Extracted from www.spine-dr.com

If the disc is herniated it can be protruded/extended or sequestered. This is basically when the tough annulus part of the disc has gotten a tear or blowout in it, and some of the inside of the nucleus has come out. This is Herniated Nucleus Pulposus (HNP). Even still, when the nucleus material (which is kind of like toothpaste) comes out, it too tends to shrink down with time. (Have you ever squeezed out toothpaste and left it on the sink overnight? The next morning it has shrunk as the water dried out of it.) If the herniated disc material shrinks enough, the squeezing and irritation to the nerve root gets less and the nutrition and blood supply return to the nerve root, and it stops complaining. The pain, numbness, and weakness goes away. How do you get this to happen?

1) Stay active

Think of it this way. Your heart is a pump. It pumps the blood through the arteries to the nerves. But, as the blood passes through, it needs to enter the veins. The veins have very little pressure, about 5cm of water. What pumps the veins are the muscles. When the muscles contract they pump the blood through the nerve and back to the heart. If you stay inactive, sit still, stand still, or lay in bed, you are stopping the muscle pump, and just when you need it most. By doing Aerobic exercises and getting the pump going, you get that blood to the pinched nerve and the nutrition to the discs so they can heal. If you are inactive, not only do you stop the muscle pump, but also you begin to get weak. Estimates are that you lose 1% of your muscle strength for each day of inactivity. How many of us can afford to lose 5-20% of our strength? But this is the effect of 5-20 days of bed rest. Bed rest also effects other body functions, such as the ability to think, see, and hear clearly. Inactivity leads to all these bad side effects, and begins to perpetuate the problem. Estimates are that when we are forty-five years old we need 45% of our normal strength/power to get through a normal day, but by age seventy-five, we need 90%. So the effects of inactivity/bed rest are worsened with age. One day of bed rest is okay while you begin other parts of the program (i.e. ice, anti-inflammatories), but any more leads to problems.

2) Use Ice

If we had a medicine that would make blood supply/nutrition go to a specific place in the body, we would give it to you. We don't. Most anti-inflammatories work systematically, and all have side effects. Ice will increase the blood flow to the deep structures (nerves, muscles, and ligaments), and help get the swelling down. Both ways help to relieve pain and improve the healing. The optimum is to use and ice pack twenty to twenty-five minutes and no more. This can be repeated every two hours. Watch your skin so that you don't get frostbite, but with the new form of packaged reusable soft ice this rarely occurs. Heat does not work. While it makes it feel better for a while by relaxing the muscles, it also makes the blood supply come to the skin and takes it away from the deep structures. This perpetuates the problem.

3) Medications

Anti-inflammatories: Aspirin, Ibuprofen, Aleve (not Tylenol)

These medicines help to decrease the inflammation if you can get blood flow to the effected area. These need to be taken regularly and at advised dosages. Some people respond like a miracle to some medication, others do not. So, if an anti-inflammatory isn't working, it is often useful to try another. Contact your physician. Many people get side effects form antiinflamitories: Upset stomach, bleeding, eye, kidney, and other effects, so you certainly should use them under the care of a physician. Antiinflamitories are better at keeping the swelling down than at getting the swelling down. So, start its use early, and it is more effective. Once the pain is gone, it is rarely necessary or prudent to continue use of the medication.

Muscle Relaxants: Often useful for a brief time, but usually cause sleepiness and depression. You should not operate a car while using them. They do not relax the muscles in a direct way, but have a more central effect. They are especially useful to get some relief for sleeping at night. Muscle relaxants can be habit forming.

Narcotics: Usually are not very useful. When you take a narcotic, you basically block the pain messages, but you are not improving the blood flow or strengthening the muscle. It can be moderately useful if it allows you to undertake an exercise program to improve blood flow/nutrition and muscle strength. Remember, they are allowing you to ignore the pain signal/warning, so they allow you to do things that are potentially damaging, such as sitting or lying too long in one position. They also cause sleepiness, depression, constipation, upset stomach, and are habit forming. They are not useful for chronic pain because of the above cautions, and because even the good effects diminish as the bad ones increase.

Chiropractic: Can be useful if it decreases the muscle spasm or tightness of the muscle. If you are then able to undertake an active exercise program and function improving the blood flow,this is very useful. Basically, try it. If you feel improvement, it is useful to have repeated manipulations. However, it does not make the disc slip back in. In the long run it only works by improving blood flow. If a manipulation increases the pain it may be actually pinching the nerve more. If numbness or weakness worsens, you need to try something else.

Massage: As with Chiropractic, can temporarily decrease muscle spasm and increase blood flow, but will only be effective if you start the exercise program and continue the blood flow.

PT/Exam: Aerobic Lumbar Stability. The idea is to improve the muscle pump without pinching the nerve by bending or twisting the spine.

