Treatment

From the existent literature, Hahne et al. (2010) concluded that on long term, microdiscectomy does not provide more benefits than advice. Stabilization exercises are better than no treatment, manipulation better than sham manipulation (when the annulus is intact), and mechanical traction should be added to medication and electrotherapy. There is no difference between traction, laser and ultrasound (Hahne et al. 2010) (moderate evidence).

According to Eck et al. (1999) most patients respond well to conservative treatment, with the McKenzie exercise program being one of the most beneficial ones. The first six weeks of symptoms onset, symptomatic treatment should be provided. Conservative treatment, like advice, exercise therapy, and limited bed rest, should be carefully designed and adjusted to the individual patient to provide the greatest benefit. Explanations about the condition and its natural history, advice on methods of relieving the symptoms and potential forms of treatment should be given. The individual limitations and goals, as well as the optimal strategy should be determined for every patient (Eck et al. 1999).

Obese people should try to lose weight during the therapy process, as Albert et al. (2009) found that obese patients benefit less from treatment of lumbar disc herniation as nonobese patients.

Patient History

Assessment