This topic is for a people who have a herniated disc in the lower back. If you are looking for information on a herniated disc in the neck, see the topic Cervical Disc Herniation.
What is a herniated disc?
The bones
(vertebrae) that form the
spine in your back are cushioned by small, spongy
discs. When these discs are healthy, they act as shock absorbers for the spine
and keep the spine flexible. But when a disc is damaged, it may bulge or break
open. This is called a herniated disc. It may also be called a slipped or
ruptured disc.
You can have a herniated
disc in any part of your spine. But most herniated discs affect the lower back
(lumbar spine). Some happen in the neck (cervical spine) and, more rarely, in
the upper back (thoracic spine).
What causes a herniated disc?
A herniated disc may be caused by:
Wear and tear of the disc. As you age, your
discs dry out and aren't as flexible.
Injury to the spine. This may
cause tiny tears or cracks in the hard outer layer of the disc. When this
happens, the thick gel inside the disc can be forced out through the tears or cracks
in the outer layer of the disc. This causes the disc to bulge or break open.
What are the symptoms?
When a
herniated disc presses on
nerve roots, it can cause pain, numbness, and weakness
in the area of the body where the nerve travels. A herniated disc in the lower
back can cause pain and numbness in the buttock and down the leg. This is
called sciatica (say "sy-AT-ih-kuh"). Sciatica is the most
common symptom of a herniated disc in the low back.
If a
herniated disc isn't pressing on a nerve, you may have a backache or no pain
at all.
If you have weakness or numbness in both legs along with
loss of bladder or bowel control, seek medical care right away. This could be a
sign of a rare but serious problem called
cauda equina syndrome.
How is a herniated disc diagnosed?
Your doctor may
diagnose a herniated disc by asking questions about your symptoms and examining
you. If your symptoms clearly point to a herniated disc, you may not need
tests.
Sometimes a doctor will do tests such as an
MRI or a
CT scan to confirm a herniated disc or rule out other
health problems.
How is it treated?
Symptoms from a herniated disc
usually get better in a few weeks or months. To help you recover:
Rest if you have severe pain. Otherwise, stay
active. Staying in bed for more than 1 or 2 days can weaken your muscles and
make the problem worse. Walking and other light activity may help.
Try using a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm
shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. You can also try an ice pack
for 10 to 15 minutes every 2 to 3 hours.
Do the exercises that your
doctor or physical therapist suggests. These will help keep your back muscles
strong and prevent another injury.
Ask your doctor about medicine
to treat your symptoms. Medicine won't cure a herniated disc, but it may help
with pain and swelling.
Usually a herniated disc will heal on its own over time.
About half of people with a herniated disc get better within 1 month, and most
are better within 6 months. Only about 1 person out of 10 eventually has
surgery.1
Be patient, and keep following your
treatment plan. If your symptoms don't get better in a few months, you may want to
talk to your doctor about surgery.
Can a herniated disc be prevented?
After you have
hurt your back, you are more likely to have back problems in the future. To
help keep your back healthy:
Protect your back when you lift. For example,
lift with your legs, not your back. Don't bend forward at the waist when you
lift. Bend your knees, and squat.
Use good posture. When you stand
or walk, keep your shoulders back and down, your chin back, and your belly in.
This will help support your lower back.
Get regular exercise.
Stay at a healthy weight. This may reduce the load on your lower
back.
Don't smoke. Smoking increases the risk of a disc
injury.
Wear and tear, also called disc degeneration, is the usual cause of a herniated disc. As we age, the discs in our back lose some of the fluid that helps them stay flexible. The outer layer of the discs can form tiny tears or cracks. The thick gel inside the disc may be forced out through those cracks and cause the disc to bulge or break open.
This can also happen when you injure your back. Injury can occur from:
A sudden heavy strain or increased pressure to
the lower back. Sometimes a sudden twisting movement or even a sneeze will
force some of the material out.
Activities that are done over and
over again that may stress the lower back, including poor lifting habits,
prolonged exposure to vibration, and sports-related injuries.
Symptoms
If the
herniated disc isn't pressing on a nerve, you may have an ache
in the low back or no symptoms at all.
Only a few people who have
herniated discs have severe or troublesome symptoms.
When the disc does press on a nerve, symptoms may include:
Pain that travels through the buttock and
down a leg to the ankle or foot because of pressure on the sciatic nerve. Low
back pain may accompany the leg pain.
Tingling ("pins-and-needles" sensation) or
numbness in one leg that can begin in the buttock or behind the knee and extend
to the thigh, ankle, or foot.
Weakness in both legs and the loss of bladder and/or bowel
control are symptoms of a specific and severe type of nerve root
compression called
cauda equina syndrome. This is a rare but serious
problem. A person with these symptoms should see a doctor
right away.
