Slipped disc - Treatment 

Treating a slipped disc 

Lumbar surgery

Around half of us have back pain at some time in our lives. It often heals in time, but for some people the pain doesn't go away and surgery is the only answer. Watch this video to see how lumbar surgery can relieve pressure on the spinal nerves in the lower back.

Media last reviewed: 11/03/2014

Next review due: 11/03/2016

Exercises for sciatica: slipped disc

In this video a physiotherapist demonstrates gentle exercises for a herniated or slipped disc, a form of sciatica

In most cases, a slipped disc will slowly improve with rest, gentle exercise and medication. It can take up to four to six weeks to recover from a slipped disc.

Keeping active

It is very important that you keep active if you have a slipped disc.

Initially, it may be difficult to move around. If you are in severe pain, you may need to rest completely for the first couple of days.

However, after this period, you should start to move around as soon as you can. This will keep your back mobile and speed up your recovery.

You should ensure any exercise you do is gentle and does not put a strain on your back. Swimming is an ideal form of exercise because the water supports your eight and it puts very little strain on your joints.

Movement and exercise will also help strengthen any muscles that have become weak. Avoid any activities that could aggravate your condition, such as those that involve:

  • reaching
  • lifting
  • sitting for a prolonged period of time

You may find your pain increases at first when you start moving around.

This is normal and doesn't mean you are causing more damage to the spine or the slipped disc. This pain should settle quite quickly, allowing you to gradually increase the amount of exercise you are doing.

Physiotherapy

As part of your treatment programme, you may be referred to a physiotherapist. Physiotherapists are healthcare professionals who use physical methods, such as massage and manipulation.

A physiotherapist will be able to draw up an individually tailored exercise plan for you. This will keep you active, minimise pain and help prevent any further damage to your back.

Read more about physiotherapy.

Osteopathy and chiropractic

Some people choose to try osteopathy or see a chiropractor. Both types of therapy are used to treat back pain.

Osteopathy and chiropractic are not widely available on the NHS and you will usually have to pay for treatment privately.

Read more about osteopathy and chiropractic.

Medication

You may be prescribed a number of different medicines to help ease any painful symptoms of a slipped disc. These are outlined below. 

Analgesics

Analgesics are painkillers, such as paracetamol. They are available over the counter from pharmacies or on prescription.

Some people worry that taking painkillers may mask something more serious going on with their back.

This isn't true – painkillers taken regularly can help you get back to moving around, which will help make the pain better more quickly.

Always read the manufacturer's instructions before using analgesics.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofendiclofenac and naproxen, can help relieve pain and reduce any inflammation.

NSAIDs may not be suitable for people with hypertension (high blood pressure), asthmaheart failure, or kidney failure. Again, you should always read the manufacturer's instructions before use.

Read more about NSAIDs.

Codeine

Codeine is a stronger painkiller that is often taken in combination with paracetamol. It is usually only prescribed when other painkillers and NSAIDs have not worked.

Codeine can cause side effects such as constipation.

Corticosteroids

Corticosteroids are a type of medication that contain hormones (powerful chemicals that have a wide range of effects on your body). They may be injected into your lower spine to help reduce inflammation.

Read more about corticosteroids.

Muscle relaxants

You may be prescribed a muscle relaxant, such as diazepam, to take for a few days if your back or leg muscles are very tense.

Surgery

Surgery is required in about 1 in 10 cases of a slipped disc. It may be considered if:

  • there is evidence of severe nerve compression
  • your symptoms have not improved using other treatments
  • you are having difficulty standing or walking
  • you have very severe symptoms, such as progressive muscle weakness or altered bladder function

The aim of surgery is to cut away the piece of the disc that bulges out. This is known as a discectomy and it can be done in several ways.

Some of these procedures are explained in more detail below.

Open discectomy

An open discectomy is a procedure to remove part or all of the slipped disc. It will be carried out under anaesthetic (painkilling medication).

An incision is made in your spine and the disc is removed. For more information about this type of surgery, see the lumbar decompressive surgery topic.

Prosthetic intervertebral disc replacement

Prosthetic intervertebral disc replacement involves having a prosthetic (artificial) disc inserted into your back to replace the slipped disc.

An incision is made in your spine and the damaged disc is either partially or completely removed. A replacement disc is then inserted into the space.

