Conservative management of a patient with lumbar disc disease: averting lumbar disc surgery

To illustrate multifaceted clinical components often present with lumbar disc herniation that require concomitant resolution before optimal conservative case management can be achieved.

A 33-year-old male with insidious low back pain and a gradual onset of lower extremity symptoms had a declining physical activity lifestyle, diminished fitness level, and weight gain over a 4-year period. Symptoms progressively worsened over a two-year period. Magnetic resonance imaging revealed a disc herniation with neurological compromise and surgical intervention was medically recommended.

Management consisted of patient education, acute inflammation control, closed disc reduction, remedial therapeutic (passive joint movement) care directed at preservation and improvement of joint and soft tissue mobility, low tech physical capacity evaluation and individualized rehabilitation training for home based care exercise. Patient compliance was ultimately achieved with a positive long-term outcome.

This case illustrates common clinical components of care associated with disc herniation case management, the potential of conservative care, and the benefits of combining manual therapy and rehabilitative exercise.