If a surgeon has looked at your MRI and told you an operation is the next step, it is reasonable to want to understand every alternative to back surgery before you schedule one. This post walks through what a herniated or bulging disc is, what the usual non-surgical options look like, where spinal decompression fits, and how we decide at our Lincoln Square office whether it makes sense for you.
Summary
- A herniated disc pushes disc material out through a weak spot, which can press on nearby nerves and cause pain, numbness or weakness, often down one leg.
- Most people start with conservative care such as rest, medication and physical therapy. Surgery is usually considered when symptoms do not go away with other treatments and time.
- Spinal decompression is a non-surgical option for disc herniation, bulging discs and sciatica from a disc. It may suit some people who have been told surgery is next, but not everyone.
- Your exam and MRI review decide whether decompression is a fit, and which care plan makes sense. Nobody picks a plan before that.
- Loss of bladder or bowel control, or numbness and weakness that are getting worse, need urgent medical care, not a chiropractic appointment.
- What a herniated or bulging disc actually is
- Common non-surgical options, and when surgery comes up
- Where spinal decompression fits
- Why the exam and MRI review decide
- Why it is a plan, not a single visit
- Red flags that need urgent care
- When to come see us
- Frequently Asked Questions
What a herniated or bulging disc actually is
Your spinal bones are separated by discs that cushion the spine, keep space between the vertebrae and let you bend and reach. According to MedlinePlus, a herniated (or slipped) disc happens when all or part of a disc is forced through a weakened part of the disc. That can put pressure on nearby nerves, which can lead to pain, numbness or weakness.
The lower back is the most commonly affected area, followed by the neck. With a lower back herniation, MedlinePlus describes sharp pain in part of the leg, hip or buttocks, numbness in other areas, and sometimes pain or numbness in the back of the calf or sole of the foot.
A bulging disc is a related finding you may see on an MRI report. Whether it is the source of your symptoms is something your exam has to answer. Either way, when disc material presses on the sciatic nerve, the result is often sciatica. MedlinePlus lists a slipped or herniated disc as a common cause. Its sciatica page also notes the pain may get worse after standing or sitting, at night, or when sneezing, coughing or laughing, especially when a herniated disc is the cause. We cover that leg pain in more detail in our post on sciatica and leg pain.
Common non-surgical options, and when surgery comes up
Rest, medication and physical therapy
MedlinePlus says the first treatment for a herniated disc is usually a short period of rest and pain medication, followed by physical therapy, and that most people who follow these treatments recover and return to normal activities.
Steroid injections and epidurals
For people who do not improve, the next step is often a steroid injection near the affected disc. MedlinePlus notes these injections may help control pain for several months by reducing swelling around the nerve and disc, but they do not solve the underlying problem, and pain may return after weeks or months.
When surgery is considered
According to MedlinePlus, surgery may be an option if your symptoms do not go away with other treatments and time. One common procedure is a diskectomy, which removes all or part of a disc. The National Institute of Arthritis and Musculoskeletal and Skin Diseases says surgery for back pain may be suggested when other treatments have not relieved the pain, that research shows surgery can help people with herniated discs, and that not everyone is a candidate even if pain persists. For sciatica in particular, MedlinePlus describes surgery as usually the last resort.
Where spinal decompression fits
Spinal decompression is the lead service at our office, and it is built for the person this post is written for: someone with a disc herniation, a bulging disc or sciatica from a disc who has been told surgery is the next step and wants to avoid it if they can. Often that person has already tried steroid injections, an epidural or physical therapy without lasting relief. Some want to get off gabapentin or opioids, or never start them. Any change to a prescription is a conversation to have with the doctor who prescribed it.
True decompression versus traction
Not every table sold as "decompression" works the same way. Many are really computerized traction. Our office uses a true spinal decompression table. As Dr. Jeff Haynes describes it, the difference is that true decompression targets a specific disc level, and the pull oscillates rather than holding steady. That oscillation helps draw fluid and nutrients back into the disc and keeps the muscles around it from spasming.
Dr. Haynes has more than 20 years of clinical experience, and our office is a member of Disc Centers of America. Decompression is not a cure, it is not a guarantee, and it does not replace surgery for everyone. It is a non-surgical option that may suit some people with disc problems, and the exam is how we find out whether you are one of them.
