Disc herniation is a result of a disc protruding out of the spine. The disks in the spine are important structures for providing space and cushioning between the individual bones (vertebras) in the spine. The disk is a round soft cushion which has a soft jelly-like consistency in the center and tougher outer part providing for the structural integrity. When too much pressure is generated on the disc, the tough outer part can break and small tear develops. The inner soft part can protrude outside of the disc and irritate or push against the nearby nerves causing pain and other symptoms. Herniated disc doesn’t always cause pain, and there are some individuals who only find out about disc herniation accidentally when imaging of their torso is done for other purposes. Studies indicate that 41% of disk protrusions and up 71% of more severe disk extrusions eventually resolve spontaneously.

Symptoms

The symptoms related to disc herniation can vary not only in intensity but also in presentation. The major differentiating factor is whether the herniated disc touches the spinal nerve or not. If the disc is not touching the nearby spinal nerve, the affected individual may only experience low-grade back pain which is worse with certain movements. If, however, the disc is touching a spinal nerve and causing impingement of the nerve, the pain is typically more intense. There will be also other associated symptoms based on the level of the spine where the herniation occurred. In most cases of disc herniation in the lower back, when the herniated disc is impinging on the spinal nerve, the pain will be mostly felt in the buttock and in the legs rather than in the low back. Radiating pain may, in some cases, reach all the way down into the foot. This is usually described as sciatic pain.

The symptoms of electric shooting pain radiating down the leg usually resolve fairly soon with or without any treatment, however, the numbness may be present for several months. In severe cases of herniation, the numbness can become permanent, and it may never completely resolve. Many individuals also develop weakness in the leg supplied by the affected nerve and may have difficulties maintaining a steady gate. It is important for the individual developing this type of back pain, to contact their provider immediately if they notice new changes in their bowel movement or urination. A condition called Cauda Equina can result from impingement of the nerves controlling bowel movement and emptying the urinary bladder. The affected individual may develop difficulty emptying their bladder and present with loss of sensation in the area of the buttock that would be in contact with a horse saddle- hence called saddle anesthesia.  This is a serious complication of disc herniation that requires a surgical intervention to prevent permanent nerve damage.

Causes

While the exact cause of disc herniation is usually hard to elicit, it is generally associated with more advanced age and activities involving heavy lifting and or twisting movements. As we age, the tough outer layer of the disc becomes more fragile as it undergoes degeneration. The disc also loses some of the inner soft cushioning jelly-like substance. This makes the disc more fragile and prone to rupture when it is exposed to sudden twisting movement or excessive load.   Young individuals engaged in strenuous jobs or sports activities that require heavy lifting, especially when combined with twisting movements, are at great risk for disk herniation due to the instability that this combination of pressure and twisting movement creates in the spine. Additionally, having tight muscles that attach to the individual vertebras above and below the disc, can also predispose the individual to disc herniation by keeping the disc under constant pressure. In such cases, a small innocent movement such as picking up a pen from the floor can be the final hit for rupturing the disc and causing herniation.

Treatment guidelines

Pain due to acute disc herniation can be very debilitating. Unless there are, however, any so-called red flags, which your provider will rule out during his physical exam, there is no need for any invasive procedures to treat acute disc herniation. Most patients will feel significantly better in 4-6 weeks, and they will fully recover in 3-4 months. Conservative treatment is therefore recommended as first-line therapy. There are a number of treatment options and all of them help to some extent in the recovery process. Their selection depends on availability and personal preference. Making certain changes to your daily routine can also speed up the recovery process. You can read more about optimizing your recovery process here. During the acute onset of symptoms, bed rest can be helpful for one to two days. Being inactive and staying in bed longer than two days has been associated with worse outcomes. Motion is the lotion, therefore early referral to physical therapy to learn appropriate mobilization and stretching exercises is very important for successful rehabilitation. Pain medication such as Motrin or Naproxen can help ease some of the pain, but if this is not sufficient, talk to your provider about using additional pain medication for short period of time. After initial 24-48 hrs from the onset, hot baths or heating pads applied for no more than 20 minutes can also help loosen up the muscle spasm and relieve some pain. This should be followed by gentle stretching. Avoid sitting for extended periods of time and walk slowly avoiding any sudden movements. If heated pool or larger Jacuzzi tub is available, stretching for 15- 20 minutes in the warm water and doing gentle ranges of motion can also be very helpful.