Limit narcotics to acute phase only. Referral to physical therapy for acute pain therapy, to include ultrasound, short wave, TENS, electro-acupuncture, traction, and manipulation. Follow-up at two weeks and four weeks with thorough exam on each visit. If any improvement occurs, instruct the patient to return to work with limitation of activity. Surgery for HNP is usually not indicated.
Most patients heal with conservative therapy.
Progressive neurologic deficit. Severe deficit or multiple nerve root involvement. If signs of nerve root compression are present, and no improvement occurs with 2-4 weeks of conservative therapy. Prognosis may be improved by returning to work early. References Hall H. Examination of the patient with low back pain.