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More research needed to clarify role of physical therapy

A herniated disc occurs when the outer ring of an intervertebral (spinal) disc tears, which allows the soft central portion to bulge out past the outer rings. Lumbar, or lower back disc herniation, can lead to symptoms like numbness, weakness and leg or low back pain (LBP). Though some patients with lumbar disc herniation heal spontaneously within a few weeks, most are prescribed conservative (non-surgical) treatment. In cases that don't improve with this treatment, surgery such as lumbar disc surgery may be recommended. One type of conservative treatment is Mechanical Diagnosis and Therapy (MDT), also known as the McKenzie method, which aims to eliminate or minimize pain. Some studies have shown that MDT leads to positive results, but research is lacking to confirm the effectiveness of this therapy. Therefore, a study evaluated MDT on lumbar disc herniation patients to determine if it improved their condition or affected their likelihood of having surgery.

Patients are assigned to either surgery or MDT

A group of 150 patients with lumbar disc herniation for at least six weeks were selected; however, 70 of them spontaneously recovered, and were therefore excluded. The remaining 80 patients were assigned to either lumbar disc surgery or a nine-week long program of MDT, which was administered by a physical therapist. All patients were assessed using a series of questionnaires for pain, disability and other measures, and data was collected before treatment, then again 3, 12 and 24 months later.

MDT leads to significant improvements that last for two years

Results showed that patients who underwent structured physical therapy using MDT experienced significant improvements for all assessments measured. These improvements were identified as early as three months into treatment, and were still seen two years later when patients were reassessed. In addition to improvements in pain and disability, patients also reported better quality of life, less depression and sick leave, and the majority (80%) were satisfied with the MDT treatment. Finally, only four patients (9.75%) ended up having surgery. Theses outcomes show that a structured physical therapy program using MDT is effective for treating patients with lumbar disc herniation, and it should be utilized before surgery is considered.