A herniated disk is a back problem. And it’s one of those things that has more then one name. It is sometimes called a slipped disk, bulging disk or a ruptured disk and I’m sure there are others I’m not thinking of at the moment…
So, this sounds like it is really serious. And it can be, but not always. It is definitely something that you should be seeing a doctor for so that the status of the disk(s) can be monitored. So, let’s talk about what’s going on, what to do about it and why shit happens.
A spinal disk is a like a jelly doughnut (but not as tasty), with a softer center encased within a tougher exterior. A herniated disk occurs when some of the softer “jelly” pushes out through a crack in the tougher exterior. Sometimes this “jelly” pushes out against a nerve which causes irritation and inflammation. Nerves really don’t like being poked. As a result of pissing them off, you can experience numbness, weakness or tingling in an arm or leg, depending on which nerve is getting pushed into.
There are some people who have a herniated disk without any symptoms and there are those people who have severe symptoms. It will largely depend on whether or not there are nerves involved. Most of the time a person experiences pain it is from the nerves being compressed.
The most common signs and symptoms of a herniated disk are:
- Arm or leg pain. If your herniated disk is in your lower back (where most herniated disks occur), you’ll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
- When having nerve pain, it can also be experienced as a burning, crawling or an itching sensation. Some people experience both the pain as well as these sensations.
- Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.
- Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
- With muscle weakness comes muscle fatigue. You can experience cramping and muscle aching as a result of your muscles feeling over worked.
All of these symptoms are due to the nerve being compressed. Not all herniated disks cause compression of the nerve and thus those cases don’t present with these symptoms. It all depends out where that jelly squirts out! If you look back up at the picture, you can see that it shows the jelly squished out onto the nerved, but it could have moved out the other way and the nerve would not have been involved.
Seek medical attention if your neck or back pain travels down your arm or leg, or if it’s accompanied by numbness, tingling or weakness. Or if you are having sudden weakness or decreased coordination. Some of these symptoms are also the symptoms of a stroke which needs to be treated right away. So, be sure to have a doctor check you out if you are presenting with any or all of the symptoms discussed above.
Your spinal cord doesn’t extend into the lower portion of your spinal canal. Just below your waist, the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse’s tail. Rarely, disk herniation can compress the entire cauda equina. Emergency surgery may be required to avoid permanent weakness or paralysis.
Seek emergency medical attention if you have:
- Worsening symptoms. Pain, numbness or weakness may increase to the point that you can’t perform your usual daily activities.
- Bladder or bowel dysfunction. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.
- Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.
- If any of the symptoms listed here or in the previous list occur suddenly, you should be seen at the ER.
Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. The more you carry around that box of doughnuts, the more likely that the box is going to get torn, squished or just plain wear out. As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist. Unfortunately, this is the largest risk factor for a herniated disk and there is nothing you can do about it. We all get older and as we get older our parts are more likely to break down.
It is uncommon for there to be a single event that people can pinpoint as causing this injury. Some things that have caused this sudden kind of injury are lifting heavy objects with your back rather then your legs. Twisting and turning while lifting heavy objects. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.
Because the process is slow, the symptoms often creep in slowly as well. As that jelly pushes out more and more onto the nerve, it will cause more and more symptoms. Since it is unlikely to be caused by a sudden event, sudden onset symptoms should be fully evaluated for other possible causes.
How does one tell if the jelly isn’t where is should be? Well, the first thing to keep in mind is that the doctor will not be checking you for this unless you are presenting with symptoms of a compressed nerve. If there is no nerve involvement, they are going to leave a herniated disk alone even if they should discover it for some other reason. The herniated disk itself isn’t what causes all the problems, its the nerves being compressed.
Like everything else, they start out with a physical assessment to get a sense of what is going on. During the physical exam, your doctor will check your back for tenderness. He or she may ask you to lie flat and move your legs into various positions to help determine the cause of your pain. They are also going to be looking to see if they can locate where the pain starts. Knowing where the pain and other symptoms start will tell them which nerves are being effected.
Your doctor may also perform a neurological exam, to check your:
- Muscle strength
- Walking ability
- Ability to feel light touches, pinpricks or vibration
And these are also to help figure out which nerves are being effected and in what ways.
In most cases of herniated disk, a physical exam and a medical history are all that’s needed to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.
