Non-Surgical vs Surgical Treatment for Herniated Disc Pain


One of the most wondrous things about the human body is its amazing ability to heal itself. Yet when many people experience severe low back pain caused by a herniated disc, they assume that nothing short of surgery can correct it. However, research has shown time and time again that at two and five years after diagnosis, there is little difference between patients who had surgery to correct lumbar disc herniation (LDH) and those who had conservative treatment.

Mounting Evidence for Conservative Treatment of LDH

Since surgery is expensive and carries many inherent risks, it seems logical to explore non-surgical alternatives to treat herniated disc pain. In fact, there is evidence that patients who receive conservative, non-surgical treatment often resolve their back pain within a matter of weeks. We now know that in response to conservative treatment, herniated discs are frequently resorbed spontaneously, although little is know about the exact mechanisms by which resorption takes place.

In a 2017 literature review, Zhong et al. set out to explore the incidence of spontaneous lumbar disc resorption after conservative treatment of LDH, as reflected by MRI and CT scans. The research team reviewed results from 11 cohort studies, and found that the overall average incidence of spontaneous resorption after LDH was 66.66%, and in the UK alone it was as high as 82.94%. Those statistic holds promise for the large numbers of LDH sufferers who want effective relief without the risk and expense of surgery.

Causes of LDH

When coming to grips with LDH, it is important to understand its underlying causes, particularly because there is a relatively high rate of recurrence. While many practitioners will treat the symptoms of LDH, they often neglect to follow through with rehabilitative measures to prevent a relapse. Yet the cause of disc herniation is often behavioral or postural in nature, and can therefore be eliminated with proper intervention.

Some common causes of LDH include:

  • Age: LDH is most prevalent in people aged 35-50
  • Gender: Men are more likely to have LDH that women
  • Occupation: Certain types of manual labor put you at higher risk for LDH, as does driving and jobs that require long hours of sitting
  • Obesity: Excess body weight can add extra load to the lumbar spine
  • Sedentary lifestyle: Being out of shape can increase your overall risk of injury, especially to the spine
  • Smoking: Cigarette smoking interferes with blood flow to spinal discs, which speeds up disc degeneration and slows healing
  • Genetics: Some people have a family history of LDH

Conservative Treatment Options for LDH

There are a variety of conservative treatment methods for addressing herniated disc pain. Some common treatment strategies include:

  • Physical therapy
  • Exercise and gentle stretching to help relieve pressure on the nerve root
  • Ice and heat therapy for pain relief
  • Manual therapies like spinal manipulation
  • NSAIDs such as ibuprofen or naproxen
  • Education and retraining for lifting techniques
  • Postural retraining

Herniated Disc Treatment in NYC

The back pain specialists at NYDNRehab are dedicated to not only relieving your pain, but to identifying and correcting the underlying causes. Some treatment methods used at NYDNRehab include DNS (dynamic neuromuscular stabilization), ISM (integrated system model approach), clinical Pilates, postural retraining, myofascial release, acupuncture and other approaches, based on the individual needs of the patient. If you are suffering from low back pain, contact NYDNRehab today, and get the treatment you need to get back to the activities you love.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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