Physiotherapeutic and Pharmacological Approaches to Conservative Treatment of Lumbar Intervertebral Disc Herniation: A Narrative Review

Abstract

Low back pain (LBP) is one of the most common musculoskeletal disorders, with symptomatic lumbar disc herniation (LDH) accounting for approximately 1–3% of cases. LDH frequently presents with sciatica that stems from lumbar radiculopathy. Both mechanical compression of neural structures by displaced nucleus pulposus fragments and accompanying inflammatory responses are central to LDH pathophysiology, leading to its characteristic symptoms. The primary aim of this study is to present current non-surgical treatment options for lumbar nucleus pulposus herniation and to evaluate the effectiveness of each approach. A literature review reveals that pharmacotherapy for LDH management is primarily symptomatic. Nonsteroidal anti-inflammatory drugs, muscle relaxants, and antidepressants may modestly reduce pain for some individuals, though the supporting evidence is limited. Systemic glucocorticosteroids might offer slight functional gains, and epidural steroid injections are mainly beneficial for achieving short-term radicular pain relief. Furthermore, available data highlight the important role of physiotherapy in the conservative management of the condition. Biomechanical interventions may reduce pain, enhance patient function, and, in some cases, induce favorable structural changes in the intervertebral disc.