Back Pain: A Visual Guide to Herniated Disks

A herniated disk pushes on a nearby nerve.

What Is a Herniated Disk?

The bones of your spine, called vertebrae, are separated by rubbery disks. If one of them tears, you have a "ruptured" disk. When the jelly-like substance inside leaks and pushes on a nearby nerve, it's called a "herniated" disk.

Making a wrong move or simple aging may cause a herniated disk.

What Causes It?

It's often hard to know exactly what makes a disk break open. It could be that you lifted something heavy and strained your back. A simple awkward turn or twist could do it, or even a fall or sudden hit to the body. Sometimes it's just aging. As you get older, your disks start to lose water, which means they don't flex as well and may tear more easily.

A herniated disk may cause sharp shooting pain, weakness, numbness, or tingling.

What Are the Symptoms?

You might notice a sharp pain that shoots from your rear end down the back of your leg. Your leg or foot could feel weak, numb, or tingly. In the neck, a herniated disk can send pain, tingling, and numbness down your arm and into the muscles between your neck and shoulders.

Warehouse and delivery workers may be more likely to suffer from a herniated disk.

Who Gets It?

You're more likely to tear a disk if you lift, push, or bend a lot or do the same motion over and over. Think of warehouse or delivery workers. Sitting all day in the same position, as many office workers do, can also do it. It happens more after middle age and if you're overweight or a smoker. Some people inherit genes from their parents that lead to disk problems.

Your doctor will use imaging tests, a physical exam, and your history to diagnose a herniated disk.

How Is It Diagnosed?

Your doctor will ask detailed questions about your symptoms and test your reflexes and muscle strength. She might rub, touch, or prick your skin to see how much you can feel. You may also need to get some imaging tests, like an X-ray, CT scan, or MRI.

Your doctor may recommend over-the-counter meds or prescription meds to treat your symptoms.

Which Medications Help?

You can start with over-the-counter meds that lessen swelling and pain, like ibuprofen and naproxen. If you're hurting a lot, your doctor may prescribe stronger drugs like narcotics, anticonvulsants, and muscle relaxers. To curb inflammation around your herniated disk, you may need to take steroid medicine by mouth. Your doctor might also inject steroids into your back to ease swelling near the disk.

Try ice first for a herniated disk and then later you can apply heat.

Cold and Heat Treatments

Try an ice pack at first to ease pain and swelling, but don't use it for more than 20 minutes at a time. In a few days, after any muscle spasms settle, you also can switch to some gentle heat to relieve pain.

You might need physical therapy to treat a herniated disk.

Physical Therapy

If your back still hurts after a few weeks, your doctor might send you to a therapist who can show you a set of exercises that take pressure off the nerve. These often help strengthen your back and stomach muscles. It's best to get an expert to instruct you on the right way to do them so you don't reinjure yourself or make your symptoms worse.

Some people may need to consider surgery if their symptoms are not resolving after 6 weeks of other treatments.

Surgery

Most people won't need surgery, but if you still have serious pain, numbness, trouble walking, or bladder problems after 6 weeks of other treatments, it may be time to consider it. The surgeon may remove part of the disk where it pushes on any nerves. In the neck, the surgeon may take the whole disk out and replace it with bone, and sometimes a metal plate for support.

A herniated disk in the area of the cauda equina may be associated with more serious complications.

Complications

Just past your waistline, your spine divides into a group of nerve roots called the cauda equina. In rare cases, a herniated disk can push on this cluster. You might lose control of your bladder and bowel movements, and you might need immediate surgery to prevent permanent damage like weakness or paralysis. Go to an emergency room right away if you notice these symptoms or if you lose feeling in your feet, legs, or genital area.

Maintain a healthy weight and avoid repetitive motion to keep your spine healthy.

How to Prevent Trouble

There are no guarantees, but there are things you can do to keep your disks in good shape. It helps to stick to a healthy weight to keep extra strain off your spine. Try to avoid doing the exact same motion over and over again. If you sit all day, try to get up at least every hour or so, and move around to take pressure off your back.

Maintaining good posture will help keep the strain off your spine.

Good Posture

You'll lessen pressure on your spine and disks if you keep your back straight, particularly when sitting for long periods. When you lift heavy objects, you should mostly use the muscles in your legs, not your back. If you're not sure exactly how to do this, your doctor or a physical therapist can help.

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REFERENCES:

  • American Academy of Family Physicians: "Herniated Disk."
  • American Academy of Orthopaedic Surgeons: "Herniated Disk," "Cauda Equina Syndrome."
  • Mayo Clinic: "Herniated Disk."
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