In most cases, a herniated disk (with or without sciatica) will respond to conservative treatment. This may include limited bed rest (generally no more than a day or two); warm baths; heating pads; and medications, such as aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants. Some doctors prescribe oral corticosteroids, although the benefits of this treatment are uncertain.
Because prolonged inactivity can promote deconditioning, your doctor may suggest that you start an exercise regimen early. Even if you begin your treatment with one to two days of bed rest, you may still be asked to complete two or three 20-minute periods of walking each day. After one to two weeks, you usually can begin a more strenuous program of daily aerobic exercises (walking, biking, swimming) and physical therapy. Other types of conservative treatment that have been helpful to some people include ultrasound, massage and acupuncture.
When these more conservative measures don't work, epidural steroid injections may be helpful. This involves the careful injection of a long-acting steroid and an anesthetic into the space near the spinal cord and compressed nerves. These injections are guided by X-rays or CT scanning so that the needle can be placed precisely in the proper location. If you have lost bowel or bladder control, if you have evidence of progressive nerve damage, or if you have unrelenting pain that persists despite weeks of conservative treatment, more aggressive treatment may be needed, including surgery. In most cases, this means removing the disk (diskectomy), which may require major surgery. Increasingly, though, a less invasive operation is done in which the herniated disk is removed through a hollow tube inserted through a tiny incision.
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