What Happens
Due to age,
injury, or both, the outer layer of a spinal disc may dry out and
form tiny cracks. Sometimes this causes a:
Bulging disc. Some of the thick gel in the disc may leak into the cracks. The disc
may begin to bulge out from between the bones of the spine (vertebrae).
Ruptured disc. The gel breaks through the capsule.
Free fragment. Fragments of a ruptured disc may
break completely free of the disc and lodge in the
spinal canal.
Any of these stages can cause pressure on a nerve
root and symptoms of pain and numbness.
The cracks in the disc don't repair themselves, but the pain usually fades over time. Often
the body reabsorbs the material from the disc, which helps the pain go away. This process is called resorption. About
half of the people with herniated discs in the low back recover within 1 month. And
within 6 months, most recover.1
Long-term problems
It's important to see your doctor if you've had constant or increasing pain for more than 4 to 6 weeks. Getting help early on can lower your chance of having lasting problems, such as the following:
Pain may come and go. Pain-free periods happen less and less.
Long-lasting (chronic)
and recurring pain can develop because of continued tissue irritation caused by
the disc pressing on a nerve.
Chronic pain syndrome can result from having ongoing pain, causing depression,
anxiety, and trouble coping with daily life.
Symptoms caused by
long-term nerve root compression include loss of agility, strength, or
sensation in one or both legs and feet.
What Increases Your Risk
Risk factors are things that increase your risk of having a herniated disc. Some risk factors you can change, and some you can't.
Risk factors that you cannot change
Getting older.
Being male.
Having a history of back injury, previous herniated disc, or back surgery.
Risk factors that you can change
Your job or other activities. These may include:
Long periods of sitting.
Lifting or pulling heavy objects.
Frequent bending or twisting of the back.
Heavy physical exertion.
Repetitive motions.
Exposure to constant vibration
(such as driving).
Not exercising regularly, doing strenuous
exercise for a long time, or starting to exercise too strenuously after a long
period of inactivity.
Smoking. Nicotine and other toxins from
smoking can keep spinal discs from absorbing all the nutrients they need from
the blood, making disc injury more likely. Smoking also increases your
sensitivity to pain.
Being overweight. Carrying extra body weight (especially in the stomach area) may put additional
strain on the lower back, although this hasn't been proved. But being
overweight often also means being in poor physical condition, with weaker
muscles and less flexibility. These can lead to low back pain.
When To Call a Doctor
Call 911 or other emergency services immediately if:
You have a sudden loss of bowel or bladder control.
An injury causes numbness or weakness in one or both legs.
Call your doctor if:
Leg pain is accompanied by persistent weakness,
tingling, or numbness in any part of the leg from the buttock to the ankle or
foot.
New low back pain is accompanied by vomiting and/or fever
[101°F (38.5°C) or higher]
that lasts longer than 48 hours.
Leg pain or intermittent weakness,
tingling, or numbness lasts longer than 1 week despite home
treatment.
You have back pain that either won't go away or builds in
intensity over a few weeks.
A back injury is work-related, and
symptoms don't improve in 2 to 3 days.
Back pain is accompanied by
pain during urination or blood in the urine.
You have back pain that is worse when you are resting than when
you are active.
You notice a gradual increase in problems with
bowel or bladder control.
Watchful waiting
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.
If you have pain, numbness, or tingling in one
leg that gets worse with sitting, standing, or walking (without any obvious leg
weakness):
You may try a brief period of bed
rest—usually no more than 1 to 2 days—then gradually begin activities if the
pain is manageable.
Take short walks.
Avoid movements
and positions that increase pain or numbness.
Who to see
For diagnosis and nonsurgical treatment of a
herniated disc, you may see:
Your doctor will do a
medical history and physical exam. If this suggests that you have a
herniated disc, you probably won't need other tests.
If your doctor needs more information, or if treatment hasn't worked after 4 weeks, you may have an MRI or a CT scan.
X-rays typically aren't useful or needed. But if your medical history and physical exam
suggest a more serious condition (such as a tumor, infection, fracture, or
severe nerve damage), or if your leg pain and other symptoms don't get better
after 4 weeks of nonsurgical treatment, your doctor may order X-rays.
Other tests
Other
tests, such as blood tests, may be done to rule out other conditions.
The following
tests aren't used as often as an MRI or a CT scan, but they may give
your doctor more information:
A myelogram may be done if you can't have an MRI (for
example, if you have a pacemaker) or if the results of an MRI aren't clear.
Discography can help diagnose disc problems but is rarely used.
A nerve block may show which nerve is causing a problem.