Why the exam and MRI review decide
MedlinePlus notes that a careful physical exam and history are the first step with a suspected herniated disc, and that an MRI can show where the disc is pressing. The NIAMS adds that MRI can help diagnose damage to soft tissues such as discs, ligaments and nerve roots.
That is why your first visit with us is a consultation, exam and MRI review, not a treatment session. Dr. Haynes reviews your MRI, examines you, and looks at which disc level is involved and the grade of the herniation. He may offer some pain control that day, such as electrical stimulation and ice, but decompression does not start at the first visit.
You go home with literature about the treatment and time to think it over. Often that means talking it through with a spouse or partner and looking at finances, because decompression is a cash service here. If you decide to move forward, you sign a care plan agreement and start. If you want a broader sense of what a first appointment looks like, our post on what to know before you book a chiropractor in Lincoln Square covers it.
Why it is a plan, not a single visit
Decompression is done as a plan rather than as visits picked one at a time. Care plans at our office are 20, 25 or 30 visits, chosen from your MRI and the grade of your herniation.
- 20 visits: about three times a week for four weeks, then twice a week for four weeks.
- 30 visits: about three times a week for six weeks, then twice a week for six weeks.
Which plan fits you is decided after the exam, never before. We don't believe in unnecessary treatment plans or keeping patients dependent on care they don't need. The plan has a start and an end, and the goal is for you to finish it and get back to your life.
What you do between visits matters too. MedlinePlus recommends avoiding heavy lifting and twisting early on and gradually returning to exercise. How you sit at work and in the car also plays a part, which we cover in the worst sitting positions for lower back pain.
Red flags that need urgent care
Some symptoms are not a reason to book a decompression consult. They are a reason to get medical care right away. MedlinePlus says to contact a provider right away if you have:
- Loss of control of urine or stool
- Weakness or numbness in your buttocks, thigh, leg or pelvis
- Unexplained fever with back pain
- Back pain after a severe blow or fall
- Severe pain where you cannot get comfortable, or pain that is worse lying down or wakes you at night
The MedlinePlus herniated disk page also lists any numbness, loss of movement, weakness, or bowel or bladder changes as reasons to contact your provider, and notes that in rare cases a herniated disc can lead to loss of bowel or bladder function. If that is happening to you, go to an emergency room.
When to come see us
A consultation makes sense if you have a diagnosed herniated or bulging disc, or sciatica from a disc, and:
- You have been told surgery is the next step and want to understand your options first.
- Injections, an epidural or physical therapy helped for a while, or not at all.
- You would like to rely less on pain medication.
- You have an MRI you can bring, or can get the report sent to us.
Bring your MRI and any notes from your other providers. If decompression is not the right fit, Dr. Haynes will say so.
Frequently Asked Questions
Is spinal decompression an alternative to back surgery for everyone?
No. It may suit some people with a herniated disc, bulging disc or sciatica from a disc, especially those who have been told surgery is next and want to try a non-surgical option first. Your exam and MRI review decide whether it is a reasonable fit for you.
Do I start decompression at my first visit?
No. The first visit is a consultation, exam and MRI review, possibly with some pain control such as stim and ice. You take literature home, think it over, and if you decide to go ahead you sign a care plan agreement and start at a later visit.
How many visits will I need?
Our care plans are 20, 25 or 30 visits. Dr. Haynes chooses the plan from your MRI and the grade of your herniation, so nobody is assigned a plan before the exam.
How is your table different from the traction I had before?
Many tables sold as decompression are computerized traction. As Dr. Jeff describes it, ours is a true spinal decompression table that targets a specific disc level and uses an oscillating pull, which helps draw fluid and nutrients back into the disc and keeps the surrounding muscles from spasming.
Do I need an MRI before I come in?
An MRI is a big part of how we choose a plan, so bring it if you have one. If you do not, call us and we can talk through next steps before you book.
If you have been told surgery is next and want to know whether spinal decompression is worth a look first, Dr. Jeff Haynes can review your MRI and examine you before any decision is made. Call (312) 658-0658 or visit us at 4526 N. Lincoln Ave.
