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Conservative therapy

The goal of conservative therapy is to eliminate acute back pain and sometimes arm and leg pain without paralysis by a combination of pain medication, local injections and physical therapy.

The treatment methods aim to soothe muscle tensions and blockages as well as irritated nerves. The conservative treatments cannot eliminate the actual problem, such as a herniated disk. The body has to do it itself. The body has appropriate repair systems for that.

How anyone can observe, wounds on the skin usually heal by themselves. Immune cells are primarily involved. This healing process is associated with an inflammatory reaction, since the immune cells release substances that attract other immune cells, and set the healing in motion. These chemical messengers (also called mediators) also lead to a swelling of the tissue, which can be noticed after an injury, such as foot sprains. Inside the body, it also comes to such a swelling, for instance at the nerve root. Therefore, the drug therapies are also aimed at the swelling of the nerve root (for example with the so-called nonsteroidal anti-inflammatory drugs such as Voltaren or Ibuprofen) or the injection of cortisol. Through this, the excessive immune response will be contained. Thus, the healing process can be seen as a race between the effects of the immune response and the objective, which is the removal of the herniated disc.

This will ultimately be resolved by the immune cells and slowly be “eaten up”. This works in about 80% of the cases within about 6-12 weeks. If symptoms continue after this period, it is likely that the immune system has not managed to eliminate the problem. This happens because the immune cells in the so-called “bradytrophic tissues”, i.e. tissues which are not really supplied with blood, do not work as effectively as in the skin, which has a very strong supply of blood. The disc is not supplied with blood in the end, which means immune cells have to immigrate from neighbouring tissues.

When the body does not manage to remove the herniated disc within a time window of 6-12 weeks, then an operation must be considered (this can usually be done endoscopically). A long adherence to treatment procedures without improvement leads to chronicity of the complaints with the emergence of pain memory and a fixation of poor posture, since muscle attachments are being shortened, joint capsules are shrinking and disc herniation are calcifying. In late stages of it, various forms of spinal instability and deformation result. This is why the motto that surgery should be delayed as much as possible does not always apply. In a very advanced stage of degeneration or wear certain therapies are not possible (such as the artificial disc); more elaborate reconstruction and stabilization operations must be carried out.

Overview of conservative therapies