Herniated disk

A herniated disk happens when one of the soft, rubbery cushions between the bones in your spine gets damaged. These cushions are called disks. They sit between the bones that stack to make the spine. These bones are called vertebrae.

Each disk has a soft, jelly-like center, called the nucleus, and a tougher outer layer, called the annulus. A herniated disk happens when part of the soft center pushes out through a tear in the outer layer. You also may hear this called a slipped or ruptured disk.

A herniated disk can happen in any part of the spine, but it is most common in the lower back. It can cause pain, numbness or weakness in an arm or leg, depending on where the herniated disk is.

Some people with a herniated disk don't have any symptoms. If you do have symptoms, they typically get better over time. Most people don't need surgery to treat a herniated disk.

A herniated disk typically happens in the lower back, but it also can happen in the neck. Symptoms depend on where the disk is and whether it's pressing on a nearby nerve. Most of the time, a herniated disk affects just one side of the body.

• Arm or leg pain. A herniated disk in the lower back may cause pain in the lower back, buttocks, thigh and calf. It may cause pain in the foot as well.

  A herniated disk in the neck typically causes the most pain in the shoulder and arm. You may feel sharp or burning pain that gets worse when you laugh, cough, sneeze or move a certain way.

• Numbness or tingling. A herniated disk may cause radiating numbness or tingling in the area of the body affected by the irritated nerve.
• Weakness. The muscles linked to the affected nerve may get weaker. You might drop things, have trouble lifting or feel unsteady when walking.

Some people have no symptoms and may not even know they have a herniated disk unless it shows up on an imaging test.

When to see a doctor

Call your healthcare professional if pain in your neck or back spreads to your arm or leg. Call if you have numbness, tingling or weakness.

A herniated disk typically happens over time because of the natural aging process that causes disks to wear down. As you get older, the disks in the spine become less flexible and can tear or rupture more easily, even with small movements such as bending or twisting.

Most of the time, people don't know what caused their herniated disk. Sometimes, lifting heavy things using your back muscles instead of your leg and thigh muscles can lead to a herniated disk. Twisting and turning while lifting also can cause a herniated disk. In rare cases, a fall or a hit to the back can be the cause.

Some factors can make you more likely to have a herniated disk, including:

• Extra body weight. Carrying too much weight puts extra stress on the disks in the lower back.
• Physically demanding work. Jobs that involve lifting, pulling, pushing, bending or twisting increase the risk of a herniated disk.
• Family history. Some people inherit a higher risk of getting a herniated disk.
• Smoking. Smoking may lessen blood flow to spinal disks, making them break down faster.
• Frequent driving. Being seated for long periods combined with the vibration from a motor vehicle engine can put pressure on the spine.
• Lack of exercise. Staying active helps protect your back and may lower your risk of a herniated disk.

Just above your waist, your spinal cord ends. Below that, a bundle of nerves continues through the spinal canal. This bundle is called the cauda equina, which means horse's tail in Latin because of the way it looks.

Rarely, a herniated disk can press on the entire bundle of nerves in this area. This is a medical emergency. Without quick treatment, you may have lasting weakness or even paralysis. Emergency surgery may be needed to prevent serious, long-term damage.

Seek emergency medical attention if you have:

• Worsening symptoms. Pain, numbness or weakness that gets worse and makes it hard to do everyday activities.
• Bladder or bowel issues. Trouble holding urine or stool, or trouble urinating even when your bladder feels full.
• Saddle anesthesia. Numbness or loss of feeling in the areas that would touch a saddle, such as the inner thighs, backs of the legs and around the rectum.

You can lower your risk of a herniated disk by taking care of your back.

• Stay active. Exercise regularly to strengthen the muscles in your stomach and back. Strong core muscles help support and protect your spine.
• Keep good posture. Sit and stand up straight to lessen stress on your spine. When lifting something heavy, bend your knees and use your legs, not your back, to lift.
• Keep a healthy weight. Extra weight adds pressure to your spine and disks, which can make injury more likely.
• Don't smoke. Smoking and other tobacco use can weaken the disks in your spine and increase the risk of a herniated disk.

Your healthcare professional starts with a physical exam. They may gently press on areas of your back to check for pain and tenderness. You may be asked to lie down and move your legs in different ways to help figure out the source of your pain.

Your healthcare professional also may check your nervous system by testing:

• Reflexes.
• Muscle strength.
• How well you walk.
• How well you feel touch, pinpricks or vibration.

For many people, a physical exam and a medical history are enough to diagnose a herniated disk.

If your healthcare professional thinks something else may be causing your symptoms, or wants to see exactly which nerves are affected, you may need imaging or nerve tests.

