What is a Herniated Disc?

A herniated disc (also spelled: herniated disk) is a problem with the disc in the spinal column. It is also called a slipped disc or ruptured disc.

The human spine consists of bones called vertebrae that are separated by rubbery pads called spinal discs. Each spinal disk has a soft, gel-like or jelly-like central part called the nucleus pulposus (also called nucleus). This is surrounded by a protective, rubbery outer layer called the annulus fibrosus (also called annulus). Herniated disc disorders are conditions in which a part of the nucleus pulposus herniates or slips out through a break or tear in the annulus.

Herniated disks can develop in any part of the spine but are most common in the lower back (this is called a herniated lumbar disc).

Causes of Herniated Discs

Disk herniation frequently occurs due to disk degeneration, which is a gradual wear and tear caused by age. As you grow older, the disks in your spinal canal become less flexible. This increases the risk of tearing or rupturing of a disk with even minor strains and sprains.

It is usually impossible to pinpoint the exact injury or cause of a herniated disk in most people. Common causes include:

Lifting heavy objects using your back muscles instead of your thigh and leg muscles.
Twisting while lifting heavy objects.
Traumatic injuries due to falls or blows to the back (rare).

Risk Factors for Herniated Discs

Your risk of developing a herniated disk may be higher if:

You are obese or overweight. Excess body weight can put pressure on the spinal disks in your lower back.
You have a physically demanding job that requires repetitive lifting, pulling, pushing, twisting, or bending, increasing your risk of back problems.
You sit for prolonged periods, especially if you drive frequently. Sitting for long periods and vibrations from the car engine can place stress on your spine.
You have a family history of problems with herniated discs. The predisposition to develop a herniated disk can be inherited in some cases.
You smoke, which can lead to decreased oxygen supply to your spinal disks, making them more prone to injuries.
You have a sedentary lifestyle. Regular exercise is necessary to strengthen the muscles surrounding your spinal cord and prevent herniated discs.

Symptoms: Could I Have a Herniated Disc?

Common symptoms of a herniated disk include back or neck pain, numbness, and weakness. Depending on the location of the herniated disk in the spinal column, the symptoms can be present in an arm or leg.

Note: Herniated discs do not cause any symptoms in many people. When present, the symptoms can be managed with pain medication and usually improve gradually over time. Most herniated disks heal in 4-6 weeks. Surgery is rarely required to correct a spinal disk herniation.

Lower Back Symptoms from Lumbar Spine Disk Herniation

When a spinal disc in the lower back bulges or herniates, it can cause symptoms due to spinal nerve inflammation (pressure and irritation of the spinal nerves). Lumbar herniated disk symptoms can include:

Back pain. Pain in the back from lumbar disc herniation is usually worse with movements such as bending, prolonged sitting or standing, coughing, and sneezing, and improved with rest.
A sharp pain in the buttock, hip, or leg.
Paresthesias (numbness and tingling) in parts of the body such as the back of the calf or the sole of the foot.
Weakness in the leg or hip muscles.
Spasms in the back muscles.
Sciatica (a sharp pain that shoots down the sciatic nerve at the back of the leg).
Decreased reflexes in the knee or ankle.

Leg Symptoms

A herniated or bulging disk can cause leg symptoms, including:

A sharp or burning leg pain that travels down one or both legs.
Numbness or tingling in the legs, feet, or other parts of the body.
Muscle weakness in the legs, making it difficult to walk, climb stairs, or lift things.
Loss of reflexes in one or both legs.

Neck Symptoms: What Are The Symptoms of a Herniated Disc at C2?

A herniated disc in the neck (C2 or other cervical spine levels) can irritate a cervical nerve root and cause symptoms such as:

Pain in the neck, particularly in the back and sides of the neck. This neck pain typically increases with turning or bending the neck. The pain may also be felt near or between the shoulder blades. It can also radiate to the arm, hand, and fingers.
Numbness or tingling in the shoulder, upper arm, elbow, forearm, hand, and fingers.
Weakness in the shoulder or arm muscles.
A type of headache called a cervicogenic headache, which can cause pain in the back of the head, temples, or behind the eyes.
Radiculopathy (radiating pain that starts in one part of the body and travels to another part of the body). This pain may come and go intermittently, often lasting a few minutes or less at a time.

What Does A Bad Herniated Disc Feel Like?

Severe and Rare Symptoms

Trouble with fine motor activities such as buttoning a shirt.
Problems with balance and coordination.
Loss of bowel or bladder control.
Foot drop.
Saddle anesthesia (a progressive loss of sensation in the groin, thighs, and buttocks - the areas that would normally come in contact with a saddle). This can be a sign of cauda equina syndrome, a rare but serious condition in which there is compression of the nerves at the lower end of the spinal cord. It requires immediate surgery to decompress the nerves.

How Do You Know If Disc Has Re-Herniated?

A return of symptoms such as pain, numbness, and weakness may be a sign that a disk has re-herniated.