Treatment Overview
Your doctor
may recommend a short period of rest or reduced activity followed by a gradual
increase in activity.
Usually a
herniated disc heals on its own. So most of the time nonsurgical treatment is tried first, including:
Heat or ice, exercise, and other steps at home to help with pain and make your back stronger. For more information, see Home Treatment.
Physical therapy. For more information, see Other Treatment.
Pain medicine. For more information, see Medications.
You're likely to get the most benefit if you have treatment before you've had more than 6 months of symptoms.2
Surgery
Surgery is eventually done for
about 1 out of 10 people. It can be a good choice for
people who have nerve damage that is getting worse or pain that hasn't improved after at least 4 weeks of nonsurgical
treatment.1 For more information, see Surgery.
Prevention
To help prevent low back
pain or a
herniated disc:
Stay at a healthy body weight. This may
reduce the load on your lower back.
Exercise regularly.
Quit smoking. Nicotine can harm the discs in your back, because it lowers the ability of the
discs to absorb the nutrients they need to stay healthy. And it may cause them
to become dry and brittle.
Think about your posture. Slumping or slouching alone may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse.
Keep your back in
the neutral position while sleeping. Place a pillow between your knees when sleeping on your side.
Home Treatment
To reduce pain
The following steps may help
to reduce pain:
Relax. Find a comfortable position for rest. You might prefer lying on the floor or a medium-firm bed with a small pillow under your head and another under your knees. Or you can try lying on your side with a pillow between your knees. Don't stay in one position for too long.
Walk. Take a short walk (10 to 20 minutes) on a level surface (no slopes, hills, or stairs) every 2 to 3 hours. Walk only distances you can manage without pain, especially leg pain.
Take pain medicine if needed. These medicines usually work best if you take them on a regular schedule instead of waiting until the pain is severe.
Try heat or ice. There is not strong evidence that either heat or ice will help, but you can try them to see if they help you. You may also want to try switching between heat and cold. You can try:
A heating pad on a low or medium setting for 15 to 20 minutes every 2 to 3 hours.
A warm shower in place of one session with the heating pad.
Single-use heat wraps that last up to 8 hours.
An ice pack for 10 to 15 minutes every 2 to 3 hours. You can use an ice pack or a bag of frozen vegetables wrapped in a thin towel.
To strengthen your back
Keep active and do
exercises, as recommended by your doctor or physical therapist, to help you
return to your usual level of activity.
Core stabilization exercises can help you strengthen
the muscles of your
trunk to protect your back.
Although medicine doesn't cure a
herniated disc, it may reduce
inflammation and pain and allow you to begin an
exercise program that can strengthen your stomach and back muscles.
Surgery is considered if the
following conditions are present:
You have leg pain that
hasn't improved with at least 4 weeks of nonsurgical treatment, and your symptoms are bad enough to interfere with normal activities and work and to require strong pain medicine.
You have weakness, loss of motion, or abnormal
sensitivity.
Tests show that your herniated disc can be treated surgically.
People who have surgery may feel better faster. But in
the long run, people treated with surgery and people treated without surgery
have similar abilities to work and to be active.3 Some people require
additional disc surgery after their first surgery.
Many people are able to gradually resume work and daily activities soon
after surgery. In some cases, your doctor may recommend a rehabilitation
program after surgery, which might include
physical therapy and home exercises.
Disc surgery isn't considered effective treatment for low back pain that
is not caused by a herniated disc. Disc surgery is also
not done if back pain is the only symptom the herniated disc causes.
Surgery choices
Discectomy. This
may be the most effective
type of surgery for people who have tried nonsurgical treatment without success
and who have severe, disabling leg pain.
Laminotomy and laminectomy. Either procedure may be done at the same time as a discectomy, or
separately.
Experimental procedures
A number of technologies using small incisions or injections for destroying the disc are used by some surgeons. Examples are endoscopic discectomy and electrothermal disc decompression. These techniques are experimental and unproved. If your doctor recommends one of them to treat your herniated disc, make sure to get as much information as possible about the procedure. Consider getting a second opinion.
Laser
discectomy uses a focused beam of light to dissolve a herniated disc. Although
this technology has been used by some surgeons for several years, it is
considered experimental because of the lack of studies on its effectiveness and
safety.4
Other treatments that have
been tried include removing the center of the disc and removing all or part of
the disc by using suction. These treatments are not considered to be
effective.
Other Treatment
You can try other treatments besides medicine and surgery, including:
Talk to your doctor before using complementary and alternative medicine to treat a herniated
disc.