Imaging tests

These tests create pictures of your spine and nearby structures:

• X-ray. An X-ray can't show a herniated disk, but it can help rule out other causes, such as broken bones, spinal alignment issues, tumors or infections.
• CT scan. A CT scan takes many X-rays from different angles to create detailed cross-section images of your spine. This helps diagnose a herniated disk by providing clear, detailed images of the bones and soft tissues.
• MRI. This test uses radio waves and strong magnets to show even better images of soft tissues in your spine. This helps confirm the location of a herniated disk and show which nerves are affected.
• Myelogram. This test uses a special dye that is injected into the spinal fluid before a CT scan. It helps to show if there is pressure on the spinal cord or nerves from herniated disks or other conditions.

Nerve tests

An electromyogram (EMG) measures how well your nerves and muscles work together. A small needle is placed into your muscles to measure electrical activity when your muscles are resting and when they move. This helps show which nerves may be damaged.

A nerve conduction study also is done during this test. Small patches with sensors, called electrodes, are placed on your skin. A gentle electric pulse checks how fast and strong nerve signals travel. This may help pinpoint the location of any nerve damage.

Most people feel better with simple treatment, such as avoiding painful movements and taking medicine for pain. This is called conservative treatment, and it often helps lessen symptoms in a few days or weeks.

Medications

• Pain medicines you can buy without a prescription. If your pain is mild to moderate, your healthcare professional may suggest medicine such as acetaminophen (Tylenol, others) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
• Nerve pain medicine. These prescription medicines help calm overactive nerves that cause pain. The medicines include gabapentin (Horizant, Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta), and venlafaxine (Effexor XR).
• Muscle relaxers. If you have muscle spasms, your healthcare professional may prescribe muscle relaxers. They can cause drowsiness or dizziness.
• Opioids. These strong pain medicines are usually avoided unless other medicines haven't helped. If used, opioids are prescribed for a short time. They can cause side effects such as nausea, confusion, constipation and drowsiness.
• Steroid injections. If your pain doesn't improve with oral medicines, your healthcare professional may recommend a steroid injection near the affected nerve. Imaging typically is used to guide the needle to the affected nerve.

Therapy

Your healthcare professional may suggest physical therapy to help with your pain. A physical therapist can show you stretches and exercises to strengthen your core, lessen pain and help you move more easily.

Surgery

Most people don't need surgery. But your healthcare professional may recommend it if your symptoms don't improve after six weeks or if you have:

• Ongoing or serious pain.
• Numbness or significant muscle weakness.
• Difficulty walking or standing.
• Loss of bladder or bowel control.

In most cases, a surgeon removes only the part of the disk that is pressing on a nerve. In rare cases, the whole disk is removed. If that happens, your surgeon may fuse the nearby bones together using a bone graft. Metal rods or screws often are used to keep the spine stable while it heals. This can take several months.

Rarely, an artificial disk is placed instead of doing a bone fusion. Your surgeon will talk with you about the best option for your situation.

In addition to any pain medicine your healthcare professional recommends, you can try the following:

• Use heat or cold. Cold packs may help reduce pain and swelling in the first few days. After that, you can try gentle heat for comfort and relief.
• Avoid too much bed rest. Lying in bed for long periods can make your joints stiff and your muscles weaker. This can slow down your recovery. Try resting in a comfortable position for 30 minutes, then take a short walk or do light tasks. Try gentle stretching exercises. Don't do activities that make your pain worse.
• Resume activity slowly. Let your pain guide you. Move slowly and carefully, especially when bending and lifting.

Some people find that alternative or complementary treatments help ease long-term back pain. These treatments include:

• Chiropractic care. A chiropractor may use spinal manipulation to improve movement and ease pain. This may help with low back pain that lasts more than a month. Neck adjustments are less common and in rare cases can lead to serious side effects such as certain types of strokes.
• Acupuncture. This treatment uses thin needles placed in the skin to ease pain. It may help relieve long-term pain in the back or neck, but the effects typically are modest.
• Massage. Massage therapy may provide short-term relief for people with chronic low back pain.

You're likely to see your primary healthcare professional first. You may be referred to a specialist in physical medicine and rehabilitation, orthopedic surgery, neurology, or neurosurgery.

What you can do

Before your appointment, be ready to answer questions such as:

• When did your symptoms start?
• Were you lifting, pushing or twisting when the pain began?
• Has the pain made it hard to do your regular activities?
• What helps make your symptoms feel better?
• What makes the pain worse?
• What medicines, vitamins or supplements do you take?

What to expect from your doctor

Your health care team might ask other questions, such as:

• Does your pain travel into your arms or legs?
• Do you feel weakness or numbness in your arms or legs?
• Have your bowel or bladder habits changed?
• Does coughing or sneezing make the pain worse?
• Is pain affecting your sleep or work?
• Does your job involve heavy lifting?
• Do you smoke or use other tobacco products?
• Has your weight changed recently?