My husband has a herniated disc in lower back (I think L5). He has been in pain for about 6 months. Physical Therapy did not help. He had two of the three scheduled steroid injections and he actually got worse after the third. Right now he is on bed rest. He takes Flexaril, Hydrocodine, Tramadol and an antiflammitory (don’t remember which one). It just seems to keep getting worse.

Without seeing him clinically, it’s difficult and dangerous to give him specific treatment advice. What is also tricky is the term "herniated disc." Radiologists and other medical practicioners commonly use this term haphazardly. In it’s true sense, a herniated disc differs from that of a "bulge" or a "protrusion" in that in a herniation, the wall of the annulus (the outer layer of the disc) remains intact, but it is incompetent. This means that the material that has been displaced in the disc is unable to be restored to a normalized position. The clinical presentation is typically one that pain (and possibly numbness and tingling) usually radiates to the foot, and is constant. Some relief may occur with lying down or specific exercises, but the second the patient returns the standing, the symptoms return. In the incompetent annulus, recovery with physical therapy…whether manual therapy, traction, direction specific exercises, or "stabilization" exercises is a moot point. Many of these patients will get better with time as the disc firms up again, or they may need surgery.

The fact that you say he was worse after injection is worrisome. Was it done under flouroscopic guidance? If not, I’ve seen a handful of cases where people were worse after injection done in the physician’s office. Typcially, these patients will, after injection, have a progression of their leg pain, which may have been intermittent before, but is now constant and worse than the back pain. If this is the case, this correlates highly with an extruded fragment…presumably because the injection went into the disc instead of the epidural space and subsequently ruptured the disc. Not a whole lot can be done in these cases other than surgery or time.

However, in cases where the disc is only protruding or bulging, these frequently respond to physical therapy. Yet, I would have expected a much greater recovery at this point…should have occured in days to weeks, not months. The next thing to discuss is that the quality of physical therapy varies greatly between practicioner. Having spent literally hundreds of hours of continuing education and residency in spine care, the best advice I can give you, as opposed to specific exercises is to have your husband follow up with a physical therapist who is at least certified, but preferrably a diplomate in Mechanical Diagnosis and Therapy. If he did not receive care from such a PT, I would HIGHLY recommend it, as an easy and simple solution may have been grossly overlooked. Or, if it does appear to be an incompetent annulus or an extruded fragement, this becomes very apparent during assessment, and they will relay this information to you.

Find a certified or Diplomate in MDT at: www.mckenziemdt.org

Best wishes

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