Every possible Non-Surgical option available

Most cervical herniated discs get better on their own over a period of 6 weeks. Even though I am a spine surgeon, I believe that it's best to avoid unnecessary surgery and allow the body to heal naturally. With that in mind, I have listed below nearly every possible non-surgical treatment being used to address herniated discs in the neck. The list starts with the most time-tested conservative treatments and goes on to list more alternative methods at the end.

Each treatment is defined and explained. Following that, in the "Here's The Bottom Line:" section, you will find my personal opinion about whether that treatment is worthwhile.

Remember, for those people with a herniated disc in the neck, sometimes there is a risk to NOT having surgery. If you are experiencing numbness, weakness, bowel/bladder changes, difficulty with coordination or trouble walking please see a spine specialist immediately.

If the pain is not going away and you just can't take it anymore then you may not want to take more time with these non-surgical treatments. In that case it's OK to move on and consider the surgical options. Everyone has their own individual tolerance for pain.

Medications: Just about everyone with a symptomatic herniated disc will try some type of medication. Listed below are the most common ones used.

• Over-the-counter analgesics, such as Tylenol®. They are appropriate for mild pain.
• NSAIDs (non-steroidal anti-inflammatory drugs), available both over-the-counter (Advil®, Aleve®, Motrin® or generic ibuprofen) or at prescription strength (Motrin® or Celebrex®) and many others. They are used after an injury when inflammation is suspected. Careful consideration is given to patients with impaired kidney function, liver disease, cardiac disease, or ulcers and reflux disease.
• Muscle relaxants that may be used after an injury when spasms are frequent and disabling.
• Topical pain medications, typically pain patches, gels or ointments, which deliver medicine directly through the skin to the bloodstream, traveling to the painful site.
• Oral steroids may be given immediately after an injury to rapidly reduce swelling. They are used only for a limited time as doses are gradually reduced. Steroids have many side effects and are not appropriate for long-term use. Generally when steroids are taken for a short period there are no long-term effects such as weight gain, hair loss and bone loss leading to osteoporosis. A common steroid to try for a herniated disc is called the "Medrol Dose Pack."
• Narcotic analgesics are used to treat extreme pain. These controlled substances require a special prescription and must be carefully monitored by a physician to limit the likelihood of addiction and adverse reactions. It's best to start with the least powerful and work your way up, if needed. Frequently used narcotics to treat herniated discs are Tylenol #3, Vicodin, Lortab or Hydrocodone.

Bottom Line: Based on your general medical condition and history of allergies, start with appropriate over-the-counter medications. If not better within a few days contact your physician for a prescription drug. I usually treat painful disc herniations with an anti-inflammatory and a narcotic. I find that the muscle relaxants usually don't help with this type of pain and just tend to make you more groggy and depressed than you already are. You are better off with a good gin and tonic! Use pain medications with caution.

Bed Rest: When treating a herniated disc there is no point to "strict bed rest" although taking it easy and letting the inflamed nerve settle down is appropriate treatment.

Bottom Line: If the pain is severe then taking few days for rest may be a good idea. Bed rest is not going to do anything to "treat" the disc herniation but it might make it easier for you to deal with the pain. As long as your work doesn't involve heavy lifting or use of your neck then there is really no reason to stay home, unless the pain is too severe to function at your job.

Physical Therapy: Physical therapy is one of the most popular and time-tested methods of treating a herniated disc. I prescribe it all the time and many patients find it to be helpful. You will need a doctor's prescription for this treatment. The therapist will teach you how to properly bend, lift, exercise, walk, and perform other activities. If you are experiencing weakness, they will instruct you in doing strengthening exercised to rehabilitate the muscles that are affected. You will also do stretching exercises to maintain flexibility of the spine and legs.

Bottom Line: Physical therapy is just about always one of the first treatments used for herniated discs. There is usually no down side to this treatment and it will keep you active and moving. It's helpful to work with a therapist who can objectively measure how you are improving. The downside with this therapy is that it doesn't actually do anything to treat the herniated disc inside the spine. Therapy is a supportive treatment only. If you are going to therapy and feeling better then it's great to continue. If you are feeling worse after each treatment session then consider informing your physician that you would like to stop.

Chiropractic: Here's how the chiropractor, Arn Strasser DC, describes chiropractic treatement of herniated discs: "First we should address a misconception. Chiropractors do not attempt to "pop a disc back in place" with forceful adjusting or manipulative techniques. There is a form of disc insult to a nerve with low back instability, often resulting in a quite dramatic lean of the low back with spasm that responds well to traditional chiropractic adjusting. However, all other disc conditions are treated in chiropractic with a gentle program of low-force techniques.

Another misconception is that chiropractic care involves a few quick treatments, again usually seen as popping the back, which will fix the disc. Instead, chiropractors who treat disc conditions integrate their low force adjusting techniques in an organized protocol of evaluation and treatment."

Bottom Line: In general, I like chiropractic and frequently refer patients for treatment of small herniated discs or low back and neck pain. I do not recommend chiropractic treatment for any herniated disc of a medium or large size and certainly this treatment should be avoided for an extruded fragment or any time there is spinal cord compression noted on the MRI. For those with small herniated discs, chiropractic might be worth a try. OK to continue as long as you are getting better but if symptoms get worse after a treatment I would stop. I have great respect for many of the fine chiropractors we have in our community. If you chose this treatment, be sure to get a personal referral to an experienced chiropractor.

High velocity manipulations should be avoided. There are risks involved whenever someone manipulates your spine and it is possible that such movement could make your problem worse.

Traction: Traction is a term to describe applying a distracting force to the neck. The theory is that this will create negative pressure in the disc and pull the herniation back in place. You can do traction with the physical therapist or chiropractor. There are home cervical traction units that are also very popular. This treatment has never been proven to definitely work.

Bottom Line: Although it makes sense, traction has never been scientifically proven to treat herniated discs. I still like it though and if I had a small herniated disc I would definitely give it a try. At home I have an inversion table and it works well to apply traction force on my low back for pain in that region. For neck traction it's easy to get and use a "home cervical traction unit." Cost is about $20. Although it looks a bit barbaric it does the trick. Start off with not too much weight (less than 5lb.) and if tolerated you may slowly increase the force. Stop immediately if you experience worsening symptoms.

DRX9000 and Extentrac: These are two different machines that uses force to manipulate the spine. The company that makes the DRX9000 states, "The system is designed to apply spinal decompressive forces to compressive and degenerative injuries of the spine."

Bottom Line: Results are anecdotal and without scientific controlled studies to back it up so we can't say with any certainty that it works. On the other hand there is not much to lose by trying if you have the time and the money. The treatment is expensive and usually not covered by insurance, so give it a trial before continuing for any extended period of time. You should know within a couple of visits whether it's going to help.

Bracing: Braces for the neck are usually in the form of a soft cervical collar. The idea is to support the neck and allow the muscles to rest.

Bottom Line: Waste of time and money.