A herniated disc
is a problem with one of the spinal discs that provide cushioning for the bones of the spine (vertebrae). It is also called a slipped or ruptured disc.
The spinal discs have a tough, rubbery exterior and a soft, jellylike center. If the outer layer weakens or tears, some of the center can push out through the exterior.
When this happens, the disc can press on a spinal nerve or cause inflammation that affects the root of a spinal nerve. This can result in symptoms such as pain, numbness, or weakness in a leg or arm.
A herniated disc can occur anywhere along the spine. Not everyone with a herniated disc has symptoms. Many cases can be managed with non-surgical treatments.
What are the signs of a herniated disc?
The signs and symptoms of a herniated disc depend on which spinal disc is affected and whether it is pressing on a spinal nerve. Signs usually occur on one side of the body. They may include:
- Pain in the buttocks or leg. If the herniated disc is in the lower back (lumbar spine), a sharp or burning pain can occur in the buttocks, thigh, calf, or foot. The pain may worsen in certain positions such as sitting, or during certain activities.
- Pain in the shoulder or arm. If the herniated disc is in the neck (cervical spine), the pain can occur in the shoulder and arm. This is usually a sharp or burning pain and can be worse in some positions or during certain activities.
- Numbness or tingling in the arms, legs, or other parts of the body. The location depends on which nerves are affected by the herniated disc.
- Weakness in the limbs. This can happen if the nerves to the muscles are affected by a herniated disc. Weakness can show up as stumbling while walking, or having difficulty lifting or holding objects.
What causes herniated discs?
A herniated disc is usually due to age-related changes in the spinal discs, what’s known as disc degeneration. As you grow older, the discs become more rigid, which increases the chance that they will rupture or tear.
The disc may tear while doing certain activities, such as lifting a heavy object with your back muscles instead of using the leg muscles, or twisting suddenly. However, many people don’t know the exact moment
when the disc tears.
Sometimes an injury, such as a fall or blow to the back, can cause a herniated disc, although this is rare.
Who is at risk for a herniated disc?
While everyone has some degeneration of the spinal discs as they age, other factors can increase your risk of having a herniated disc, such as:
- Excess weight. Carrying extra weight can put more stress on the spinal discs in the lower back.
- Occupation. Jobs that are physically demanding, such as those that involve heavy lifting and extreme forward bending, can increase the risk of a herniated disc. Also, jobs that involve repetitive activities such as lifting, pushing, pulling, twisting, or bending sideways can increase the risk of back problems.
- Genetics. If one or more close relatives has had a herniated disc, you may have a higher risk of disc herniation.
Can you prevent a herniated disc?
It is not possible to stop the age-related changes that occur in the spine, but you can take steps to reduce your risk of a herniated disc, such as:
- Exercise regularly, including doing activities that strengthen the muscles that support and stabilize the spine.
- Practice good posture, especially while standing or sitting for long periods, or when doing repetitive activities.
- Take frequent breaks when sitting or standing for long periods.
- Maintain a healthy weight to reduce the pressure on the back and spinal discs.
When should you see a doctor?
“Clear warning signs that someone needs medical attention include muscle weakness and loss of balance,” says Dr. Gbolahan Okubadejo, a spinal and orthopedic surgeon with The Institute for Comprehensive Spine Care
. “These symptoms may indicate spinal nerve compression.”
In addition, if you have neck or back pain that doesn’t go away on its own or with rest and over-the-counter medications, contact your doctor. This could be caused by a herniated disc or other conditions.
Okubadejo says that in some cases a herniated disc can compress the spinal cord itself, although this usually only happens in severe cases.
A large disc herniation in the lower back can also compress the spinal nerves at the bottom of the spine. This is known as cauda equina syndrome, which Okubadejo says “is serious and rare, but requires immediate medical attention.”
Cauda equina syndrome can cause the following “red flag” symptoms:
- Urinary retention, including loss of the urge to urinate
- Loss of bladder and/or bowel control
- Numbness in the anus, genitals, and buttock areas
- Weakness or paralysis in the legs and/or feet
- Sexual dysfunction
If you experience any of the “red flag” symptoms, seek immediate medical care.
