A herniated disc happens when the soft, jelly-like center of a spinal disc pushes through a tear in its outer layer, pressing on nearby nerves. This can cause pain in the neck or back, and may lead to tingling, numbness, or weakness in the arms or legs, depending on the affected spinal area. The lower back (lumbar region) is the most common site for this type of injury.

Symptoms

The main symptom of a herniated disc is back pain, which may be followed by radiculopathy—pain caused by nerve root irritation. Symptoms of radiculopathy can include:

  • Tingling or numbness
  • Weakness
  • Sharp, burning, or “pins and needles” sensations

Symptoms vary based on the disc’s location:

  • Lumbar Region: Pain, tingling, or numbness in the lower back, buttocks, and down the leg (sciatica).
  • Cervical Region: Pain in the neck or between the shoulder blades, radiating down the arm to the hand or fingers, with possible numbness or tingling in the shoulder or arm.

Serious Complications

In rare cases, a herniated disc in the lower back can cause cauda equina syndrome, which includes symptoms like numbness in the groin or around the anus and loss of bowel or bladder control. This requires immediate medical attention.

Causes

To understand herniated discs, it’s useful to know spinal anatomy. The spinal cord runs from the neck to the lower back, protected by vertebrae with discs in between. Each disc has a tough outer layer (annulus fibrosus) and a soft center (nucleus pulposus). A herniated disc occurs when the nucleus pulposus pushes through the annulus fibrosus and presses on nearby nerves.

Common causes include:

  • Aging: Discs naturally shrink and weaken over time.
  • Trauma: Injuries from accidents or lifting heavy objects.
  • Genetics: Some people are genetically prone to disc problems.

Risk Factors

Risk factors for developing a herniated disc include:

  • Being a young adult, especially male (ages 20 to 50)
  • Improper lifting techniques
  • Obesity
  • Activities that strain the back
  • Prolonged sitting, particularly while driving
  • Sedentary lifestyle
  • Smoking

Diagnosis

Diagnosing a herniated disc involves:

  • Medical History and Physical Exam: Your healthcare provider will review symptoms and perform exams to identify pain triggers and assess muscle strength, reflexes, and sensation. The straight leg raise test may be used for lower back issues.
  • Imaging Tests: X-rays might suggest a herniated disc, but an MRI is usually needed to confirm it. If MRI isn’t possible, a CT myelogram may be used.

Treatment

Most herniated discs can be managed with non-surgical treatments. Surgery is considered if symptoms persist or are severe.

Non-Surgical Treatments

  • Activity Modification: Engage in light physical activity instead of complete bed rest.
  • Ice Therapy: Apply ice to the affected area for 15 to 20 minutes several times a day.
  • Medication: NSAIDs can reduce pain and inflammation.
  • Muscle Relaxants: Help relieve muscle tension, often combined with heat.
  • Epidural Injections: Steroid injections reduce pain and inflammation around the nerve.
  • Physical Therapy: Exercises and stretches strengthen the back and reduce pain.
  • Complementary Therapies: Acupuncture, pharmacopuncture, or spinal manipulation may offer relief.

Surgical Treatments

If conservative treatments fail, surgery may be necessary. A common procedure, microdiscectomy, involves removing the herniated disc and fragments pressing on nerves. Urgent surgery is needed for worsening neurological symptoms or cauda equina syndrome.

Summary

Herniated discs are often due to aging or genetic factors rather than specific actions. Most cases improve with conservative treatments. Stay active and follow your healthcare provider’s advice for the best outcomes.