A herniated disc, also known as a slipped or ruptured disc, occurs when the soft inner gelatinous nucleus pulposus of an intervertebral disc is pushed out through a tear or fissure in the tougher exterior annulus fibrosus. This can cause pain, numbness, tingling or weakness in the back and extremities depending on the location of the herniated disc in the spine. Herniated discs are most common in the lumbar spine (lower back) and the cervical spine (neck), but can occur anywhere along the length of the spine.
The most common symptoms of a herniated disc include:
– Localized pain in the back near the site of the herniated disc is very common. This occurs as the disc pushes on or irritates nearby nerves.
– Pain may worsen with certain positions or movements that increase pressure on the affected disc. Sitting, bending, twisting or lifting are often aggravating factors.
– The pain is often described as sharp, shooting or burning in nature. It may radiate out from the back into the buttocks or thighs.
– Sciatica refers to radiating leg pain that follows the path of the sciatic nerve, which runs from the lower back down the back of each leg.
– Sciatica occurs when a herniated disc in the lumbar spine irritates or presses on the sciatic nerve roots.
– Pain typically radiates down one leg and into the foot or toes. Numbness, tingling or weakness may also occur along the affected nerve distribution.
– A herniated disc in the neck region can irritate nerve roots exiting the cervical spine, causing pain and neurological symptoms to radiate down one or both arms.
– This is referred to as cervical radiculopathy or a pinched nerve in the neck.
– Symptoms may include numbness, tingling, weakness or burning sensations shooting down the arm into the hands or fingers on one side.
What Causes the Pain?
There are a few mechanisms that are responsible for producing pain and symptoms from a herniated disc:
1. Mechanical Compression
– The displaced disc material can press directly on the spinal nerve roots as they exit the spine. This compresses the delicate nerves.
– Nerve compression interrupts normal nerve signaling, leading to symptoms of radiating pain, numbness and weakness along the compressed nerve.
– Chemicals from the nucleus pulposus disc material can irritate and inflame the surrounding nerves. This is because the inner disc material is not meant to be exposed.
– Inflammation around spinal nerves can make them extra sensitive, causing neuropathic pain signals to be generated with even small amounts of irritation or pressure.
– A herniated disc can affect the biomechanics and stability of the spine. This can put additional pressure on surrounding discs, joints and nerves.
– Abnormal motion or instability between vertebrae is painful and can further compress nerves. The muscles may spasm in response as well.
Common Areas for Herniated Discs
The most frequent locations for herniated discs include:
– About 95% of herniated discs occur in the low back or lumbar spine, between L3-S1.
– A lumbar herniated disc often causes sciatica pain radiating down the legs.
– Herniated discs in the neck or cervical spine make up about 4% of cases.
– Upper extremity radicular symptoms are common, such as numbness, tingling or weakness radiating down the arms into the hands.
Less Common Locations
– Thoracic spine: The mid back or thoracic region contains less mobile vertebrae and fewer nerve roots, so herniated discs are less common here.
– Lumbosacral: This transition area between the lumbar spine and sacrum has some mobility and vulnerability to herniated discs.
Certain factors can increase your risk of developing a painful herniated disc. These include:
– Age: Discs deteriorate with age. Herniated discs are most common between ages 35-50.
– Occupation: Jobs with frequent lifting, bending, twisting or vibration raise risk. Construction, manufacturing, nursing and office work with long periods of sitting are associated with more disc herniations.
– Obesity: Excess weight puts more strain on the spine, especially the lower back. Increased body weight is linked to higher incidence of lumbar disc herniations.
– Sedentary Lifestyle: Weak back muscles provide less support for discs. Regular exercise helps maintain muscle strength and flexibility.
– Genetics: Some people inherit weaker connective tissues that make discs more likely to deteriorate.
– Prior Injury: Previous significant back injuries make future herniated discs more likely. Damaged areas become weaker.
Diagnosing a Herniated Disc
If a herniated disc is suspected based on symptoms, a physician will perform examinations and tests to confirm the diagnosis. These can include:
– Physical exam assessing range of motion, reflexes, muscle strength, pain and neurological function
– Medical history questions to understand onset, location, severity and triggers for pain
– Imaging tests:
– X-ray to see changes in disc spaces and alignment
– CT scan for a cross-sectional view of the discs and nerves
– MRI for the best soft tissue visualization of disc herniations and nerve impingement
– Electromyography (EMG) to measure nerve impulses and check for nerve damage
Herniated Disc Pain Relief Options
Many patients with a herniated disc improve with conservative treatment methods focused on alleviating pain and allowing the body to heal. Nonsurgical options may include:
– Over-the-counter medications like NSAIDs (ibuprofen, naproxen) or acetaminophen for mild pain relief.
– Prescription opioids for short-term use in cases of severe acute pain.
– Muscle relaxants to help reduce painful muscle spasms.
Ice and Heat
– Ice packs can help reduce inflammation for the first 2-3 days after injury or acute flare-ups. Apply ice wrapped in a towel for up to 20 minutes several times per day.
– Heat wraps, warm baths or heating pads may help relieve muscle tension and spasms after the first few days. Use a moderate heat setting for 15-20 minutes at a time.
– Avoid strenuous activity and get ample rest, especially during flare-ups. Let pain be your guide for when to rest your back.
– Sleep on a supportive mattress. Lying on your side in a fetal position with a pillow between your knees may help.
– Stretches and exercises can improve mobility, strengthen muscles, and correct posture issues like muscle imbalances. This provides better spine support.
– Traction, massage, ultrasound and other modalities may also be used to decrease pain.
Epidural Steroid Injections
– Steroid medication injected near irritated spinal nerves can help reduce local inflammation.
– Providing short-term relief, allowing time for conservative treatment to become effective.
– Alternative options like chiropractic adjustments, acupuncture, yoga, or massage therapy may complement other pain relief treatments.
– A structured multidisciplinary rehabilitation program can optimize results through combined therapies.
When Is Surgery Needed for a Herniated Disc?
Most patients improve with nonsurgical treatment, but surgery may be considered if:
– Legs or arm weakness progresses due to nerve damage
– Bowel/bladder dysfunction develops, indicating spinal cord compression
– Chronic severe pain is unrelieved by conservative measures over 6-12 weeks
– The herniated disc is very large, extruded or sequestered
Possible surgical procedures include:
– Microdiscectomy – Removing the protruding portion of the disc compressing the nerve root
– Laminectomy – Accessing the disc by removing a portion of the lamina bone
– Spinal fusion – Permanently joining two or more vertebrae together to eliminate motion and instability
While herniated discs often occur due to age-related changes in the spine, you can take proactive steps to help reduce your risk:
– Exercise regularly to build core and back muscle strength as well as flexibility
– Maintain proper posture and use good lifting mechanics – lift with the legs, keep the load close to your body
– Manage your weight to avoid excessive stress on the spine
– Be careful with high-impact activities and sports to avoid acute disc injuries
– Listen to your body and stop activities causing new back pain
– Address chronic coughs which can increase intradiscal pressure
The hallmark of a herniated disc is pain radiating into the arms or legs caused by compression and inflammation of spinal nerves. Low back herniations with sciatica are most common, but discs can herniate anywhere along the spinal column. With an accurate diagnosis, most patients find relief through conservative treatments focused on pain management and physical therapy. Surgery may be a last resort option if weakness progresses or pain remains unrelenting. Being proactive about spinal health through regular exercise, core strengthening, proper lifting and healthy weight can help prevent many herniated discs.