My mother-in-law has a herniated disc at L45. She’s in quite a bit of pain. But she doesn’t want to have any invasive treatment (like injections or surgery). What are her other options?

Exercise therapy has been proven effective as a first-line treatment for low back pain (LBP) and disability from disc disease. Injections and/or surgery are important options for patients who have not improved with exercise. Patients at risk for permanent neurologic damage are also advised to consider more invasive treatment.

Exercise guidelines for the management of LBP are not specific yet. Research so far comparing one type of exercise to another shows no long-term difference in results. Aerobic exercises, strength-training, and flexion or extension exercises all seem to benefit the patients who try them.

It’s not clear if that’s because any type of exercise works or the fact that people who exercise feel more in control and benefit psychologically from doing exercises. There may be other factors to explain the reasons exercise works. It may turn out that these vary from person to person.

Whatever type of exercise is chosen should be done consistently five to seven days a week. The program should last at least six to eight weeks. Some people find they must continue exercising indefinitely in order to maintain the benefits. Exercise sessions three to five times a week seem to do the trick.

Incorporating different types of exercise and alternating them may help prevent recurrence of back pain. Studies are underway to identify types of patients who get the most help from each kind of exercise. Some day we may know what type, frequency, intensity, and duration of exercise are needed to prevent or manage LBP.