Herniated disks

The vertebrae in your spine are separated by round “cushions” called disks. They have a softer inside and a tough outer layer. This outer layer can tear. The softer substance inside the disk can then push through the outer layer (“herniate”) and press against nerves, causing pain.

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Symptoms of herniated disks

The common symptoms of a herniated disk:

  • 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 disk 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 disk has slipped and isn’t resting on surrounding nerves, you may experience no symptoms.

Diagnosing herniated disks

In order to diagnose a herniated disk 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 disk 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 disk, 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 disks

Non-surgical treatments

The first course of treatment for a herniated disk 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 disk herniation using a spinal needle under X-ray guidance.

Surgical treatment

About 10% of those with herniated disks 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 disk, 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 disks

How painful is a herniated disk?

With every person having a different pain tolerance, measuring the pain of a herniated disk 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.

Does a herniated disk hurt all the time?

No. Herniated disk pain depends on if the disk 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.

Can a bulging disc become a herniated disk?

Yes, a bulging disk can become a herniated disk. If you have a bulging disk, 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.

Do herniated disks go away?

Typically, slipped disks can heal with conservative therapy, rest, and proper exercise over a period of days up to a couple of months. Should the herniated disk symptoms persist following your treatment plan, surgery may become an option.

What activities should you avoid with a herniated disk?

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.

Is climbing stairs bad for herniated disks?

Certain elevated and repetitive leg motions like stair climbing can aggravate disk herniation.

How do you fix a herniated disk at home?

Mending a herniated disk 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 disk.

Can you push a herniated disk back into place?

Special extension exercises can help relieve pain from a herniated disk. Exercise can work like a vacuum to suck the center of the disk 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.

Is walking good for a herniated disk?

Low impact activities, like walking, can often help a patient with herniated disk related pain and help maintain the strength of the muscles supporting the spine.

Is massage good for herniated disks?

Massage can be beneficial for a herniated disk because it effectively relaxes the muscles and reduces tension and muscle spasms surrounding the disk.

Deep tissue massage is an ideal option if you have a herniated disk 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.

Should I get surgery for a herniated disk?

If your physician has determined that all non-invasive herniated disk treatments have been exhausted, with little relief, then surgery may be considered. For the most part, few patients with a herniated disk need surgery.

How successful is back surgery for herniated disks?

Back surgery is only suggested for a herniated disk 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 disk 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)