A herniated disc occurs when the soft gel-like material of the disc is forced out. If the material presses against a nerve, it can cause pain. To understand how this can happen, it’s helpful to have a basic understanding of the spinal column.
The human spine has 33 individual bones (vertebrae) stacked one on top of the other. Between each is a soft pad (disc) that serves as a cushion to keep the vertebrae from rubbing together, while minimizing the impact of movement on the spinal column.
Each disc has a soft, central component (nucleus pulposus). Pressure can cause the interior material to bulge and become misshapen (bulging disc). If a disc ruptures, the soft interior material pushes out through a tear in the tough exterior of the disc (herniated disc).
Herniated discs can press on the spinal cord or adjacent spinal nerves causing pain, weakness, and numbness in the neck, back, arms, and legs. The symptoms can vary greatly depending on the position of the herniated disc and the size of the herniation. Sciatica is a common result of a herniated disc in the lower back. The pressure on the nerves can cause a sharp, electric shock-like pain, that radiates into the leg and even the foot.
It is possible for the herniated disc to not press on any nerves. In this case, the person will not experience pain and will not know there is a problem until it is discovered with a spinal image taken for other medical reasons.
Most people who have a herniated disc do not require surgery to correct the problem.
Causes of a Herniated Disc
The most common location for a herniated disc is the lower back. The disc between the fourth and fifth lumbar vertebrae constantly absorbs much of the weight of the upper body. Furthermore, this area of the spine bears the weight of the upper body and constantly absorbs the impact of the body’s daily movements.
As we age, suffer injury, or as the disc degenerates, the softer central portion of the disc is more likely to rupture (herniate). When this happens, the central portion of the disc pushes through the surrounding, tougher outer shell (annulus fibrosus). This rupture, or herniation, of the central portion of the disc, is often referred to as a “slipped disc.”
Treatments for a Herniated Disc
The treatment for a herniated disc depends on the severity of symptoms. The various therapies include physical therapy, muscle-relaxant medications, pain medication, anti-inflammation medications, epidural injections of cortisone, and surgical operations.
The primary goal of treatment is to relieve pain and other symptoms resulting from the herniation. To achieve this goal, each patient receives an individualized treatment plan. The treatment is based on the source of the pain, the severity of the pain, and the specific symptoms the patient exhibits.
Treatment generally begins with various conservative care options. If conservative treatments are successful in reducing pain and discomfort, the patient may choose to continue them. For those who experience severe pain and a high loss of function without finding relief from conservative treatments, a minimally invasive procedure may be necessary to relieve the pain.
In severe cases, surgical intervention may be required to stop further neurological damage and allow the nerve to recover. In such cases, without surgical intervention, nerve loss can occur, and the damage may be permanent. However, a very small number of people with herniated discs need major surgery.
Conservative Herniated Disc Treatment
Conservative treatment consisting mainly of avoiding painful positions and following a doctor-prescribed exercise and pain medication treatment can relieve symptoms in most people within a few days or a few weeks. However, conservative treatments for lumbar and cervical herniated discs may take up to six weeks to actually reduce the pain and discomfort.
Treatment that focuses on pain relief (such as medications) may help the patient better tolerate other treatments (such as manipulation or physical therapy). In addition to helping with recovery, physical therapy is often used to educate patients on proper body mechanics (such as proper lifting technique), which can help prevent excessive wear and tear on the vertebral discs.
The different types of conservative treatment options for lumbar and cervical herniated discs include:
Ice and heat therapy for pain relief.
Medications, both over-the-counter and prescription, can help relieve pain and discomfort.
Physical therapy, exercise, and gentle stretching help relieve pressure on the nerve root.
Manipulation (such as chiropractic manipulation).
Oral steroids to decrease inflammation for pain relief.
Epidural injections to decrease inflammation for pain relief.
Sometimes taking it easy for a few days can be beneficial and all that’s needed. Rest means avoiding exercise and other activities that involve bending or lifting. Rest can help relieve swelling and give the back time to heal. However, the patient must limit rest to no more than 1 or 2 days in most cases. Movement is essential in keeping joints and muscles from stiffening up because of inactivity.
Ice and heat can also help relieve the pain. Initially, use cold packs to relieve pain and inflammation. After a few days, switch to gentle heat.
Pain medications. If the pain is mild to moderate, a non-steroidal, anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin IB, and others), naproxen (Aleve, and others), or COX-2 inhibitors (Celebrex, and others) may provide sufficient pain relief. These medications should not be used for more than 10 days without being ordered by a doctor. Using them for an extended period of time can cause other health problems including an increased risk of heart problems and bleeding.
Anticonvulsants. Drugs originally designed to control seizures may be helpful in the treatment of the radiating nerve pain often associated with a herniated disc.
Muscle relaxers. Muscle relaxants may be prescribed for muscle spasms. However, sedation and dizziness are common side effects of these medications.
If the pain has not resolved within a few weeks, physical therapy may provide relief. A physical therapist can demonstrate positions and exercises designed to minimize the pain of a herniated disc, and help strengthen the muscles that support the back. Physical therapy programs include:
Stretching exercises to keep muscles flexible.
Yoga can be beneficial for some patients.
Aerobic exercises like walking or riding a stationary bicycle.
Ice and heat.
Electrical muscle stimulation.
If rest, pain relievers, and physical therapy don’t help with relieving the pain, an injection of a steroid medicine into the area around the spinal nerve (epidural injection) may help. Inflammation-suppressing corticosteroids can help reduce swelling, allow easier movement, and ease the pain. Steroid injections are very effective in decreasing pain.
Some patients find alternative and complementary medicine treatments helpful in easing chronic back pain. Examples include:
Chiropractic. Spinal manipulation has been found to be moderately effective for low back pain that has lasted for at least a month.
Acupuncture. Although only modest results are reported by many patients, acupuncture appears to ease chronic back and neck pain reasonably well.
Massage. This hands-on therapy can provide short-term relief to people dealing with chronic low-back pain.
Yoga. A combination of physical activity, breathing exercises, and meditation can improve function and relieve chronic back pain in some people.
Most herniated discs don’t require surgery. However, surgery may be an option if other treatments fail to provide pain improvement.
There are a variety of surgical approaches to treat disc herniation. Your doctor may suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially in cases where there is continued:
Numbness or weakness.
Difficulty standing or walking.
Loss of bladder or bowel control.
How to Protect the Spine
Most herniated discs get better on their own, or with the aid of treatment. Here are some tips on protecting the spine and preventing a herniated disc:
Sit and stand up straight. If standing is necessary for a long time, rest one foot on a stool or box to take pressure off the back.
Be careful when lifting heavy objects. Squat from the knees to pick up heavy objects. Don’t bend from the waist, because it puts too much pressure on the back.
Maintain a healthy weight. Extra pounds put more strain on the back.
Don’t smoke. Smoking can cause hardening of the arteries, which can damage the discs in the spine.
A herniated disc can only be prevented by avoiding injury to the spine.
Novus Spine & Pain Center
Dr. Torres established Novus Spine & Pain Center in Lakeland, Florida with a goal of providing the highest quality pain management care to every patient. Whether pain is the result of an injury or from another condition, Dr. Torres offers many different treatment options.
Novus Spine & Pain Center utilizes a comprehensive approach and cutting-edge therapies to restore normal function and allow patients to regain an active lifestyle while minimizing the need for opiates. As our patient, you are our top priority. Our goal is to help you achieve the best possible quality of life.
Our Mission Statement:To provide the best quality of life to people suffering from pain, by providing state of the art treatments, knowledge and skill, compassion, and respect for all.