What causes a herniated disc?
The bones of your spine are cushioned by intervertebral discs. These discs act as vital “shock absorbers” to help reduce the effects of natural stresses placed on the spine during movement. The annulus fibrosus (the outer fibrous ring) and the nucleus pulposus (the inner, gel-like center) make up each disc.
A herniated disc, sometimes called a ruptured or “slipped” disc, occurs when the outer ring cracks or slowly degenerates, causing the “gel” in the center to leak out. Herniated discs are somewhat common. Several factors contribute to disc degeneration, including advanced age, lack of exercise, obesity and poor posture.
More acute factors, such as improper lifting, twisting or stretching may also cause a herniated disc. As you age, your discs may dry out or lose some of their inner composition, increasing the risk of disc problems. Some individuals may also have a genetic predisposition to disc problems, or the physical demands of their jobs may put them at an increased risk.
What are the symptoms?
Herniated discs present with various symptoms, ranging from dull pain and weakness to intense burning or back spasms.
Other symptoms include:
- Muscle spasm or cramping
- Numbness, tingling or pain in the buttock, hip, thigh or lower leg – typically on one side of your body (often called sciatica)
- Dull or sharp lower back pain that worsens with coughing, sneezing, bending or other sharp movement
- Weakness, pain or loss of function in the area impaired by the affected nerve – this may include the arm or leg, depending on which spinal region the herniated disc is located, and may result in an inability to lift certain items or walk without stumbling
How are they diagnosed?
Your physician will conduct a physical examination designed to assess:
- Your strength and limitations (including your ability to walk, lift or feel basic sensations)
- Medical history and symptoms through a one-on-one evaluation
In some instances, a series of imaging tests to confirm the diagnosis may be beneficial. In many cases, a review of symptoms and basic physical assessment are all that is needed to diagnose a herniated disc.
Should imaging be necessary, your physician may order an X-ray, MRI, CT scan or myelogram. These tests may be conducted to rule out other potential causes of your symptoms or better identify the exact source of the herniated disc.
How are they treated?
The vast majority of patients who suffer from herniated discs respond well to conservative treatment, including some combination of basic activity modification, a formal exercise or physical therapy plan, and pain management, as needed, through over-the-counter medication.
Your physician may recommend that you discontinue lifting certain items or sitting in certain positions. If over-the-counter medications do not resolve your pain, injections or nerve medications may be recommended, as well.
A very small percentage of patients with herniated discs ever require surgery. Your physician will continue to evaluate you over the course of six to twelve weeks. If your condition does not improve with conservative treatment, you may wish to discuss surgery options with your doctor.