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Herniated Disc

Herniated Disc / Slipped Disc Definition:
A herniated disc occurs when the spongy, gel-filled cushion between two bones of the spine bulges or slips out of place. The spine is made from 33 bones, stacked to form a tunnel, within which lie the spinal cord and nerves. The vertebrae are separated by discs which acts as shock absorbers, and allow the spine to be flexible. These discs are made up of a hard outer capsule (annulus fibrosus) and a soft, spongy middle (nucleus polposus).

Herniated discs are sometimes called ruptured discs, although there is a difference. When a disc bulges out between the vertebrae, it is termed herniated. If the nucleus inside the disc breaks through the capsule, it is known as a ruptured disc. Sometimes pieces of a ruptured disc, called free fragments, become detached and get lodged in the spinal canal. These are often reabsorbed by the body and cause no problems.

Herniated discs are a very common spinal abnormality, and often bulge away from the spinal cord, causing no problems at all. Herniated disc symptoms such as pain and numbness are only experienced when the herniated disc presses on a nerve in the spinal canal. Most occurrences of this condition are in the lower back (lumbar spine), between the 4th and 5th lumbar vertebrae. They can also happen in the neck (cervical spine) and, rarely, in the upper back (thoracic spine).

Herniated Disc / Slipped Disc Causes:
The normal aging process is responsible for many herniated discs. This is termed disc degeneration. As the body ages, the outer capsule of the disc starts to dry out and become less flexible. This loss of elasticity causes tiny cracks or tears to appear, and the nucleus (the spongy gel) can form a bulge in the capsule or even break through.

Another, less common, cause is injury. A sudden strain on the lower back might cause a disc to herniate. Repetitive actions such as pulling, lifting with poor posture, playing some sports, or even constant exposure to vibration when driving can also be causes of this condition.

Slipped Disc Risk factors:
  • A history of back injuries or surgery.
  • Being male.
  • Being overweight.
  • Being between the ages of 35-45.
  • Herniated Disc Symptoms:
    The main symptoms are pain, numbness, pins-and-needles, or weakness.

    If the affected disc is in the lumbar spine (lower back), symptoms will be felt anywhere from the buttocks to the foot, but will only affect one leg. If the disc is in the cervical spine (neck), the symptoms will be similar, but felt in the shoulders, arm or chest.

    A sufferer of a herniated disc in the lumbar spine might well feel 'shooting' pains, sometimes radiating from the buttocks, sometimes from behind the knee, down one leg and possibly reaching the ankle or foot. This is known as sciatica, and is the most common herniated disc symptom that people experience. It has been described as feeling like an electric shock and can be triggered by coughing or sneezing. Sometimes the pain might be more of a dull, burning, feeling, or even pins-and-needles. The pain might happen suddenly, or come on gradually. It may be intermittent or constant. Sitting or standing for long periods, or bending or twisting might make the pain worse, whereas walking, lying down, or being in any position that relieves pressure on the spine may make it better.

    If the nerve being compressed is in the upper part of the lumbar spine, pain might be felt near the ends of the lowest ribs, or perhaps in the front of the thigh.

    Weakness or numbness might be felt in particular muscles, depending on the destination of the affected nerve.

    Deep muscle pain or muscle spasms might be experienced.

    There is a rare, but very serious, condition called cauda equine syndrome, which happens when the entire bundle of nerves in the spinal canal is compressed. In this instance, both limbs will be affected. There may be weakness or numbness and the symptoms may get progressively worse, with a loss of sensation in the inner thighs, buttocks and rectal region. There may be loss of bladder and bowel control, and possibly even paralysis. If you suspect you may have this condition, you should seek immediate medical help.

    A condition called spinal stenosis, which is when the spinal canal narrows and therefore compresses the spinal cord and its nerves, can cause similar symptoms to a herniated disc.

    Herniated Disc / Slipped Disc Diagnosis:
    Your doctor will take your medical history, and perform an examination that will include testing your reflexes, muscle strength and ability to walk. Your sensitivity to light touch, pinpricks and vibration will probably be assessed. One diagnostic test is called the Leségue test. This involves you lying or sitting down and raising one straight leg. If this elicits a painful or strange sensation in the foot or leg, your doctor will probably consider this a positive diagnosis of a herniated disc and will not order further tests, unless they are needed to pinpoint which nerves are being affected, or another condition is suspected. Such further tests might include an X-ray, CT (computed tomography) or MRI (magnetic resonance imaging). Very occasionally a myelogram, electromyogram or a nerve conduction study might be required.

    Herniated Disc / Slipped Disc Treatment:
    The tiny tears and cracks in the annulus of a disc will not repair themselves, but the pain caused by the herniation will usually lessen with time. Half of all sufferers will be better within one month, and most within six months.

    Self-help options, if the pain is severe:
  • Rest. Try relaxing either on the floor or on a medium-firm bed, with a small pillow under your head and another under your knees. Be careful not to stay in any one position for too long.
  • Apply an ice pack to the affected area, for 20 minutes, several times per day. After any spasms have ceased, try applying heat, again for about 20 minutes, every 2-3 hours.
  • Take pain-reducing medications such as Tylenol, Advil, Motrin or Aleve.
  • Avoid painful positions, or activities that make the pain worse.
  • Self-help options, if the pain is mild:
  • Keep active if possible.
  • Walk on a level surface for 10-20 minutes, every 2-3 hours, but only do this if you are not experiencing any pain. It is important to maintain muscle strength.

    If your symptoms do not improve after a week or two, contact your doctor. You may be referred to a physiotherapist for further exercises, heat treatment, ultrasound or electrical stimulation. Your doctor may prescribe stronger pain medication, such as codeine or Vicodin, or muscle relaxants such as Valium. Another possible treatment is a corticosteroid injection into the site of the herniated disc.

    Alternative medicine such as chiropractic, massage and acupuncture might help. There is also a treatment called modern decompression, which involves lying on a machine and having your spine very gently stretched to relieve the pressure.

    Surgery for a herniated disc is only occasionally called for as most cases resolve themselves, given time.

    What to look for in a brace to help a herniated disc:
    There are two types of brace available, rigid or corset. Which one is best for you depends on your particular need and which is the best fit.
    Although rigid braces used to be heavy and tended to make wearers feel too hot, modern materials have lessened the weight and improved ventilation, making them more comfortable to wear.
    Corset-style back braces allow for a bit more flexibility.

    Herniated Disc / Slipped Disc Prevention:
    Unfortunately, once a back has been weakened through injury or age, it tends to remain weak and therefore vulnerable to further problems. The most important things to remember are:
  • When lifting, use your legs. Do not bend at the waist, but squat down instead.
  • Maintain good posture at all times.
  • Exercise in order to keep your muscles strong and your spine flexible.
  • Maintain a healthy weight.
  • Don't smoke. Nicotine damages discs and increases one's sensitivity to pain.
  • Back (or neck) braces may be helpful, mostly to remind you to maintain correct posture, and to provide support if you are recovering from surgery or a particular back injury.
  • Avoid positions or activities that are known to cause you problems.

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