Lumbar Disc Herniation

Q I am a 46-year-old carpenter running a small workshop in Dong-gu, Incheon. The doctor mentioned surgery; please tell me honestly which cases can be managed with traditional Korean medicine without surgery and which cases absolutely require surgery.

A. Surgery is the priority in cases of bowel and bladder control dysfunction, progressive paralysis involving weakness in the ankles and toes, or unbearable pain that worsens despite conservative treatment. On the other hand, if pain and numbness are the main symptoms and there is no paralysis, the majority of disc patients improve with non-surgical treatment. In reality, cases where surgery is absolutely necessary are estimated to be around 10% of the total.

Q My father is 72 years old and is said to have a herniated disc and spinal stenosis. Can he improve with Korean medicine treatment at this age? He adamantly refuses surgery.

A. Yes, it is possible. In the elderly, the value of conservative treatment actually increases due to the burden of anesthesia and surgery, and treatments such as acupuncture, moxibustion, and pharmacopuncture can be applied without age restrictions. If the goal is not the complete disappearance of the disc but rather pain relief, increased walking distance, and maintenance of daily functions, significant improvement can be expected even in one's 70s.

Q I am a 54-year-old supermarket cashier. I have been told I have a herniated disc, but some doctors say it is spinal stenosis, while others suggest it might be piriformis syndrome. Can these conditions occur together? How do the treatments differ?

A. Yes, it is common for all three to occur together. As disc degeneration progresses, it can easily lead to spinal stenosis, where the spinal canal narrows. Additionally, if you experience back pain, it can be overlapping with piriformis syndrome, where the piriformis muscle in the buttocks becomes overtight and further constricts the sciatic nerve. Since the symptoms are similar, differentiation is crucial, and the treatment target varies depending on which condition is the primary culprit.

Q I am a 47-year-old nurse. My back feels like it’s going to break after a night shift. What sleeping position should a patient with a herniated disc sleep in, and what kind of bed is best?

A. Lying on your back with a pillow under your knees, or lying on your side with a pillow between your knees, places the least strain on the discs. Sleeping on your stomach should be avoided as it causes excessive arching of the lumbar spine. A mattress of medium firmness—neither too soft nor too hard—is ideal, and the key criterion is whether it provides adequate support so that your lower back does not lift off the mattress.

Q I am a 58-year-old factory worker. I have heard that walking is good for herniated discs; how long should I walk, and conversely, what exercises should I avoid?

A. It is recommended to walk on flat ground for around 30 minutes a day, starting within a pain-free range and gradually increasing the duration. Swimming (freestyle and backstroke), McKenzie extension exercises, and core stabilization exercises are also recommended. Conversely, during the acute phase, sit-ups, deep bending stretches, twisting exercises like golf or tennis, and lifting heavy weights should be avoided.

Q I am a 61-year-old housewife. I was told to get *Dochim* (slicing with a blade) on my lower back, but I am scared to think that a blade-like needle is inserted near the spine. Is there any risk of damaging a nerve or something going wrong?

A. *Dochim* is a procedure in which a fine blade-like tip less than 1mm in diameter is used to separate only the adhered ligaments and fascia, avoiding nerves and blood vessels. It is performed within an anatomically safe zone, and for deep areas, the location of nerves and blood vessels is monitored in real-time using ultrasound, so the risk of serious accidents is very low. Stiffness for 1 to 2 days after the procedure is a normal reaction.

Q I am a 52-year-old bus driver. I am currently taking anti-inflammatory painkillers and nerve pain medication prescribed by an orthopedic clinic. Is it okay to receive herbal medicine and acupuncture treatment at the same time?

A. Yes, in most cases, it is possible to combine them. Acupuncture, moxibustion, and pharmacopuncture have almost no pathways for interaction with oral medications, and it is rare for herbal medicine to be contraindicated for concomitant use with general anti-inflammatory painkillers or neuropathy medications. However, if you inform the Korean medicine doctor of all medications you are currently taking, the prescription can be adjusted to avoid overlapping gastrointestinal burdens. If you are taking anticoagulants, please be sure to inform them before any invasive procedures.

Q I am a 35-year-old daycare teacher. I developed a herniated disc from lifting children up. How long does it usually take to recover with treatment? I need to continue working.

A. Acute pain usually subsides significantly within 2 to 6 weeks of starting treatment, and it typically takes 3 to 6 months for neurological symptoms, such as leg numbness, to stabilize. The natural absorption of the herniated nucleus pulposus also takes place over several months. However, if you must continue to lift your child, correcting the lifting posture will determine the recovery period.

Q I am a 44-year-old self-employed individual. I suffered from a herniated disc three years ago and recovered, but recently my lower back has been aching again. Is it normal for herniated discs to recur like this? What are the ways to prevent it?

A. Yes, herniated discs are a condition where recurrence is common. Once damaged, the annulus fibrosus heals in a weakened state, much like a scar, so it can be pushed out again if the same load is repeated. The key to preventing recurrence is strengthening core muscles, managing weight, correcting posture when lifting or sitting, and restoring the weakened tissues and the body's overall condition. Getting a checkup at the stage of stiffness can block recurrence early on.