One study found 87% of people felt their quality of life had improved three months after having a prosthetic intervertebral disc replacement. However, as the procedure is still quite new, long-term results are not yet available.

The National Institute for Health and Care Excellence (NICE) has published guidance on the use of artificial discs.

Endoscopic laser discectomy

During endoscopic laser surgery, a small incision will be made to gain access to the spine and an endoscope will be used to view the disc. An endoscope is a long, thin, flexible tube with a light and camera at one end.

The procedure is performed under either local anaesthetic or general anaesthetic, depending on where in your spine your slipped disc is. 

After the incision has been made, the compressed nerve causing you pain will be released and part of your disc will be removed with a laser.

A study found 67% of people could move around more easily six months after having endoscopic laser surgery, and around 30% needed less pain-relieving medication. Around 2-4% of people needed another operation.

Another study reported that, on average, people returned to work seven weeks after having endoscopic laser surgery. 

As endoscopic laser surgery is still a relatively new procedure, it is often only performed with special arrangements – for example, as part of a clinical trial (a type of medical research that tests one type of treatment against another). 

The National Institute for Health and Care Excellence (NICE) has published guidance on the use of laser treatment for damaged discs.

Recovery

For most people with severe symptoms, back surgery helps ease their symptoms.

You will usually be able to return to work after two to six weeks. However, the surgery does not work for everyone, and you may need to have further operations and treatment if the initial surgery is not effective.

Possible complications resulting from surgery may include:

  • infection
  • nerve injury and paralysis
  • haemorrhage (severe bleeding)
  • temporary dysaesthesia (impaired sense – for example, losing the sense of touch)

Before having surgery, you should ask your surgeon about their experience in doing the surgery, and their success and complication rates.

They will advise whether you are at risk of developing complications and how long it will take to recover. You may be given a rehabilitation programme to follow.

One review of a number of studies found exercise programmes that started four to six weeks after surgery on the lumbar spine (lower back) helped decrease pain and improve a person's ability to function.

Read more about the risks of lumbar decompressive surgery and recovering from lumbar decompressive surgery.

Page last reviewed: 01/08/2014

Next review due: 01/08/2016

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Comments

The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Greenfingers68 said on 10 October 2014

I have a herniated disc L3/4 and have seen 3 consultants, had 4 MRI scans and an epidural injection in the last 10 months. My problem was probably caused by a car accident I had, my first 2 consultants wouldn't stick their neck out and confirm that due to litigation consequences and instead thought I had Myelitis, totally missing the bulging disc on my MRI scan. I have had tingling/frozen toes for 10 months now, and my right leg feels numb with varying degrees of pain. My back feels much better thanks to my chiropractor and I have started Pilates in the hope that will help strengthen my core muscles. Failing that my only option is surgery and all because someone wasn't paying attention & drove into the back of my car.

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Ladywriter1968 said on 19 August 2014

Thanks for info from others here about chiropractors, I did not know that, I thought they were qualified, wow that is scary, I am in pain from trap nerve. seeing my gp tomorrow, went hosp the doc there gave me pain killers, but felt it was rushed. Had back pain years but got on with it, but its come on real bad again the other day I could not walk or move, feel like a person who is 100. I am in my 40s.

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User709288 said on 03 September 2012

Anima you are bang on right I was treated by a chiropractor who was so heavy handed that he collapsed two of my discs and I have been in pain every since, I would say steer clear of chiropractors I know for a fact the one that injured my spine was out to make has much money as possible and to my mind was corrupt also they are not regulated enough.

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ruby41 said on 04 April 2011

Anima, it is unusual to have Chiropractor work on the NHS however this is not acroos all NHS trust and therefore some patients may get support from a NHS Chiropractor. As for training all Chiropractors have to be registered by the General Chiropractic Council the Proffesional body setup by government to regulate the profession. It is illegal to use the title of Chiropractor without completing a degree recognised by the GCC for registration. So a Chiropractor will have undertaken substantial levels of training to ofer patients help and support.

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anima said on 05 March 2011

Referred to a chiropractor? By the NHS? Really? Please do correct me if I'm wrong but I was under the impression that chiropractors need to have had no proper medical training in order to open up shop, and that there is little / no clinical evidence that their treatment method has any benefits. The way I see it, anyone manipulating my spine had better been through proper medical training. If a doctor advised me to go see a chiropractor I'd seek a new doctor.

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