Obviously there are surgical approaches to some of these issues but most of the time people want to take conservative approaches so let’s show some conservative approaches that we would do non-surgical options rest what you’re gonna crazy about because you’ve talked to me about that about you know just too much rest is not good either you got it yeah you don’t want to cause bone mass loss you don’t want to cause muscle atrophy so studies show that no more than a day or two of rest and if there’s the problem is continuing it’s time to get a workup exactly over-the-counter pain relievers say look I’m not a big believer in nonsteroidals a short course of steroids does wonders especially for young people and the frequently I see them take a six or seven day course of steroids and their pain is just gone okay and then muscle relaxers cold compresses or ice physical therapy yes or no let me start from the bottom the physical therapy is great for muscle dysfunction but once you quench the source of the pain like a disc herniation pain just goes away including muscle pain okay ice heat there’s very little science about this so I say to patients do what feels good but beware ice just like heat can burn the skin so no more than 20 minutes on 20 minutes off nonsteroidals look I’m a surgeon when patients come to me they’ve tried nonsteroidal so I’m very biased and saying that it’s not something that I see making a big difference but the reality is that it probably does make a big difference and those patients just never make it to my office okay so what point do you say time for surgery when a patient says that it’s time for surgery when a patient says that they can’t tolerate it I would say one out of a hundred I’ll have to tell them that look you should consider getting the pressure off a nerve or especially if the spinal cord is compressed but even then in order to have surgery in order to accept the risks of surgery those patients need to say two things that they have tried reasonable quality high quality conservative means and that they’re dying in pain they can’t continue to live like this you