Patient education: Herniated disc (The Basics)

What is a herniated disc? — 

This is a condition that affects the back. It can cause pain, numbness, or tingling down 1 or both legs.

To understand what a herniated disc is and how it causes symptoms, it's helpful to first learn a little about the back and spine.

The back is made up of (figure 1):

●Vertebrae – These are the bones of the spine. Each has a hole in the center. The vertebrae are stacked on top of each other, and the holes form a hollow tube called the "spinal canal." The spinal cord passes through this tube and is protected by the vertebrae.

●Spinal cord and nerves – The spinal cord is the bundle of nerves that connects the brain to the rest of the body. It runs through the vertebrae. Nerves branch from the spinal cord and pass in between the vertebrae. From there, they connect to the arms, legs, and organs.

●Muscles, tendons, and ligaments – These support the vertebrae. They are used to move the head and neck, stand upright, and bend and flex the body. They are also called the "soft tissues" of the neck and back.

●Discs – Rubbery discs sit in between each of the vertebrae. These add cushion and allow movement.

The discs have a tough outer shell and jelly-like center. The outer shell can sometimes break open, spilling the jelly material inside. This is a herniated disc.

Herniated discs can cause symptoms, because the jelly material that spills out can irritate nearby nerves. Also, the disc itself can bulge and press on nerves (figure 2).

This article discusses herniated discs only in the lower back. Other parts of the back can have herniated discs, but that is less common.

What are the symptoms of a herniated disc in the lower back? — 

Herniated discs do not always cause symptoms. When they do, the most common symptoms are tingling, pain, or numbness that spreads down 1 leg. These symptoms affect different parts of the leg, depending on which disc in the lower back is herniated.

Will I need tests? — 

Probably not. There are tests that can check for a herniated disc, but they are usually not needed. That's because symptoms of a herniated disc usually get better on their own, regardless of what the tests show.

Imaging tests, such as an MRI or a CT scan, can show what the tissues inside the back look like. These tests can find a herniated disc if you have one. But doctors do not usually order them until you have had symptoms for at least 4 to 6 weeks. In most cases, it does not make sense to do the test sooner, because the treatment for a herniated disc during those first few weeks is the same no matter what the tests might show.

How is herniated disc treated? — 

A small number of people need surgery to treat a herniated disc. But most people do well with simpler treatments, such as:

●Over-the-counter pain medicines

●Medicines to relax the muscles (called "muscle relaxants")

●Injections of medicines to numb the back or reduce swelling

●Physical therapy to teach you special exercises and stretches

●Spinal manipulation, which is when a physical therapist or chiropractor moves or "adjusts" the joints of your back

●Acupuncture, which is when someone who knows traditional Chinese medicine inserts tiny needles into your body to block pain signals

●Massage

Should I get surgery? — 

Your doctor will tell you if surgery could help you. Then, you can decide together if surgery is right for you.

Surgery to treat a herniated disc usually involves removing the part of the disc that is damaged. Sometimes, the entire disc is removed. It could help you feel better faster than you would without surgery. But, like any surgery, it also comes with risks.

Although surgery can speed up recovery, it is not usually necessary for a herniated disc. That's because, over time, the body absorbs the jelly from a damaged disc and heals on its own. But this can take months.

People who have a lot of pain or who want to get better fast sometimes choose surgery. People who are afraid of surgery or who feel like they can cope with their symptoms sometimes decide against surgery.

If your doctor suggests surgery to treat your herniated disc, ask:

●How likely is it surgery will help or completely fix my symptoms?

●How quickly will I recover from surgery?

●What are the risks of surgery?

●What happens if I do not have surgery?

What can I do on my own to feel better? — 

It is very important to stay as active as possible. Even if you have some pain or discomfort, do not stay in bed or rest too long.

People used to think bedrest was the best treatment for an injured back. But bedrest can actually make back problems worse. Too much rest can cause the back to become weak and stiff.

Can herniated discs be prevented? — 

Probably not. People sometimes think they got a herniated disc because they lifted something the wrong way or strained their back somehow. But there is not much proof moving or lifting the wrong way can cause a herniated disc.

To reduce the chances of hurting your back, it might help to:

●Stay active – The best thing you can do is stay as active as possible. Doing exercises to strengthen and stretch your back can help.

●Learn to lift using your legs instead of your back – In general, it is best to keep your back straight when moving and carrying things. Other tips include:

•When picking up something from the ground, spread your feet apart, then bend with your knees.

•When moving something, keep the object as close to your body as possible. Do not twist your body.

●Try losing weight, if needed – Carrying excess weight puts extra strain on your joints. Your doctor or nurse can talk to you about healthy ways to lose weight.

When should I call the doctor? — 

Call your doctor or nurse right away if you have:

●New back pain that goes into your groin or down your leg

●Back or leg pain, along with leg weakness or problems controlling your bowels or bladder

●Numbness or tingling in your buttocks or between your legs

●"Foot drop," which is when you cannot hold your foot up. You might notice this especially while walking.

●Back or leg pain, along with a fever or other symptoms that worry you

More on this topic

Patient education: Low back pain in adults (The Basics)
Patient education: Lumbar spinal stenosis (The Basics)
Patient education: Cauda equina syndrome (The Basics)
Patient education: Do I need an X-ray (or other test) for low back pain? (The Basics)
Patient education: Laminectomy (The Basics)
Patient education: Degenerative disc disease (The Basics)
Patient education: Thoracic or lumbar spinal fusion (The Basics)

Patient education: Low back pain in adults (Beyond the Basics)