How is a herniated disc diagnosed?
If you have signs of a herniated disc, your doctor will ask you about the type of symptoms you are having, when they started, and whether they get worse during certain activities.
Your doctor will also conduct a physical exam that may include checking your:
- Spine for tenderness
- Muscle strength
- Ability to walk
- Ability to feel light touches and other sensations in your limbs
Often, the medical history and physical exam is all that a doctor needs to diagnose a herniated disc. However, your doctor may order another test in order to determine which nerves are affected, or if they suspect another cause of your symptoms.
These tests include:
- X-rays, CT scan, or MRI. These are used to see which nerves are being compressed or to rule out other causes such as a broken bone, tumor, or infection.
- Myelogram. In this test, a dye is injected into the spinal fluid before an X-ray to provide a clearer image of the spinal cord and nerves. This can help a doctor see which nerves are affected.
- Nerve tests such as a nerve conduction study or electromyography (EMG). These can help a doctor see how well the electrical impulses are moving along the nerve, which can help determine the location of the nerve damage.
What happens when you have a herniated disc?
If you are diagnosed with a herniated disc, your doctor will usually first recommend conservative treatments such as:
- Over-the-counter medications to relieve pain and reduce inflammation that is affecting the nerve. This includes acetaminophen, ibuprofen, and naproxen.
- Steroid injections in the spine to control inflammation around the herniated disc.
- Muscle relaxers to reduce muscle spasms.
- Physical therapy to teach you positions and exercises that can help reduce the pain and other symptoms caused by a herniated disc.
“In many cases, a herniated disc can heal on its own
with over-the-counter anti-inflammatories and plenty of rest,” says Okubadejo. “Generally, the pain from a herniated disc will improve within a couple of days and completely resolve in four to six weeks.”
Other times, “people find that the pain gets worse as the disc breaks down further,” he says. In more severe cases, your doctor may recommend surgery for a herniated disc, such as:
- Discectomy. A surgeon removes the part of the herniated disc that is pressing on a nerve root or spinal cord. In some cases, the entire disc may be removed.
- Spinal fusion. After removal of the entire herniated disc, the vertebrae at that level of the spine are fused together to increase the stability in that part of the spine.
- Artificial disc replacement. The herniated disc is removed and replaced with an artificial disc device that mimics the cushioning and movement of the natural disc.
Can you treat a herniated disc at home?
Doctors will usually recommend that people with a herniated disc first try conservative treatments such as over-the-counter medications or physical therapy. Many of these can treatments can be done at home.
Okubadejo says cold or heat therapy can help reduce muscle tension that is commonly present with a herniated disc in the lower back. Cold therapy can also reduce inflammation and pain. This can include using a heating pad periodically throughout the day or a cold pack after exercise or taking warm baths or showers.
“See what works best for you,” says Okubadejo, “as there is no single treatment that is appropriate for everyone. The type of heat and how you use it is often a matter of personal preference.”
He says if you have a herniated disc in the lower back, you can also experiment with different positions and pillow positions in bed to reduce the discomfort.
“Using a pillow under your knees can help relieve tension on the lower back and ease herniated disc pain,” says Okubadejo. “Or try lying on your side with your spine straight, hips balanced, and a pillow between your knees.”
A herniated disc can cause symptoms such as pain, numbness, or weakness in the arms or legs, usually on one side. These signs can also be caused by other spine conditions. If you experience any of these symptoms, visit your doctor to get an accurate diagnosis.
In many cases, herniated discs can be safely treated with non-surgical treatments such as over-the-counter pain medication, cold or heat therapy, and physical therapy. In more severe cases, surgery may be needed.
It’s not possible to prevent all herniated discs, but you can take steps to reduce your risk by maintaining a healthy weight, exercising regularly, and practicing good posture. These measures are good for your spine health, as well as your overall health.
Updated: June 11, 2021