Know the basics
1. What is a herniated disc?
A herniated disc refers to a problem with one of the rubbery cushions (discs) between the individual bones (vertebrae) that stack up to make your spine.
A spinal disc is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disc or a ruptured disc, a herniated disc occurs when some of the softer “jelly” pushes out through a tear in the tougher exterior.
2. How common is a herniated disc?
A herniated disc is a relatively common condition that can occur anywhere along the spine, but most often affects the lower back or neck region. Please discuss with your doctor for further information.
The common symptoms of a herniated disc are:
- Arm or leg pain. If your herniated disc is in your lower back, you’ll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disc is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
- Numbness or tingling. People who have a herniated disc often experience numbness or tingling in the body part served by the affected nerves.
- Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
You also can have a herniated disc without knowing it — herniated discs sometimes show up on spinal images of people who have no symptoms of a disc problem.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
Diagnosis & Treatments
1. How is a herniated disc diagnosed?
History and physical examination point to a diagnosis of a herniated disc. A herniated disc is likely if low back pain is accompanied by radiating leg pain in a nerve root distribution with positive straight leg raising test (ie, elevating the leg while lying down causes radiating pain down the leg), and other neurologic deficits such as numbness, weakness, and altered reflexes.
Imaging studies are usually necessary to confirm a diagnosis of a herniated disc. X-rays are not the imaging medium of choice because soft tissues (eg, discs, nerves) are hard to capture with this technology. However, they may be used as an initial tool to rule out other disorders such as a growth or fracture. Confirmation of the suspicion of herniated disc is generally accomplished with:
- Magnetic Resonance Imaging (MRI): This technology reveals the spinal cord, surrounding soft tissue and nerves. It is the best imaging study to support the diagnosis of a herniated disc.
- Nerve Conduction Studies (NCS) and Electromyogram (EMG): These studies use electrical impulses to measure the degree of damage to the nerve/s caused by compression from a herniated disc and other conditions that cause nerve impingement can be ruled out. NCS and EMG are not routine tests to diagnose herniated disc.
2. How is a herniated disc treated?
Conservative treatment — mainly avoiding painful positions and following a planned exercise and pain-medication regimen — relieves symptoms in most people within a few days or weeks.
Over-the-counter pain medications. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others).
• If your pain doesn’t improve with over-the-counter medications, your doctor might prescribe narcotics, such as codeine or an oxycodone-acetaminophen combination (Percocet, OxyContin, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs.
• Drugs originally designed to control seizures also may be helpful in the treatment of the radiating nerve pain often associated with a herniated disc.
• Muscle relaxers. Your doctor may prescribe muscle relaxants if you have muscle spasms. Sedation and dizziness are common side effects of these medications.
• Cortisone injections. The doctor may inject inflammation-suppressing corticosteroids directly into the area around the spinal nerves. Spinal imaging can help guide the needle more safely. Occasionally a course of oral steroids may be tried to reduce swelling and inflammation.
If your pain has not resolved within a few weeks, your doctor may suggest physical therapy. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disc.
A very small number of people with herniated discs eventually need surgery. Your doctor may suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to experience:
- Numbness or weakness
- Difficulty standing or walking
- Loss of bladder or bowel control
In many cases, surgeons can remove just the protruding portion of the disc. Rarely, however, the entire disc must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability. Rarely, your surgeon may suggest the implantation of an artificial disc.
Some alternative and complementary medicine treatments may help ease chronic back pain. Examples include:
Chiropractic. Spinal manipulation has been found to be moderately effective for low back pain that has lasted for at least a month. Rarely, chiropractic treatment of the neck can cause certain types of strokes.
- Although results are usually only modest, acupuncture appears to ease chronic back and neck pain fairly well.
- This hands-on therapy can provide short-term relief to people dealing with chronic low-back pain.
- A combination of physical activity, breathing exercises and meditation, yoga can improve function and relieve chronic back pain in some people.
Seek medical attention if your neck or back pain travels down your arm or leg, or if it’s accompanied by numbness, tingling or weakness. If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
1. What causes a herniated disc?
A disc herniation is most often the result of a gradual, aging-related wear and tear called disc degeneration. As you age, your spinal discs lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.
Most people can’t pinpoint the exact cause of their herniated disc. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disc, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disc.
2. Risk factors
There are many risk factors for herniated disc, such as:
- Excess body weight causes extra stress on the discs in your lower back.
- People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disc.
- Some people inherit a predisposition to developing a herniated disc.
Need further information? Contact GO.CARE manage team to get more details from expert doctors and medical specialists.
GO.CARE does not provide medical advice, diagnosis or treatment.
|Herniated Disc Center. https://www.spineuniverse.com/conditions/herniated-disc. Accessed July 5, 2017.
Herniated disk. http://www.mayoclinic.org/diseases-conditions/herniated-disk/home/ovc-20271246. Accessed July 5, 2017.