glides, focus on reducing tension in the sciatic nerve and improving its flexibility. These exercises are usually done while seated. They involve movements of the leg and ankle to help ease tension within the nerve.

Acupuncture

Acupuncture involves placing very thin needles into specific points on your body. Studies show this technique can be more effective than both lumbar traction and pain medications for treating pain from herniated discs⁵. It works by reducing inflammation and improving blood flow, which can help lessen the discomfort caused by sciatica related to a herniated disc.

Massage therapy

Massage therapy offers several benefits. It can improve blood circulation, reduce muscle spasms, and provide significant pain relief. Techniques like Swedish massage, myofascial release, and trigger point therapy are particularly effective for some people. They help to ease muscle stiffness and alleviate sciatic pain.

Retraining your pain

Sometimes, your pain might not actually be caused by a herniated disc. In a study, 90 people who had no symptoms at all underwent an MRI scan of their thoracic spine and it was found that 33 of them had a herniated disc but did not feel any pain⁶.

Your pain might be due to something called central sensitization. This is when your nervous system becomes overly sensitive to even small disturbances. Without this effect, your herniated disc might not cause you any problems.

To manage central sensitization, we can start by retraining your pain response. First, identify what makes your pain worse. It could be stress, negative thoughts, or certain activities. Once you know these triggers, you can work on changing them. This might include eating healthier, improving your sleep, staying active, or learning new ways to think about and respond to pain triggers. With time and practice, you can teach your brain to handle pain differently. This can make the pain less intense and more manageable in your life.

Sleep

Getting good sleep can be challenging when you're dealing with back pain, but it's crucial for recovery. Here are some tips to enhance your sleep and overall wellbeing:

• Maintain a consistent sleep schedule. Aim for eight hours of sleep and keep your bedtime and wake-up time the same each day.
• Limit naps to ensure they don't affect your nighttime sleep.
• Stay active during the day to help you fall asleep more easily at night.
• Establish a bedtime routine that avoids screens. This helps your mind unwind before sleep.
• Make your bedroom a peaceful environment. Keep it dark and quiet.
• Monitor your caffeine intake, especially in the afternoon and evening, as it can linger in your system and disrupt sleep.
• Avoid heavy meals and alcohol before bedtime, as they can interfere with your sleep.
• Incorporate relaxing activities outside of sleep. This can help you manage your symptoms and sleep more effectively.

When is surgery considered for a herniated disc?

As mentioned previously, a herniated disc often produces no symptoms at all, and most hernias heal themselves and do not need surgery. However, if your pain persists for more than 3 to 6 months, consult your doctor. Your doctor might discuss some of the following procedures with you.

Spinal fusion

Spinal fusion is a surgical procedure that fuses two or more spinal bones together to restore the height of intervertebral discs and promote bone healing. It is often performed in cases of persistent spinal instability and recurrent disc herniations, especially if a person is having neurological problems such as muscle paralysis and loss of bladder or bowel control. However, surgery is usually not a useful treatment for general pain management.

The recovery period can range from six weeks to six months, depending on individual age and overall health, or may continue to cause long-term issues.

Spinal fusions are a serious procedure and about 41% of people who have a spinal fusion surgery need to undergo further surgeries within three years, because of continued or increased pain, or other complications with the initial surgery. Around 80-90% of people still need to take strong medications for pain.

If your doctor suggests this to you, ask lots of questions about the success rate and possible complications. And make sure you ask, “What evidence exists to say that having this procedure will be better for me than not having it done?” If your doctor can’t answer you to your satisfaction, or you feel at all unsure, seek a second opinion from a different healthcare professional.

Artificial disc replacement

The artificial disc replacement procedure involves replacing the problematic disc with a synthetic one designed to mimic the movement of a natural spinal disc. The goal is to preserve spinal motion and stability and most individuals can expect to recover from this surgery within approximately three months.

When to seek medical attention

If your symptoms are new, or if you are experiencing persistent back pain due to disc herniation that does not improve with time or lifestyle changes, it is crucial to consult a healthcare provider.

At MoreGoodDays®, we have developed a program based on scientific research to help you manage chronic back pain. Our approach aims to clear up common misunderstandings about back pain. We focus on finding the root causes, identifying triggers, and teaching you how to change your body's response to pain using neuroplasticity principles.

We offer personalized coaching and various tools to help you manage pain, support your mental health, and improve your overall quality of life.

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