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The most common cause of back pain is lumbar disc herniation associated with radiculopathy, a term that describes a variety of symptoms caused by a pinched nerve root in the spine. These herniations are also the most common cause of sciatica, which affects 1 to 5% of the global population each year.

New studies are exploring nonsurgical alternatives to treat them, after analyses showed that up to 90% of patients do not need surgery. As long as the symptoms are not severe or potentially dangerous, surgery may not be recommended immediately or as a first option. Instead, doctors may prescribe several months of conservative treatments. If these treatments are done responsibly and as indicated by the doctor, surgery may not be necessary at all. 

A 2024 review of nonsurgical options shows that, if therapists are knowledgeable about all the alternatives available to a patient, they can navigate the complexities of lumbar disc herniation with radiculopathy by tailoring conservative treatment approaches to patients’ individual needs.

“By customizing therapy regimens based on unique requirements, encompassing overall health and symptom severity, therapists are expected to offer optimal relief and enhanced functionality, sparing patients from the necessity of surgical intervention,” says the article.

Specifically, the researchers identified the following interventions to show moderate evidence of their applicability to conservative treatment of lumbar disc herniation associated with radiculopathy (LDHR):

Patient education and self-management

The medical literature reports that patient education and self-management programs and practices help people with musculoskeletal diseases live better lives by improving health outcomes and psycho emotional and psychosocial measures.

In these programs, patients are empowered to perform exercises, maintain postures, and learn to manage their own care. These are known as behavioral health strategies, and they encourage patients’ acceptance of their medical situation and commitment to their recovery.

McKenzie method

The McKenzie method is a specific type of physical therapy focused on treating sciatica and back, radicular, and neck pain. A primary objective of McKenzie therapy is to “centralize” the pain. Centralization refers to a change in the location of the pain from a peripheral area, like the arm or leg, to a location closer to the center of the body, usually in the lower back or neck.

Through centralization, McKenzie therapy aims to immediately relieve the most intense and painful symptoms, as nerve pain that radiates toward the arm or leg tends to be more intense than pain in the lower back or neck.

This is achieved through repeated motions that involve bending the spine backward (extension) or forward (flexion). Just like the self-management strategy, this method involves a high level of responsibility on the part of the patient, especially to complete exercise programs at home.

Mobilization and manipulation

Since 1998, the Guide to Physical Therapist Practice has defined mobilization/manipulation as “a manual therapy technique comprised of a continuum of skilled passive movements that are applied at varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement.”

Joint mobilizations and manipulations are highly effective at improving many types of lower back pain, neck pain, sciatica, headache, and a long list of other bodily ailments. They should be performed by a specialized therapist on a relaxed patient. The guides recommended performing them with a combination of other behavioral interventions.

Exercise therapy 

Exercise as a therapeutic approach involves regular, repeated activity in different modalities to increase a person’s resistance to illness and the duration of recovery after that illness. Physical therapy can play an important role in improving pain, disability, mobility deficits, and healing response after disc herniation. Not all disc herniations will reduce in size, but physical therapy can help reduce symptoms experienced as a result of the injury.

Traction 

There are different types of traction techniques. Positional traction is applied by placing the patient in various positions using pillows, blocks, or sandbags to exert longitudinal traction on spinal structures. Lateral flexion is usually incorporated, and only one side of the spinal segment is affected.

Mechanical traction can effectively relieve lower back and leg pain and improve ODI (Oswestry Disability Index, which measures disability associated with the lower back) in patients with lumbar disc herniation but does not have a significant effect on spinal movement. Lumbar traction can be used in conjunction with other traditional physical therapy.

Nerve mobilization 

Nerve mobilization is a targeted, noninvasive treatment approach that is an alternative to surgery and conventional treatments. It involves mobilizing a specific nerve using a variety of techniques and mechanisms to reduce pain, restore normal nerve function, and improve lower back pain status. Studies have shown that this technique achieves short-term results, as it repositions the nerves that have been affected by lower back pain.

Epidural injections

Epidural steroid injection (ESI) is the administration of a powerful anti-inflammatory drug directly into the space outside of the sac of fluid surrounding the spinal cord. This area is called the epidural space.

ESI is not the same as epidural anesthesia given just before childbirth or certain types of surgery.

These injections are recommended as an initial strategy to relieve acute pain but should not be administered on a constant basis. Behavioral therapies for lower back pain should be continued.

This story was produced using content from original studies or reports, as well as other medical research and health and public health sources cited in links throughout the article.