Impact of a Herniated Disk on Daily Life

Herniated discs can impact your daily life and quality of life:

You may need to limit certain movements that increase pain, decreasing your ability to do household chores and work duties and participate in some activities.
Back pain can make it difficult for you to bend, lift heavy objects, twist, or bend.
Muscle weakness in your arm or hand can make it difficult for you to hold or lift things. Decreased grip strength can make opening jars difficult.
Muscle weakness in the hips and legs can make it difficult to stand, walk, and climb stairs.
You can develop depression and anxiety from being in constant pain.

Diagnosis of Disk Herniation

To diagnose a herniated disk, your healthcare provider will obtain a medical history and perform a physical examination, including testing muscle strength, reflexes, sensation, and your ability to walk.

Imaging Tests

Your doctor can typically diagnose a herniated disk based on your history and physical exam. But if your healthcare provider suspects something else might be going on, they may request imaging tests such as X-rays, magnetic resonance imaging (MRI), CT scan, and a myelogram.

Nerve conduction studies and electromyogram (EMG) can help your doctor see how nerve signals travel and identify the spinal level where nerve damage has occurred.

Differential Diagnosis: What Can Be Mistaken For a Herniated Disc?

A herniated disc can cause the same or similar symptoms as the following conditions:

Mechanical back or neck pain
Degenerative spinal stenosis
Osteophytes
Discal cyst
Synovial cyst
Epidural hematoma
Epidural abscess
Diabetic amyotrophy
Neurinoma
Metastasis
Cauda equina syndrome

When to Seek Medical Attention

Seek immediate medical care if you develop:

Worsening pain, numbness, and weakness.
Bladder or bowel dysfunction (urinary incontinence or stool leakage).
Saddle anesthesia.
Trouble with balance or coordination.
Foot drop.
Progressive motor or sensory disability.

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Managing and Treating a Herniated Disc

Self-Care and Home Remedies

Self-care and home treatment for a herniated disk or slipped disk includes avoiding activities that cause pain and taking over-the-counter pain medicines. You can also apply cold initially and then switch over to application of gentle heat on painful areas.

Remember, while rest is important, you should not spend too much time in bed, as this can lead to stiffness. Resume activities slowly and start with low-impact exercises such as walking.

Chiropractic manipulation, acupressure, and massage therapy may help people with chronic back pain.

In most people, a conservative approach typically relieves herniated disk symptoms within a few weeks.

Rehabilitation and Physical Therapy

Physical therapy can help to strengthen your muscles and control pain. Your physical therapist can also show you exercises and positions to minimize pain caused by a herniated disc.

Medications for Herniated Discs

Over-the-counter medicines for pain relief. Examples include acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen sodium (Aleve).
Medications for nerve pain, such as gabapentin (Neurontin, Horizant) and pregabalin (Lyrica).
Antidepressants such as venlafaxine (Effexor XR) and duloxetine (Cymbalta) to manage neuropathic pain.
Muscle relaxants to relieve muscle spasms. Examples include carisoprodol (Soma), cyclobenzaprine (Flexeril), metaxalone (Skelaxin), and methocarbamol (Robaxin).
Opioid pain relievers for short-term treatment of severe pain, for example, oxycodone-acetaminophen (Percocet).

Find out: What Is The Best Medication For Lower Back Pain?

Injections for a Herniated Disk

If you have severe pain from a herniated disc that does not respond to oral pain medicines, your healthcare professional may offer corticosteroid injections. This involves the injection of steroid medicine near the spinal nerves and is done under image guidance.

Spine Surgery

Surgery is rarely required in people with herniated disks. But if your symptoms do not improve with conservative treatments for 6 weeks, your doctor may recommend surgery to control severe pain, relieve symptoms like numbness and weakness, and treat loss of bladder or bowel control.

Surgery for a herniated disc involves the surgeon removing the herniated disc (protruding part of the spinal disk) to relieve pressure on the nerve roots. This is called a discectomy.

Sometimes, the entire disk needs to be surgically removed and a bone graft is used to fuse the vertebrae. Placement of metallic hardware is necessary to provide stability to the spine and support bone fusion which occurs over a period of several months. Sometimes, an artificial disk needs to be implanted.

Tips for Prevention of Herniated Discs

You can lower your risk of disc herniation with the following measures:

Get regular exercise to strengthen your back and core muscles.
Maintain a good posture to reduce stress on your spinal column and spinal disks. Sit with your back straight and use an ergonomic chair when sitting for long periods.
Learn the proper technique to lift heavy objects using your legs.
Maintain a healthy body weight to avoid excess pressure on your spine and disks.
Quit smoking, if you smoke.

Long-Term Outlook

As mentioned before, many people with disc herniation have no symptoms and the condition is identified by chance during imaging for other symptoms.

Most people recover from a herniated disc with conservative management. However, complications of a herniated disc can include chronic back pain, muscle weakness, nerve damage, and loss of ability to do everyday tasks affecting mental and emotional health. Untreated disc herniation, although rare, can lead to severe nerve root compression and nerve damage. It is important to know that low back pain can mimic the symptoms of other diseases, so it is important to see your doctor to make a differential diagnosis.

Studies suggest that in 90% of people, herniated disk symptoms have resolved in 6 weeks. However, some studies have found that up to one-third of patients complain of ongoing back pain at one year.