Q I am a 32-year-old office worker. I have never lifted anything heavy, but I was diagnosed with a herniated disc. Why does a disc rupture when I have only been sitting?

A. Sitting for long periods places 1.4 to 1.9 times higher pressure on the discs than standing. If a hunched sitting posture is repeated for extended periods, micro-damage accumulates in the annulus fibrosus at the back of the disc, causing the nucleus pulposus to be pushed out even without lifting heavy objects. Cumulative load is a more common cause than trauma.

Q I am a 48-year-old housewife. My legs feel more numb and tight than my lower back. I have a herniated disc, so why does the pain extend from my buttocks to my calves?

A. When a herniated disc compresses the nerve root extending down to the leg, pain and numbness spread to the buttocks, thighs, calves, and feet innervated by that nerve. This is called radiating pain (sciatica), and it is common for leg symptoms to be more severe than those of the lower back itself. The location of the numbness varies depending on the position of the compressed nerve.

Q I am a 38-year-old chef. I stand all day at work, and I have even developed a herniated disc. Are there specific foods that are bad or good for a herniated disc?

A. While food does not cause the disc itself to rupture, dietary habits influence inflammation and recovery. Excessive alcohol consumption and an overconsumption of simple sugars and processed foods exacerbate systemic inflammation and increase the burden on the lower back due to weight gain. Conversely, a diet centered on vegetables and fish rich in protein and Omega-3s aids in tissue recovery and inflammation control. Smoking is one of the worst factors as it reduces blood flow to the disc.

Q I am a 29-year-old fitness trainer. I am confident in my ability to exercise, but I have been diagnosed with early-stage disc herniation. What movements or habits in daily life worsen disc problems?

A. Typical examples include twisting movements while bending over, sudden bending of the back immediately after waking up in the morning, the habit of lifting heavy objects with the lower back, sitting on a sagging sofa for a long time, and incorrect posture during deadlifts and squats. In particular, movements involving both flexion and rotation are the most dangerous for the posterior annulus fibrosus of the disc.

Q I am a 33-year-old office worker in Dongincheon. I am planning to receive treatment for a herniated disc, but how often do I need to visit per week? I am worried because I only have time after work.

A. It is generally recommended to visit 2 to 3 times a week during the acute phase, 1 to 2 times a week once the pain subsides, and gradually reduce the frequency to once a week or every other week during the stable phase. The total duration is typically estimated at 2 to 3 months. Procedures such as moxibustion or pharmacopuncture are not performed every time but are administered at intervals according to the recovery stage, so office workers can easily accommodate them within their after-work schedules.

Q I am a 39-year-old logistics center employee. I thought disc treatment at a Korean medicine clinic was just a matter of getting acupuncture and that was it, but I heard there are stages. In what order is it performed?

A. It usually proceeds in four stages. Stage 1 involves acupuncture and cupping to soothe acute pain and inflammation. Stage 2 uses moxibustion to separate hardened adhesions and strengthen ligaments. Stage 3 promotes the regeneration of weakened tissues using fire acupuncture and thread embedding. Stage 4 involves herbal medicine tailored to the patient's constitution to create a body condition that prevents recurrence. Depending on the patient's condition, the stages may overlap or be adjusted.

Q I am a 50-year-old self-employed restaurant owner. I see there are many types of acupuncture, such as bee venom therapy and herbal injections; when and which one should be administered for disc treatment?

A. Pharmacopuncture is a treatment used from the acute phase to reduce inflammation by injecting purified herbal ingredients into acupoints and painful areas. Bee venom acupuncture utilizes the strong anti-inflammatory effects of purified bee venom and is selected when inflammation around nerves is severe or chronic inflammation does not subside. Bee venom acupuncture begins with a low concentration after a skin reaction test to confirm allergies.

Q I am a 55-year-old delivery driver. Honestly, acupuncture doesn't actually push a herniated disc back in. Is Oriental medicine treatment really effective?

A. That is correct. Acupuncture does not physically push the disc back in. Instead, it plays a role in reducing pain by decreasing inflammation around the nerve and muscle tension, and helps the body endure while the herniated nucleus pulposus is naturally absorbed. Since a significant portion of the herniated nucleus pulposus is absorbed over time through immune responses, managing pain and creating an environment for recovery during that period is the core of Oriental medicine treatment.

Q I am a 41-year-old hairdresser. I have tried regular acupuncture several times, but the effect is only temporary. What is the difference between Dochim and regular acupuncture, and is it more effective?

A. General acupuncture uses fine needles to promote blood and energy circulation and control pain, whereas Dochim uses needles with flat, blade-like tips to physically separate hardened adhesions and thickened ligaments and fascia. In cases where the effects of general acupuncture are short-lived due to hardened tissues from a long-standing herniated disc, Dochim, which releases the adhesions themselves, may be more suitable.