- X-rays. Plain X-rays don’t detect herniated disks, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone. This is often a starting point if your symptoms have a sudden onset.
- Computerized tomography (CT scan). A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.
- Magnetic resonance imaging (MRI). Radio waves and a strong magnetic field are used to create images of your body’s internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.
- Myelogram. A dye is injected into the spinal fluid, and then X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
- Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.
Now that you know your doughnut has oozed out it’s jelly, what’s the treatment plan? For most cases there isn’t nerve compression and conservative treatment — mainly avoiding painful positions and following a planned exercise and pain-medication regimen — relieves symptoms in 9 out of 10 people with a herniated disk. Without nerve compression, the pain can be a result of inflammation or shifting of posture.
- Over-the-counter pain medications. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others).
- Narcotics. If your pain doesn’t improve with over-the-counter medications, your doctor may prescribe narcotics, such as codeine or an oxycodone-acetaminophen combination (Percocet, Oxycontin, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs. Yeah, these things can make you walk around like you’re drunk. So, if you’re prescribed these: avoid driving or doing other things that require focus. Get a sense of how the med will effect you before returning to your usual activities.
- Nerve pain medications. Drugs such as gabapentin (Neurontin, Gralise, Horizant), pregabalin (Lyrica), duloxetine (Cymbalta), tramadol (Ultram) and amitriptyline often help relieve nerve-damage pain. Because these drugs have a milder set of side effects than do narcotic medications, they’re increasingly being used as first line prescription medications for people who have herniated disks.
- Muscle relaxers. Muscle relaxants may be prescribed if you have muscle spasms. Sedation and dizziness are common side effects of these medications. They should also be taken with the same caution as the narcotics.
- Cortisone injections. Inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves. Spinal imaging can help guide the needle more safely. Occasionally a course of oral steroids may be tried to reduce swelling and inflammation.
Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk. They are generally not involved in cases with nerve compression until after the nerve has been decompressed. A physical therapist may also recommend:
- Heat or ice
- Electrical stimulation
- Short-term bracing for the neck or lower back
A very small number of people with herniated disks eventually need surgery. Your doctor may suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to experience:
- Numbness or weakness
- Difficulty standing or walking
- Loss of bladder or bowel control
In many cases, surgeons can remove just the protruding portion of the disk. Rarely, however, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability. Rarely, your surgeon may suggest the implantation of an artificial disk.
- Take pain relievers. Over-the-counter medications — such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others) — may help reduce the pain associated with a herniated disk.
- Use heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you may switch to gentle heat to give relief and comfort.
- Avoid too much bed rest. Too much bed rest can lead to stiff joints and weak muscles — which can complicate your recovery. Instead, rest in a position of comfort for 30 minutes, and then go for a short walk or do some work. Try to avoid activities that worsen your pain during the healing process. However, your doctor may give you specific activity restrictions and if so be sure to follow those recommendations.
Pain affects more than just your physical well-being. If you have to deal with recurring herniated disks or other back problems, your psychological and emotional health also are vulnerable. These tips may help you cope with pain related to a herniated disk:
- Identify pain triggers. Certain activities or behaviors may worsen your pain. If you identify these triggers, you can avoid or limit them.
- Manage stress. Stress magnifies pain. Try doing deep-breathing exercises and practicing other relaxation techniques when your stress level begins to rise.
- See a counselor. Talking with a mental health counselor helps you recognize and rethink unrealistic expectations and beliefs about yourself. Even if you can’t change your chronic pain, you can change the way you feel about it.
So now that we’ve talked about what they are and how they are treated, that leaves one question: What can I do to prevent it. Factors that increase your risk of a herniated disk may include:
- Weight. Excess body weight causes extra stress on the disks in your lower back. Along with all the other joints in your body.
- Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disk. How you do your job will greatly effect how at risk you are.
- Genetics. Some people inherit a predisposition to developing a herniated disk.
- And as already mentioned: Age.
To help prevent a herniated disk:
- Exercise. Strengthening the trunk muscles helps stabilize and support the spine.
- Maintain good posture. Good posture reduces the pressure on your spine and disks. Keep your back straight and aligned, particularly when sitting for long periods. Lift heavy objects properly, making your legs — not your back — do most of the work.
- Maintain a healthy weight. Excess weight puts more pressure on the spine and disks, making them more susceptible to herniation.