The vast majority of patients with back pain do not need — and will never need — surgery. Between 80 and 90% of lumbar disc herniations and acute lumbago episodes improve with a structured conservative treatment programme, especially when targeted physiotherapy, image-guided selective injections, and supportive therapies such as shockwaves or electrotherapy are correctly combined.
At the Mediterranean Spine Institute (ICEM) in Hospital La Salud Valencia, Dr. Antonio Vilatela designs and supervises personalised conservative treatment programmes, integrating all available non-surgical tools to resolve pain and restore the patient to a normal life.
What is conservative spine therapy?
It is the set of non-surgical treatments addressing spinal pathology by combining patient education, structured therapeutic exercise, manual techniques, image-guided diagnostic-therapeutic injections, and adjunctive modalities. Its goals:
- Relieve pain rapidly.
- Restore function (mobility, strength, daily-life capacity).
- Identify and correct the biomechanical, postural, or lifestyle factors that perpetuate the problem.
- Prevent recurrences through a sustainable exercise programme.
- Avoid surgery whenever possible and, when surgery is unavoidable, optimise the patient before reaching the operating theatre.
Treatments included in our conservative programme
Targeted neuromuscular physiotherapy
Individualised programme of therapeutic exercises designed for each patient’s clinical pattern. Includes motor control work, deep core strengthening, postural re-education, and gradual exercise toward functional activity. The foundation of any effective conservative programme.
Global Postural Re-education (RPG) and McKenzie method
Specific manual treatment and self-exercise techniques to correct postural dysfunctions and movement patterns that chronicify pain. Especially useful in mechanical low back pain, sciatica, and tension-type cervical pain.
Image-guided epidural injections
Application of corticosteroid and/or local anaesthetic at epidural, foraminal, or facet level, guided by fluoroscopy or ultrasound. Indicated for acute and subacute radicular pain not controlled with oral medication. Also useful to confirm the source of pain (diagnostic effect).
Facet and medial branch blocks
Injection of the facet joints or the medial branch nerves that innervate them. Very useful in facet syndrome, chronic mechanical low back pain of articular origin, and as a step prior to radiofrequency.
Facet radiofrequency (RF)
When facet block confirms the source of pain, radiofrequency interrupts pain transmission in the sensory nerves of the facets, providing prolonged relief (6–18 months) without affecting motor function.
Extracorporeal shockwave therapy (ESWT)
Application of focal or radial mechanical waves to areas of tendinopathy, myofascial pain, or trigger points associated with spinal pathology. Improves chronic pain and stimulates tissue repair processes without injections or rest.
Electrotherapy and thermotherapy
Adjunctive modalities (TENS, interferential currents, magnetotherapy, deep heat) integrated within the global programme. They do not replace therapeutic exercise but can enhance its effect at specific phases.
Structured pharmacological treatment
Analgesic and anti-inflammatory regimen tailored to each phase, avoiding opioids except in specific cases. Complements other measures and allows the patient to perform therapeutic exercise without limiting pain.
Patient education and biopsychosocial pain management
Chronification of back pain has a well-documented biopsychosocial component. Educating the patient, deactivating unfounded fears (kinesiophobia), and promoting active self-care are essential pillars of treatment.
When is conservative treatment indicated?
- Acute and subacute lumbago without neurological deficit (the vast majority of cases).
- Lumbar or cervical disc herniation without significant motor deficit: conservative treatment 6–12 weeks as first-line.
- Mild-to-moderate lumbar canal stenosis with good functional tolerance.
- Facet syndrome and chronic mechanical spine pain.
- Mechanical cervicalgia and non-disabling cervicobrachialgia.
- Non-specific chronic lumbar pain in patients who are not surgical candidates.
- Post-operative: as part of recovery after spine surgery.
Advantages of the conservative approach
- No surgery: avoids perioperative risks and surgical recovery.
- Resolves the majority of cases: 80–90% of disc herniations and lumbago resolve with well-applied conservative treatment.
- Combines diagnosis and treatment: image-guided injections confirm and treat the source of pain at the same time.
- Customisable: programme adapted to clinical profile, age, occupation, and goals.
- Reversible and repeatable: no technique leaves sequelae if it does not work; the plan can be reoriented at each review.
- Empowers the patient: at the end, the patient knows how to self-manage and prevent relapses.
How does the process work?
- Initial evaluation: clinical review, detailed history, and review of updated imaging studies.
- Programme design: personalised combination of techniques.
- Acute phase (weeks 1–4): pain control with pharmacology, injections if indicated, and tolerance-adapted exercise.
- Recovery phase (weeks 4–12): exercise progression, active physiotherapy, postural re-education, and return to activity.
- Maintenance phase: sustainable self-exercise programme and periodic reviews.
- Reassessment at 6–12 weeks: if progress is insufficient, consider bio-regenerative therapies or, as a last option, surgery.
Expected outcomes
- Significant pain improvement: 70–85% of patients in the first 6–12 weeks.
- Complete functional recovery: 60–75% in 3–6 months.
- Reduced analgesic use: in the majority of responders.
- Progression to surgery rate: 10–15% in selected disc herniation and stenosis; the rest resolves with conservative treatment.
- 1-year recurrence rate: 20–30%, clearly lower in patients who maintain therapeutic exercise.
Conservative spine treatment in Valencia
At ICEM (Mediterranean Spine Institute) we approach conservative treatment with the same rigour as surgery: personalised programme, image-guided techniques, experienced team, and scheduled reviews. When surgery is indicated, we propose it without delay; when it is not, we exhaust all conservative options first.
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📍 Hospital La Salud · C/ del Dr. Manuel Candela, 41 · Valencia
Frequently asked questions
How long until conservative treatment takes effect?
Depends on the pathology and adherence to the programme. In acute lumbago, significant improvement is usually seen within 2–4 weeks. In disc herniation with radicular pain, most patients improve substantially in 6–12 weeks. If there is no progress after 12 weeks, the plan is reconsidered.
Can any disc herniation be treated without surgery?
Most can. A herniation with progressive motor deficit, cauda equina syndrome, or disabling pain unresponsive to well-applied treatment for 6–12 weeks requires immediate surgical evaluation.
Do corticosteroid injections cause long-term harm?
Properly indicated and limited in number (typically a maximum of 3 per year in the same area), epidural or facet corticosteroid injections have a very good safety profile. Overuse (more than 3–4 per year) is associated with local and systemic effects.
This article is informative and does not replace medical judgement. Always consult a specialist for your particular case.