Spinal Stenosi s/Pseudo-Cl audi cation Muscle Cramps in the Legs with Activity, Relieved by Squatting or Leaning on a Shopping Cart

As you try to walk you get a pain or cramping in your buttock or posterior thigh or calf that gets better if you stop, squat, or lean on a cart. This arises because the cross section area inside the spinal canal has gotten smaller. This can come about because of a herniated disc, but frequently arises because the joints of the spine have enlarged and grown inwards, taking away the space, squeezing the nerves, and therefore slowing the nutrients or blood flow to the nerve. Frequently, there is no back pain simply because as the joints enlarge, they sort of naturally stabilize the spine and fuse it. The pain arises because the joints did this slowly, often over the course of years, enlarging the joint and growing into the spinal canal, taking away space for the nerve and causing resistance to blood flow. This can effect you suddenly just like the straw that broke the camel's back, the squeezing is too much to get the blood flow/nutrients to the nerve and they begin to complain and not work. When you rest enough blood flow gets to the nerves so you can walk a little farther. But when you try to walk they just can't got enough blood flow so they begin to hurt at about the same distance. This becomes a worsening problem because if you can't walk you begin to lose strength in the back muscles, which stresses the joints more and makes them enlarge further, causing more compression on the nerves and less blood flow. You can't stay healthy if you can't stay healthy. Therefore, early treatment with ice, anti-inflammatories, physical therapy, chiropractic, and massage can help for a while, but if the joint is squeezing the nerve and limiting the blood flow, the symptoms will become more frequent and more serious. Once the joints have enlarged, they can either stay that large or get bigger, but they do not tend to get smaller without surgical intervention.

The enlargement of the joints is caused by Osteoarthritis. This is the same type of arthritis that causes the joints of people's hands to enlarge. Many people have very enlarged finger joints without much pain, only symptoms of stiffness. The same process of stiffening up your back does not lead to pain unless you continue to try to bend through. If the joints grow outwards, you are okay. If the joints grow inwards, you only get into trouble when they begin to limit blood flow and squeeze the nerves. This can be made much worse if you continue to bend, inflame and stress the joints, causing them to enlarge further. Fighting the natural tendency of your back to stabilize itself can only lead to further problems.

When is Surgery Necessary?

Sometimes surgery is necessary to enlarge the spinal canal and remove the part of the joint that has grown inwards. The surgery is particularly successful if the spine has basically stabilized itself by shrinking the disc to 60% water, and enlarging the joints outward. But, how do you know when it is appropriate to go to the Surgical Option?

As we said earlier there are many menu options. At least some of these should be tried before surgical intervention. Most people do respond to one or more of these options. I basically ask patients on return appointments if they are getting better, staying the same or getting worse. If they are getting better we are obviously going the right direction. If they are getting worse or staying the same we need to try something else. If none of the easy things are working and the person is still experiencing significant limitations then we may consider surgery. Remember, you cannot stay health if you cannot stay active. For every day you are not walking at least 10 minutes 3 times a day you are losing strength. Estimates are that while you lose strength at the rate of 1% per day, you can only gain it back at the rate of 1 % per week. This means that somewhere relatively early on it is important to get to the point where you have resumed at least some level of exercise. If you are unable to get active Surgery should be considered.

It is important to understand that surgery does not remove your spine and replace it with a new one. Surgery is always a patching up type of intervention. It often improves the anatomic problem by removing what is pinching the nerve or limiting the bloodflow,but it does not make you normal. It allows you to resume activity and improve the blood supply so your body can heal and get back towards normal. Surgery is a 90:10 deal. It can do about 10% but you still need to do your 90%. It is not like carpentry where you can go in and connect two things and you are done. It's more like gardening. Surgery can prepare the area but it is the daily activity that restores the blood flow and restrengthens the muscles. Just like gardening it takes a season to get the results you want. If you plant your garden, but never water it or care for it or worse yet poison it (by smoking) you wouldn't expect much of a crop. However, if you take care of it everyday at the end of a season you could expect a prize-winning result. As I said earlier, you can only regain strength at the rate of 1 % per week and that is if you exercise at least 5 days per week. I believe that while you may feel pretty good after 6-8 weeks it will really be 100 weeks until you are back to 100% of what you should be for your age. The real problem is that at age 45 it only takes 45% of your strength to get through a normal day. Therefore, you may feel O.K. as you get to that level but given that you now have a patched-up back you need to aim for that 100% level to keep your back well protected to avoid problems as your increasing age makes increasing demands of the percentage of your strength it takes to function normally.

Other information can be found at:

Bulging Disc
Intervertabral Discs
Prolapsed Disc
Spine Dr.com

Protruded, herniated disc & nerve injury (Asia MedicineNet.com)
Disc herniation treatment? (Asia MedicineNet.com)
Herniated disc symptoms and causes (Asia MedicineNet.com)
Herniated disc L5,S1, right root damage (Asia MedicineNet.com)
Bulging Discs, cause, disc herniation (Asia MedicineNet.com)