Herniated Disc

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Introduction

What is a herniated disc?

A herniated disc occurs when the disc between two vertebrae ruptures and its contents pops out. This causes the disc to collapse and puts pressure on the spinal nerves. A herniated disc is usually caused by drying out and degeneration of a disc during the aging process. It can also be acutely caused by improper physical movement.

Your back and neck have soft, rubbery discs between every two vertebrae in your spinal column that absorb shock and assist spinal flexibility. Down the center of this spinal column runs the hollow spinal canal, which carries the spinal cord and a bundle of nerve roots. When a disc is herniated, the protrusion of disc contents usually presses on these nerves and stimulates inflammation. The most common symptoms include weakness, tingling or pain in the shoulders or extremities. Sciatica is a term used to refer to a sharp, shooting pain that runs down the full length of the back of one leg that is often caused by disc disease in the lower spine and impinging on the sciatic nerve.

Herniated disc occurs most frequently with aging, and most commonly occurs in the lumbar, or lower, spine. With proper treatment, usually a combination of pain medication and physical therapy, disc herniation symptoms can resolve within four to six weeks.

Herniated disc is not life threatening, but in some cases it can lead to nerve damage that can be permanently debilitating. Seek immediate medical care (call 911) for serious symptoms of nerve compression, such as loss of sensation in the limbs or shoulders, a complete loss of balance, or loss of bladder or bowel control (especially in combination with weakness in your legs). Also seek immediate care for abnormal sensations, weakness, or numbness in the shoulders or extremities on one side of your body.

Seek prompt medical care if you are being treated for herniated disc but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of a herniated disc?

Symptoms of herniated disc include lower back pain, especially when bending forward; sciatica, a shooting pain down the full extent of the back of one leg; muscle weakness in one limb; pain, numbness, tingling, or an abnormal sensation in one shoulder, limb or buttock; and neck pain.

Common symptoms of a herniated disc

You may experience herniated disc symptoms daily or just once in a while. At times any of these symptoms can be severe:

  • Headache (particularly in the back of the head)
  • Lower back pain
  • Muscle spasms
  • Muscle weakness in one limb
  • Neck, shoulder, or arm pain
  • Pain, numbness, or tingling in one leg or buttock
  • Sciatica
  • Twitching in arms or legs

Symptoms that might indicate a serious condition

In some cases, herniated disc can be a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care if you, or someone you are with, have any of these serious symptoms including:

  • Abnormal sensations, tingling, or weakness on one side of the body

  • Impaired balance and coordination

  • Increased pain at night

  • Loss of bladder or bowel control

  • Loss of sensation in a limb or limbs

  • Muscle weakness in the arms or legs

  • Neck pain

Causes

What causes a herniated disc?

A herniated disc occurs when the disc between two vertebrae ruptures and its inner central nucleus pops out, causing the disc to protrude toward or against the spinal canal and put pressure on the spinal nerves. While this is usually caused by a disc drying out and degenerating during the aging process, it can also be caused by improper physical movement.

What are the risk factors for a herniated disc?

A number of factors increase the risk of developing herniated disc. Not all people with risk factors will get herniated disc. Risk factors for herniated disc include:

  • Age
  • Excessive body weight
  • Improper heavy-lifting technique
  • Middle to older age group
  • Repetitive strenuous activity
  • Smoking

Reducing your risk of a herniated disc

You may be able to lower your risk of herniated disc by:

  • Avoiding smoking
  • Bending knees and hips when lifting
  • Controlling your weight
  • Stretching prior to exercise activities
  • Taking breaks from strenuous activities

Treatments

How is a herniated disc treated?

Nonsurgical treatments are effective in most cases. These involve the use of muscle relaxant drugs, analgesics, and anti-inflammatory medications, as well as modifying or eliminating some activities until you are healed.

If these measures are not successful, epidural injections of a corticosteroid or cortisone-like drug can relieve pain, and are especially useful in relieving enough pain in order for you to participate in a physical therapy regimen. In some cases you may need surgery.

In most cases, following your treatment plan of medication and physical therapy is completely effective. Surgical procedures, when needed, have also proven highly effective.

Analgesics and anti-inflammatories for pain and inflammation

The most common treatment for the pain or inflammation associated with herniated disc is analgesics (for pain relief) and anti-inflammatory medications. These include:

  • Acetaminophen (Tylenol)
  • Aspirin (Easprin, Ecotrin, Empirin)
  • Celecoxib (Celebrex)
  • Diclofenac (Voltaren)
  • Ibuprofen (Advil, Motrin)
  • Indomethacin (Indocin, Indocin SR)
  • Naproxen (Aleve, Naprosyn)
  • Oxaprozin (Daypro)

Muscle relaxants

In addition to analgesics and anti-inflammatory drugs, your medical practitioner may add or substitute a muscle relaxant. These most frequently include:

  • Carisoprodol (Soma, Vanadom)
  • Cyclobenzaprine (Flexeril)
  • Diazepam (Valium)
  • Metaxalone (Skelaxin)
  • Methocarbamol (Robaxin)
  • Orphenadrine citrate

Epidural corticosteroids

An epidural corticosteroid injection may be used to enable you to participate fully in physical therapy. This is usually a corticosteroid epidural injection.

Surgical Treatments

In some cases you may need surgery, particularly if a disc fragment is lodged in your spinal canal and is pressing on a nerve, which can cause significant loss of function.

What you can do to improve your herniated disc

In addition to following your specific treatment plan, you can also minimize back pain by:

  • Applying cold for 20 minutes several times a day

  • Applying heat after muscle spasms

  • Avoiding high heeled shoes

  • Avoiding sleeping on your stomach

  • Bending your knees and hips when lifting (keeping your back straight), if you are allowed to do any lifting

  • Easing into exercise and stretching as your medical practitioner directs

  • Elevating your knees above your hips when sitting for an extended period

  • Practicing good posture

  • Shifting your weight if you must stand for an extended period

Complementary treatments

Some complementary treatments may help some people to better deal with herniated disc. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

What are the potential complications of a herniated disc?

Complications of untreated herniated disc can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of herniated disc include:

  • Loss of bladder or bowel control

  • Permanent disability

  • Permanent nerve damage

  • Progressive pain, weakness, and loss of muscle function

  • Saddle anesthesia (permanent loss of sensation in the inner thighs, back of legs, and rectal area)

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Herniated disk. FamilyDoctor.org. http://familydoctor.org/online/famdocen/home/common/brain/disorders/341.html.
  2. Herniated disk. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00334&return_link=0
  3. Battié MC, Videman T. Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am 2006; 88 Suppl 2:3.
  4. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012.
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