Conservative Treatment of Lumbosacral Intervertebral Disc Herniations: A Review of Current Approaches

Introduction. Lumbar intervertebral disc herniation is one of the leading causes of low back pain and radiculopathy, often resulting in temporary disability. Most patients have a favorable prognosis with conservative treatment, and the available therapeutic approaches continue to evolve. The aim of this review is to summarize the findings of recent studies evaluating the effectiveness of conservative management of lumbar disc herniation using physiotherapeutic interventions. Materials and methods. For this narrative review, 23 publications available in the PubMed, CyberLeninka, and eLibrary databases were selected. The inclusion criteria were: studies involving patients with a confirmed lumbar intervertebral disc herniation; evaluation of conservative treatment approaches (comprehensive physiotherapy, traction therapy, and motor control training); and reporting outcomes related to changes in pain intensity, assessed using the Visual Analogue Scale (VAS), and functional status, assessed using the Oswestry Disability Index (ODI). Results. The findings indicate that conservative treatment is effective in the absence of neurological deficits and cauda equina syndrome. Traction therapy and motor control training have been shown to be effective in reducing pain and improving functional outcomes. The incidence of serious adverse events associated with conservative treatment is less than 1%. Сonclusion. The conclusions are based on evidence from valid studies demonstrating the superiority of interventions whose effectiveness is associated with intervertebral disc decompression, spontaneous hernia resorption, activation of anti-inflammatory pathways, and restoration of motor control of the deep spinal muscles. Future research should focus on conducting randomized clinical trials to standardize the magnitude of spinal traction force, the frequency and duration of motor control training sessions, and to improve the prediction of patient responses to different physiotherapeutic interventions.