Herniated discs
The vertebrae in your spine are separated by round “cushions” called discs. They have a softer inside and a tough outer layer. This outer layer can tear. The softer substance inside the disc can then push through the outer layer (“herniate”) and press against nerves, causing pain.
Symptoms can vary
Herniated discs (also called slipped discs or ruptured discs) can occur in the lower back or in the neck. The location of the herniated disc, and whether it presses against nerves, will determine what symptoms you experience.
Who gets herniated discs?
Herniated discs are most common in people between the age of 35 and 50. Men are almost twice as likely to get them as women.
Symptoms of herniated discs
The common symptoms of a herniated disc:
- Numbness or tingling that occurs on one side of the body.
- Pain down a leg, into the calf, or even foot.
- Pain in the arm or shoulder (most often associated with a herniated disc in the neck).
- Pain in the buttocks.
- Pain that gets worse with specific movement.
- Pain when sitting or standing too long.
- Pain when walking.
Note that in certain cases, when the disc has slipped and isn’t resting on surrounding nerves, you may experience no symptoms.
Diagnosing herniated discs
In order to diagnose a herniated disc and eliminate any other possible causes, your doctor will conduct a physical exam and have you perform a series of tests to check your range of motion and strength.
Physical exam
The physical exam usually involves the doctor watching you bend and move as well as these additional tests:
- Gait monitoring. Your doctor will look to see whether you’re walking slowly or abnormally.
- Leg raise test. One common test for a herniated disc is the straight leg raise, which requires you to lie down flat on your back and raise your affected leg until pain is felt.
- Lumbar spine area exam. If there is inflammation in the lumbar spine, the skin may appear abnormal or sensitive to touch.
- Neurological check. Your doctor will check you for any numbness or weakness in your leg and foot. You may be checked for a foot drop, where the muscles in the ankles and toes are weakened. You will also be checked for muscle strength and reflexes in other areas. Expect your reflexes to be slower than normal or even nonexistent.
- Range of motion tests. You may be asked to lean forward and back and bend from side to side.
When imaging is needed
If the physical exam doesn’t reveal signs of a serious problem, or you aren’t experiencing severe pain, then there typically isn’t a need for imaging tests to be done. However, if your doctor does determine there’s a need, they will order one of these imaging tests:
Magnetic resonance imaging (MRI). The most common way to diagnose a herniated disc, an MRI is an imaging technique that produces images of different parts of the body, including your organs and soft tissues, using powerful magnets and computer-generated radio waves. It can give your doctor an in-depth look at your spinal cord and nerve roots.
Computed tomography scan (CT or CAT scan). A CT scan stitches together multiple X-ray images taken from different angles around your body of your bones, blood vessels and soft tissues and then uses a computer to create a highly detailed, cross-sectional picture. Doctors use them to get a different view of the shape and size of your spinal canal.
Treatments for herniated discs
Non-surgical treatments
The first course of treatment for a herniated disc always begins with non-invasive/non-surgical therapy.
- Non-invasive/nonsurgical treatments may include avoidance of painful activities, getting the proper amount of rest, gentle massage, heat and cold therapy, and taking over the counter non-steroidal medications to relieve the discomfort. With any one or a combination of these therapies, symptoms typically diminish within a few days or weeks.
- Physical therapy. The doctor may also recommend physical therapy that may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises.
- Epidural steroid injection. If more passive forms of treatment prove ineffective, your doctor may suggest an epidural steroid injection. This procedure typically involves directing medication to an exact spot of the disc herniation using a spinal needle under X-ray guidance.
Surgical treatment
About 10% of those with herniated discs do not show improved symptoms after six weeks of nonsurgical treatment. Your doctor may recommend surgery in these cases.
As with any surgical procedure, there are risks and benefits to be assessed. Although surgery does provide relief to most patients, pain relief is not guaranteed.
You may be a candidate for spinal surgery if:
- Medication and physical therapy are ineffective.
- Progressive neurological deficits develop, such as leg weakness and/or numbness.
- Radicular pain limits normal activity or impairs quality of life.
- You experience loss of normal bowel and bladder functions.
- You have difficulty standing or walking.
- You are in reasonably good health.
Lumbar spine surgery. A lumbar (lower back) laminotomy and discectomy removes the herniated disc, alleviating leg pain and sciatica. This surgery may be performed via open and minimally-invasive approaches. If you have questions about the surgery and your recovery, be sure to ask your doctor.
Frequently asked questions (FAQs) about herniated discs
With every person having a different pain tolerance, measuring the pain of a herniated disc can be difficult. In some patients, pain is described being a sharp or burning feeling, and can go on to cause numbness or tingling down one side of the body.
No. Herniated disk pain depends on if the disc is pressing on any nerves. If there is nerve pressure, there can be pain or discomfort. However, some people are fortunate enough not to experience any pain.
Yes, a bulging disc can become a herniated disc. If you have a bulging disc, you may experience few or no symptoms. However, if the bulge worsens, symptoms will become more noticeable as it reaches the stage where it is near or at herniation.
Typically, slipped discs can heal with conservative therapy, rest, and proper exercise over a period of days up to a couple of months. Should the herniated disc symptoms persist following your treatment plan, surgery may become an option.
For the most part, you should avoid any activities that involve excessive bending or twisting of the back, including high-impact aerobics and high-level core strength. You should also avoid heavy lifting, sudden pressure on the back, or repetitive strenuous activities during recovery. In general, if you feel pain when doing an activity or exercise, stop immediately.
Certain elevated and repetitive leg motions like stair climbing can aggravate disc herniation.
Mending a herniated disc at home begins with relaxing the muscles through over-the-counter anti-inflammatory medicine, and the application of heat and/or cold therapy. Heat can relieve the muscles of tightness and spasms by increasing the blood flow and improving the elasticity of connective tissue. Cold therapy reduces inflammation and acts as a painkiller in the local area that is causing the discomfort. Together, conservative treatments like these along with rest and prescribed exercises can bring comfort for those with a herniated disc.
Special extension exercises can help relieve pain from a herniated disc. Exercise can work like a vacuum to suck the center of the disc back into place, helping release pressure on the nerve. Although someone suffering an attack of back pain may think it’s counterintuitive, it has been proven that specific exercises can help relieve pain.
Low impact activities, like walking, can often help a patient with herniated disc related pain and help maintain the strength of the muscles supporting the spine.
Massage can be beneficial for a herniated disc because it effectively relaxes the muscles and reduces tension and muscle spasms surrounding the disc.
Deep tissue massage is an ideal option if you have a herniated disc because it uses a great deal of pressure to relieve deep muscle tension and spasms, which develop to prevent muscle motion at the affected area.
If your physician has determined that all non-invasive herniated disc treatments have been exhausted, with little relief, then surgery may be considered. For the most part, few patients with a herniated disc need surgery.
Back surgery is only suggested for a herniated disc after more conservative treatments have failed. When symptoms and pain continue beyond six weeks, surgery may be the next best option.
Microdiscectomy and endoscopic microdiscectomy are both minimally invasive back surgery that removes parts of the herniated disc that is pressing on the nerves which helps alleviate the pain and has a high rate of success.
References
American Association of Neurological Surgeons (AANS). Herniated Disc (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Herniated-Disc)
Orthoinfo: American Academy of Orthopaedic Surgeons. Herniated Disk in the Lower Back (https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/)
MedlinePlus: National Library of Medicine. Herniated disk (https://medlineplus.gov/ency/article/000442.htm)