How does physical activity affect the condition?

Strict bed rest for more severe discogenic low back pain is the initial backbone of treatment. Spending between three and seven days in bed early on can "unload" the disc and help in the healing process. However, ultimately, the disc needs weight bearing in order to receive adequate nutrition to heal up completely. There is also evidence that people who achieve a higher level of physical fitness (flexibility, strength, and endurance) have less incidence of significant low back pain than those who are unfit. Obviously, not all physical activities are ideal for patients with disc pain. Those activities involving prolonged or repetitive sitting or forward bending are to be avoided or modified: bicycling, rowing, sit-ups, knee-to-chest exercises. Those sports involving excess rotation are also to be avoided or modified: baseball, racquet sports, and golf. Walking and swimming are often very well tolerated. Running poses an intermediate stress being least injurious when running on level soft surfaces with well cushioned shoes.

Do shoes with high heels worsen the pain?

This has been studied and not found to be the case. There is evidence that people with discogenic low back pain do better with shoes that provide good support and "good cushioning', to reduce impact in standing or walking.

Should I avoid lying on my stomach?

Actually, most people who lie on their stomach do quite well, possibly even getting better more quickly by promoting "unloading" of the disc and protecting the nerve from the injured disc. Patients who follow a protocol which includes prone-lying have reduced low back pain and return to full activity more quickly than the general population. A physical examination determines who is a candidate for such a protocol.

If I have a slipped disc, do I need surgery?

There certainly is a population of patients with "slipped discs" who require and do well with surgery, either because of progressive nerve damage, or because of persistent pain. However, the majority of patients respond well to strict bed rest, followed by a progressive rehabilitation program of modified posture, exercise, physical therapy, and education.

Can manipulation help?

There is no proof that manipulation is effective in discogenic low back pain. It may be effective in other causes of back pain but, if anything, it can make patients with discogenic low back pain feel worse.

Is a lumbar corset or support useful?

There is evidence that a well-molded lumbar support which contours well to the low back and supports the "small of the back" can reduce symptoms, although the reasons are not entirely clear as yet. In fact, newer makes of cars (especially European and Japanese models) are built with a knob that "dials in" lumbar support.

How is discogenic low back pain diagnosed?

The condition is mainly diagnosed on the basis of a thorough medical history and physical examination. Plain x-rays are rarely useful, except to eliminate other conditions. CAT scan, MRI, EMG, and other tests are sometimes useful where the clinical picture is less clear-cut or the patient is not getting better as quickly as expected.

What medications are helpful?

There is no medication that "cures" discogenic low back pain The condition is a "mechanical" condition that requires mechanical treatment. However, medications can be useful in reducing inflammation, muscle spasm, pain, and indirectly reducing factors that can worsen back pain: coughing, constipation, sneezing, etc.