A herniated disc refers to a problem with one of the discs between the individual vertebrae that make up the spine. Think of the spinal disc as a jelly donut, with a softer center inside a tougher exterior—a herniated disc is like the “jelly” pushing out through a tear in the protective exterior.
Some people with herniated discs have no symptoms, but others deal with pain, numbness or weakness. Most patients with a herniated disc don’t need surgery, but some people will require it.
Common Signs and Symptoms
Most herniated discs take place in the lower back, but they can also take place in the neck. The most common signs or symptoms include:
- • Arm or leg pain: If the herniated disc is in the lower back, you’ll feel pain most intensely in your buttocks, thigh and calf. You may also feel pain in the foot. If the herniated disc is in the neck, you’ll notice the most intense pain in your shoulder and arm—pain may shoot into one of these areas when you cough, sneeze or move your spine into certain positions.
- • Numbness or tingling: Herniated discs can affect nerves in the body, and numbness or tingling often results in the affected area.
- • Weakness: Muscles that are served by the affected nerves may weaken, which can lead to stumbling or impair your ability to lift or hold things.
Some cases of herniated discs come without symptoms, and these cases might be discovered during imaging for other concerns despite no active symptoms.
Just below the waist, the spinal cord separates into a group of long nerve roots called cauda equina—these resemble a horse’s tail. In some cases, a herniated disc can compress the entire cauda equina, and emergency surgery may be required. If you have any of the following symptoms, seek emergency medical attention:
- • Worsening symptoms: If pain, numbness or weakness become so severe that you can’t complete daily tasks, seek attention.
- • Bladder or bowel dysfunction: Cauda equina syndrome may lead to incontinence or trouble urinating.
- • Saddle anesthesia: This is a progressive loss of sensation that affects the areas that would typically touch a horse’s saddle—the inner thighs, back of the legs and the area around the rectum.
Causes and Risk Factors
In most cases, disc herniation is a result of wear and tear that’s referred to as disc degeneration. Spinal discs lose water content over time, which makes them less flexible and more prone to tearing or rupturing. In most cases, the exact cause of a herniated disc can’t be pinpointed, although traumatic events like falls or blows to the back could cause it.
Factors that can increase risk of a herniated disc include:
- • Weight: More weight places more stress on discs.
- • Occupation: People who have physically demanding jobs have higher risk of back issues. Many of these movements, such as lifting, pulling, pushing, bending or twisting can increase the risk of a herniated disc.
- • Genetics: Some people inherit a higher level of risk.
Diagnosis and Treatment
In most cases, your doctor will only need a physical exam and medical history to diagnose a herniated disc. Your doctor may also perform a neurological exam to check reflexes, muscle strength, walking ability and ability to feel basic pricks or vibrations. In some cases, your doctor will order one of a few imaging tests.
Most people find their symptoms relieved over a period of a few days or weeks with conservative treatment, such as avoiding painful positions and following a planned exercise/pain medication regimen. Medications for herniated discs may include:
- • Over-the-counter pain medications
- • Narcotics: If OTC pain meds don’t improve pain
- • Anticonvulsants: These were originally designed for seizures, but they can also help with nerve pain associated with herniated discs.
- • Muscle relaxers: If you have muscle spasms.
- • Cortisone injections: To help reduce swelling or inflammation, these might be injected directly into the area around the spinal nerves.
Many people find success with physical therapy, which can help you find positions and exercises that minimize pain. In a small number of cases, surgery will be needed if conservative treatments fail to improve symptoms after six weeks, or if numbness, bladder control or trouble with standing or walking are still issues. This is usually just a removal of part of the disc, but in some cases, it will require removal of the full disc. In rare cases, your surgeon will recommend an artificial disc.
Others have found success with alternative medicines for back pain, including chiropractic care, acupuncture, massage and yoga.
Preventing Herniated Discs
There are a few tactics that can help prevent a herniated disc:
- • Exercise: Proper exercise techniques help stabilize and support the spine.
- • Practice good posture: Good posture reduces pressure on the spine. Make sure to also use proper posture while lifting heavy items—lift with the legs, not the back.
- • Maintain a healthy weight: More weight means more pressure.
If you’re showing the symptoms of a herniated disc, your doctor will recommend a treatment plan for you.