Treatment Options

Our spine consists of 33 vertebrae that provide protection for our spinal cord and support for daily movement. Each vertebra is connected to its neighbors above and below with facet joints. This intricate structure is woven through and around with ligaments, tendons, and nerves. Cushioning all of this flexible support are your intervertebral discs.

Intervertebral discs have a tough outer wall and a jelly-like filling that eases pressure between the vertebrae and allows for comfortable movement. A herniated disc is a condition where one of your vertebral disc’s outer walls has split or torn. When this occurs, the gel-like fluid in the center can leak into the spinal canal. A herniated disc can occur anywhere in the spine but is most commonly found in the lower back.

Herniated disc treatments focus not only on relieving the painful symptoms of a herniated disc but also on repairing the damage and addressing the underlying causes of the herniation. Your pain specialist will likely recommend this approach to treatment.

1. Rest

In the acute stage of a herniated disc, rest may be your best course of action. Some people find that resting for too long increases their discomfort, so listen to your body (and your doctor!) to determine how much rest is appropriate for you.

2. Anti-inflammation medications

Non-steroidal anti-inflammatory drugs (NSAIDs) can be remarkably effective in treating the pain of a herniated disc. NSAIDs can be purchased over-the-counter or prescribed at higher doses as needed.

3. Other prescription medications

Pain medication, including oral cortisone and muscle relaxants, can step in when over-the-counter medication isn’t working. It’s important to note that only taking pain medications is not sufficient to actually repair the disc or treat the underlying cause—but it can be a good first step.

4. Exercise

In some cases, if the disc is not yet herniated and is only bulging from between the vertebrae, exercise can help increase the height in the spine to make room for the disc. Core and back-strengthening exercise can bring length to the spine. This can relieve pain and prevent further herniation.

5. Physical therapy

Don’t know where to begin with exercise? A physical therapist can help. Many painful back conditions are actually caused by tight hamstrings and inadequate abdominal support. A physical therapist can help correct that with tailored exercises, both stretching and strengthening.

6. Injections

If the pain is too great to even think about rehabilitative exercise, and medications aren’t helping, an epidural steroid injection works to relieve both pain and inflammation. This can help make other treatments possible and provide long-term pain relief for some.

7. Surgical operations

Surgery may be necessary to repair the damage of a herniated disc and restore the spine’s structure. This should only be an option when other conservative treatments have failed. Your doctor might suggest discectomy, laminectomy, or spinal fusion as a herniated disc treatment.

Symptoms

Herniated disc symptoms may be mild, worsening as the condition progresses. Some people experience all of these symptoms intensely, while others may only have mild, occasional symptoms.

If your herniated disc is caused by an injury, you might feel pain localized at the site of the injury. Sometimes herniated discs can cause back spasms or muscle weakness anywhere along the back.

If your herniated disc is in your lumbar spine, you might have symptoms of sciatic pain, such as:

• Numbness or weakness in the legs
• “Pins and needles” tingling down the legs or in the feet and toes
• Shooting pain that often occurs on one side of the body
• Shooting pain down the buttock and into the back of the leg

Herniated disc symptoms can also include limiting your range of motion, pain when shifting positions, and pain when being in one position for a long time (i.e., sitting or standing for extended periods of time).

If you experience a sudden loss of bowel or bladder control, treat this as a medical emergency. Head straight to your local ER.

Diagnosis/Tests

A herniated disc is generally confirmed by imaging tests (e.g., MRIs and X-rays), but there are other diagnostic tests that may help. These can rule out any more serious causes of your pain and include:

• Blood tests
• CAT scans
• Electromyogram (EMG)
• Neurologic examination
• Physical examination

A positive straight leg raising test is another way your doctor will check to see if you have disc herniation. For this test, you position yourself on the exam table, and your doctor raises your legs, one at a time, to see if you have pain and where it occurs. If your pain is primarily in your back, that’s a good sign of a minor disc bulge. Patients who experience pain that occurs in their back as well as in the leg are more likely to have a disc herniation.

Types

There are three primary types of disc herniation. Understanding the characteristics of each one can help with diagnosis and eventual treatment.

1. Disc protrusion

Disc protrusion is another name for a bulging disc. This is a disc that has been pressed between two vertebrae but has not yet leaked any fluid. A disc protrusion may not cause any painful symptoms (or symptoms may be mild).

2. Disc extrusion

Extrusion occurs when the disc continues to be pressed and begins to leak fluid into the spinal column. When this happens, the vertebrae may begin to compress nerves, causing pain.

3. Disc sequestration

A sequestered disc is one where not only does the disc flatten and begin to leak fluid, but the nucleus of the disc actually leaves the disc and moves to another part of the spinal column (e.g., into the spinal fluid). This occurs most often due to sudden traumatic injury or when a disc extrusion remains untreated.

Causes

A primary cause of disc herniation is a traumatic blow or injury to any part of your spine. For example, whiplash that occurs during a car accident can also cause disc herniation in the neck.

In many cases, disc herniation causes build up over time. As we age, our spines begin to press down due to gravity. We may also begin to lose muscle in our abdomen and back. These two conditions can lead to more pressure, especially in the lower back, that eventually leads to disc herniation.

People with occupations that include repetitive motions and heavy lifting have higher rates of disc herniation, as do people who are overweight. Injury from improper lifting techniques (e.g., lifting and twisting at the same time or lifting with your back instead of your legs) can also cause disc herniation.

Facts

Your lower back is the most common site of disc herniation. This highly mobile collection of vertebrae takes a lot of pressure over our lifetime. Herniated discs occur most often between the fourth and fifth vertebrae in the lower back.

The clearest way to picture a herniated disc is to imagine your intervertebral discs as a jelly doughnut with a soft middle. When this doughnut is compressed, the jelly squishes out and the cake of the doughnut flattens.