Herniated Disc

What is a Herniated Disc?

A herniated disc is a rupture of the outer casing of the disc. Discs are shock-absorbing cushions separating the vertebrae. Discs have a tough outer coating and a jelly-like inner substance.

Discs don’t actually slip out of place - they are firmly attached to the vertebrae. A disc can, however, bulge out beyond its normal position and the outer casing can tear or rupture. This is called a herniated disc.

*Always consult a doctor for pain that spreads down your leg or is accompanied by tingling, numbness or weakness.

Symptoms

When a disc is ruptured some of the inner substance protrudes and may irritate the spinal nerves. If this occurs in the lower back, it may cause sciatica - pain and/or numbness that radiates from the lower back, through the buttocks, back of the leg, and sometimes to the foot. The pain can vary, from a burning sensation or a dull ache. It may be intermittent or chronic. The severity of the pain can range from mild to severe. In some cases, there may not be any symptoms.

*When a nerve is compressed it is often referred to as a "pinched nerve."

While a herniated disc is the most common cause of a "pinched nerve" in the lower spine, other conditions such as spinal stenosis, swelling of surrounding tissues due to muscle injury, and bone spurs that may occur in osteoarthritis of the spine may compress spinal nerve roots.

The lower back (lumbar spine) is the most common location for a herniated disc as the lower back is subject to the most mechanical stress and supports most of the weight of the body. If a herniated disc occurs in the neck area (cervical spine), pain, tingling and weakness may occur in the arm or hand.

Is there a difference between a herniated disc and a bulging disc?

These terms are often used interchangeably – both are often used as catchall descriptions for an abnormality of a disc. The term bulging disc is usually used to describe a disc that bulges slightly and does not produce symptoms. A herniated disc is usually used to describe a disc that protrudes against a spinal root nerve and causes pain. However, some bulging discs bulge enough to cause problems and some herniated discs do not cause any problems.

Definition of a bulging disc:
Sometimes the disc does not actually rupture but bulges due to a weakening of the outer part of the disc that lets the inner fluid to push against the weakened wall and cause a bulge – this is called a bulging disc

Definition of a herniated disc:
A herniated disc is a rupture of the outer casing of the disc. The inner substance of the disc then protrudes.

Causes/Risk Factors and Prevention

A Herniated Disc Can Develop Gradually or Suddenly

A herniated disc is often the result of gradual degenerative changes in the discs that occur over a long period of time that make the discs susceptible to injury.

A herniated disc may also occur suddenly, e.g. by excessive compression of the disc, as in a fall or car accident or even lifting a heavy object. Click here for proper lifting techniques.

Disc damage often occurs gradually and sets the stage for a herniated disc. Even when a herniated disc has developed gradually, the back pain caused by a herniated disc can occur suddenly.

Aging and herniated disc:

Bulging discs are considered a normal part of aging. Bulging discs often cause no problems, but if a bulging disc protrudes against a spinal root nerve, back pain can result. A bulging disc is more susceptible tearing, and becoming a herniated disc.

Lack of Exercise and herniated disc:

Muscles support the spine and help maintain proper posture. Weak muscles can’t adequately support the spine and discs become more compressed and subject to damage. A damaged disc is more likely to become a herniated disc. Strengthening exercises are essential to counteract the gradual loss of muscle mass that comes with aging.

Body Weight:

Being overweight also causes extra compression of the discs, increasing the risk of a herniated disc. Even small reduction in body weight can make a difference.

Posture and herniated disc:

Poor Posture contributes to gradual disc damage and herniated disc. The pressure on the discs from poor posture is uneven, causing uneven wear on the discs. When the natural curve of the lower back is increased (sway back) or decreased (flattened back) the discs are more compressed. This increases the risk of herniated disc.

Activities and herniated disc:

When bending forward at the waist, extra weight is placed on the front of the discs causing compression to the front of the discs. Exercises like toe-touching and bending forward to stretch the legs cause excess compression of the discs in the lower back and can cause gradual damage.

Treatment / Pain Relief

*See a physician immediately if pain radiates down your leg, or is accompanied by tingling, numbness or weakness to rule out serious conditions that may require immediate surgery.

Since most herniated discs improve without surgery (the protruding part of the disc may gradually shrink), the focus is on treating the pain and any inflammation. NSAIDs (anti-inflammatory medications) such as aspirin and ibuprofen are often helpful. Stronger prescription pain medications may be needed for severe pain.

Muscles often spasm around the site of pain. Stretching exercises and/or massage therapy can help release muscle spasms and pain. Muscle relaxants are sometimes prescribed. Calcium and magnesium supplements can also help reduce muscle spasms.

The use of heat and cold often relieves pain. See back pain treatment for more information. Traction is not recommended for acute lower back pain but may relieve chronic lower back pain, especially disc problems and sciatica. Click here for information on complementary treatments.

Stretching exercises for the back increase spaces between the vertebrae, relieving pressure on the discs and allowing more room for the spinal nerves. Low-impact aerobic exercise such as walking and swimming increase blood flow to the discs and promote healing. Strong muscles are necessary for keeping the spine in proper alignment. Strengthening exercises should be eased into very gradually to avoid straining the back. Avoid exercises that place pressure on the lower back until the pain has subsided or as recommended by a physician or physical therapist. Click here for more on back exercises.

A firm mattress will help keep the spine in proper alignment. Avoid sleeping on the stomach as this shortens back muscles, increases the curve in the lower spine and increases pressure on the discs and spinal nerves.

Any movement or activity that increase symptoms of pain or numbness should be avoided. Avoid activities that strain the back such as heavy lifting and maintain proper posture. Poor posture decreases the space between the vertebrae and increases pressure on the discs. Sitting places more pressure on the discs in the lower back than standing. Avoid sitting for long periods of time. A chair that reclines slightly shifts the body weight to the backrest of the chair and takes some stress off of the discs in the lower spine. Click here for more on posture. High heels also throw the spine out of alignment and increases pressure on the discs in the lower back.

Invasive Treatments

Spinal injections may be used when severe radicular pain does not respond to non-invasive treatments. A mixture of corticosteroids (a powerful anti-inflammatory) and a local anesthetic is used in spinal injections. There are rare but serious risks involved.

Pain relief often lasts from between a few weeks to few months. Many people experience relief from one injection, others may need up to three. If no pain relief at all is obtained from the first injection, no more are usually given.

A selective nerve block is an injection given near the nerve root that appears to be causing the pain where it exits the spinal column.

An epidural steroid injection is an injection of steroids and a local anesthetic into the epidural space (the space between the membrane covering the spinal cord and the wall of the spinal canal).

Surgery does not guarantee pain relief. In the time it takes to recover from surgery, most herniated discs will have improved without any treatment. Though surgery is usually a last resort, if there are signs of progressive nerve damage (e.g. progressive weakness), waiting too long to have surgery may result in permanent nerve damage.

*If nerves that affect bladder or bowel control are affected, immediate surgery is necessary to prevent permanent nerve damage.

Fortunately, the vast majority of herniated discs improve without surgery.

A herniated disc is not nearly as common a cause of back pain as muscle or ligament strain.

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