Some people
use complementary and alternative medicine along with standard or conventional
care to treat leg and back pain caused by a herniated disc. Although no large
studies have proved that these work well or are safe, they may
help some people. Some examples are:4
The North American Spine Society (NASS) promotes education, research, and advocacy for spine care. This group's patient education website (www.KnowYourBack.org) has information on the cause, treatment, and prevention of neck and back problems. It has references and brochures to help patients make health decisions. NASS members are spine care professionals such as orthopedic surgeons, neurosurgeons, neurologists, physiatrists, physical therapists, and researchers.
RadiologyInfo
c/o Radiological Society of North America, Inc.
820 Jorie Boulevard Oak Brook, IL 60523-2251
Phone:
(630) 571-2670
Fax:
(630) 571-7837
Web Address:
www.radiologyinfo.org
RadiologyInfo is a joint project of the American College of Radiology and the Radiological Society of North America. The website is designed to answer consumer questions about radiology procedures and therapies. RadiologyInfo has information on X-ray, CT scan, MRI, ultrasound, and other procedures. The information includes how they are used for diagnosis and treatment, how to prepare for the procedures, and what a patient may experience.
American Academy of Orthopaedic Surgeons
(AAOS)
6300 North River Road
Rosemont, IL 60018-4262
Phone:
(847) 823-7186
Fax:
(847) 823-8125
Email:
orthoinfo@aaos.org
Web Address:
www.orthoinfo.aaos.org
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
American Physical Therapy
Association
1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone:
1-800-999-APTA (1-800-999-2782) (703) 684-2782
Fax:
(703) 684-7343
TDD:
(703) 683-6748
Web Address:
www.apta.org
The American Physical Therapy Association is a national
organization representing nearly 70,000 physical therapists, physical therapist
assistants, and students. Its goal is to foster advancements in physical
therapist education, practice, and research. The APTA also provides information
and education to the public about physical therapy and how it is used to treat
certain conditions.
National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone:
1-877-22-NIAMS (1-877-226-4267) toll-free
Phone:
(301) 495-4484
Fax:
(301) 718-6366
TDD:
(301) 565-2966
Email:
niamsinfo@mail.nih.gov
Web Address:
www.niams.nih.gov
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Hu SS, et al. (2006). Lumbar disc herniation section
of Disorders, diseases, and injuries of the spine. In HB Skinner, ed.,
Current Diagnosis and Treatment in Orthopedics, 4th ed.,
pp. 246–249. New York: McGraw-Hill.
Rihn JA, et al. (2011). Duration of symptoms resulting from lumbar disc herniation: Effect on treatment outcomes. Journal of Bone and Joint Surgery, 93(20): 1906–1914.
Atlas SJ, et al. (2005). Long-term outcomes of
surgical and nonsurgical management of sciatica secondary to a lumbar disc
herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
Jordan J, et al. (2011). Herniated lumbar disc, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Other Works Consulted
Atlas SJ, et al. (2001). Surgical and nonsurgical
management of sciatica secondary to a lumbar disc herniation: Five-year
outcomes from the Maine Lumbar Spine Study. Spine,
26(10): 1179–1187.
Deen GH, et al. (2003). Minimally invasive procedures
for disorders of the lumbar spine. Mayo Clinical Procedures, 78: 1249–1256.
Hu SS, et al. (2006). Lumbar disc herniation section
of Disorders, diseases, and injuries of the spine. In HB Skinner, ed.,
Current Diagnosis and Treatment in Orthopedics, 4th ed.,
pp. 246–249. New York: McGraw-Hill.
Peul WC, et al. (2007). Surgical versus prolonged
conservative treatment for sciatica. New England Journal of Medicine, 356(22): 2245–2256.
Weinstein JN, et al. (2006). Surgical vs nonoperative
treatment for lumbar disk herniation: The spine patient outcomes research trial
(SPORT): A randomized trial. JAMA, 296(20):
2441–2450.
Weinstein JN, et al. (2006). Surgical vs nonoperative
treatment for lumbar disk herniation: The spine patient outcomes research trial
(SPORT): Observational cohort. JAMA, 296(20):
2451–2459.
Credits
By
Healthwise Staff
Primary Medical Reviewer
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Hu SS, et al. (2006). Lumbar disc herniation section
of Disorders, diseases, and injuries of the spine. In HB Skinner, ed.,
Current Diagnosis and Treatment in Orthopedics, 4th ed.,
pp. 246–249. New York: McGraw-Hill.
Rihn JA, et al. (2011). Duration of symptoms resulting from lumbar disc herniation: Effect on treatment outcomes. Journal of Bone and Joint Surgery, 93(20): 1906–1914.
Atlas SJ, et al. (2005). Long-term outcomes of
surgical and nonsurgical management of sciatica secondary to a lumbar disc
herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
Jordan J, et al. (2011). Herniated lumbar disc, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
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