What is a herniated disc?
A herniated disc is a common cause of back pain, and is also called a slipped or ruptured disc.
Spinal discs are fibrous sacs filled with a jelly-like nucleus between each vertebrae, allowing the spine to twist and bend. A herniated disc occurs when the outer wall of the disc weakens or ruptures, allowing the soft interior to push through and into the spinal column.
What are some of the symptoms of a herniated disc?
Although some herniated discs produce no symptoms, the most common result is back pain. Most herniated discs occur in the lower spine, but they can cause pain, weakness, tingling and/or numbness in the neck, arms and legs.
The pain caused by a herniated disc falls into two categories:
1. Pinched nerve — Occurs when the jelly-like nucleus that has pushed through the fibrous outer wall of the disc presses up against nearby nerve roots. This type of pain can radiate through the spine and into the neck, arms and legs. Numbness and weakness of the arms or legs is also common.
2. Disc pain — Also called axial pain, this emanates from the disc space itself, usually causing low back and/or leg pain.
What causes a herniated disc?
A herniated disc is caused by one of the three reasons:
1. Disc degeneration — As our spinal columns age, they succumb to years of wear and tear. Spinal discs can lose some of their moisture, making them less flexible and more likely to rupture.
2. Injury — Injuries that result in a herniated disc are either caused by a sudden, heavy strain or increased pressure on the spine, or by repetitive actions done over the course of days or even years that can stress the back, like lifting or engaging in other spinal weight-bearing activities with poor technique.
3. Trauma — In rare instances, sudden trauma like a fall or blow to the back can cause a herniated disc.
In general, herniated discs can occur more easily in people with a history of back pain and sports-related injuries.
What factors can increase your risk of a herniated disc?
Factors that increase your risk of a herniated disc may include:
• Weight — The spinal column, specifically the lower back, absorbs the burden of supporting excess body weight. Living within your recommended weight range can greatly reduce the chances of a herniated disc.
• Occupation — Physically demanding jobs often produce back problems. Herniated discs can result from repetitive lifting, bending, pulling, pushing and twisting. Any weight-bearing while engaging in these motions increases the chance of injury.
• Genetics — Those with a family history of degenerative bone and joint conditions or weaknesses are more susceptible to a herniated disc.
How can you tell if you have a herniated disc?
The symptoms of a herniated disc — back pain and pain, numbness, tingling, weakness in the neck, arms or legs — can be vague and easy to misdiagnose.
A physical exam with a certified practitioner consists of probing the back for tenderness and manipulation of the arms or legs, as well as a neurological exam to test reflexes, muscle strength, the ability to feel light sensations and walking ability.
In some cases, the following imaging tests can be used to help diagnose a herniated disc:
• X-rays can be used to rule out other common causes of back pain, such as alignment, bone damage, tumor or infection.
• Computerized tomography (CT) scans produce vertical and horizontal cross-sectional images, or “slices,” of the body’s interior.
• Magnetic resonance imaging (MRI) uses large magnets and a computer to produce detailed images of the structures inside the body.
In addition, electromyography and nerve conduction velocity (EMG/NV) tests measure how well electrical impulses move along nerve tissue, which can help pinpoint the location of the damage.
What treatments are available for a herniated disc?
Most people who have a herniated disc don’t need surgery to correct the problem.
Treatment options depend on the location and severity, but usually involve a combination of the following:
1. Limited activity — Avoiding painful positions and activities
2. Physical therapy — Planned exercise routines designed to reduce pain and increase flexibility, in addition to heat or ice application, traction, ultrasound, electrical stimulation and short-term bracing for the neck or lower back.
3. Medication — Ranges from over the counter ibuprofen (Advil, Motrin IB) or naproxen (Aleve) to pain management medications and muscle relaxers and cortisone injections
4. Epidural steroid injection - Injecting steroids removes irritation and decreases the inflammation and swelling around the nerves and discs, thus relieving pain and pressure.
In extreme situations where symptoms persist through the above treatments, surgery to remove part or all of the disk can be the only recourse. If the disc is completely removed, the vertebrae will either be fused together for stability, or separated by an artificial disc implant.