These treatments are given either by a physiatrist (an M.D. with graduate training in physical medicine & rehabilitation) or by prescription to a licensed physical therapist (LPT). They both may use P.T Assistants to administer some or all of the treatment.
1. Flexion or Extension Exercises – see the above self-treatment section under exercises. It’s good to learn these under supervision so you can do them safely at home.
2. Heat – applied to the lower back reduces muscle spasm.
3. Massage – everyone likes to get a massage, although it probably does very little to improve a herniated disc.
4. Ultrasound – again, a way to get heat into the deep muscles of the spine to relax them.
5. Electrical stimulation – electrodes placed on the skin cause a tingling sensation, thought to block pain nerves while the current is on. It doesn’t always help. If it does, a permanent stimulator can be surgically implanted. See Spinal Cord Stimulator.
6. Traction is a way to pull down on the legs or pelvis and put downward force on the lower spine. While lying flat on the back, a belt or boots are used to pull down on the spine, with no time limit, but assistance is needed to begin and end this treatment. There is no evidence this pulls the vertebrae apart any, but it may reduce the pressure inside a bulging disc enough to help it retract back into place.
7. Spinal Decompression is a more recent way to do traction and put enough force to actually decompress the disc spaces. The patient is harnessed to the top of a table with a vest and bars protrude under each armpit to prevent sliding toward the feet. A belt around the waist attaches to a computer-controlled motor that pulls at variously prescribed amounts for each patient. The lower half of the table is moveable to allow downward displacement of the lower body. The traction force is usually set with an initial pull of half the body weight and is increased as tolerated. This amount of pull does seem to open the disc spaces, as some patients report instant relief and pain returning on getting up. From 10 to 20 treatments might be needed to give long-term relief. Compared to other methods of physical therapy, spinal decompression hasn’t yet been proven better.