A herniated disc, also known as a “slipped disc” or ruptured disc, is a common cause of back or neck pain. The herniated disc causes pressure on the nerves around the spine or on the spinal cord. This may cause pain, numbness, or weakness in the area controlled by that injured disc.
What causes a herniated disc?
Herniated discs can happen when there is an injury to the spine. The spine consists of several bones (called vertebrae) stacked on top of soft cushions (called discs). The discs have a soft gel-like center, or nucleus, with a tough and rubbery outside, also known as the annulus. The discs allow your spine to bend, stretch, and twist.
When an injury occurs to the disc, it can tear the gel-like center, which may lead to leakage. This herniation puts pressure on the nerves or spinal cord. This can cause pain, tingling, or numbness.
Depending on where the herniated disc is located, these sensations can travel down the arm or leg. In some cases, herniations do not cause any symptoms.
Herniated discs typically happen after tough activities like:
- Heavy lifting
- Sitting or standing in the same position for long periods
- Being overweight
- Repetitive bending or twisting
- An inactive lifestyle
- Frequent driving for long periods
Who gets herniated discs?
Men are twice as likely as women to have herniated discs. This injury most often occurs in people ages 30 to 50.
Symptoms of a herniated disc
Most herniated discs occur in the low back, but some happen in the neck too. Herniated discs are not generally found in the upper back. The injury may feel like burning or stinging pain.
Symptoms can vary depending on the location of the herniated disc. It can also depend on if the herniation is pressing on a nerve. Symptoms are usually on one side of the body.
There are two main types of herniated discs:
Neck (cervical) herniated disc
Symptoms of a herniated cervical disc include:
- Neck pain that can travel to the shoulder and arm or even down to the fingers
- Pain between shoulder blades
- Increasing pain with bending or moving the neck
- Numbness or tingling in one or both arms because it affects nerves
- Muscle weakness in the arm, which can make it difficult to lift or hold objects
Low back (lumbar) herniated disc
A herniated lumbar disc might result in the following symptoms:
Pain in the low back that can travel into the buttock, thigh, calf, and even the foot, like sciatica. Numbness or tingling in the buttock or leg from pressure on the nerve. Muscle weakness because of the effect on the nerve, which may cause difficulty walking
The severity of the injury can vary depending on the size of the herniation. Symptoms may get worse with movement and better with rest. Pain can also increase with actions such as:
- Lying flat
- Bearing down
Some herniations may not have symptoms. It may also be difficult to notice symptoms until you are examined by a healthcare provider.
Diagnosing herniated discs
Your healthcare provider will do a physical exam looking for signs of a herniated disc. The physical exam will assess muscle reflexes, strength, pain, and sensation.
Your provider will order x-rays of your neck or back. This is to make sure another cause is not to blame. If the x-ray looks normal, you will have a magnetic resonance imaging (MRI) test. This is the most appropriate and specific test to look for a herniated disc.
If necessary, other tests may be used to assess the nerves and spinal cord. A CT scan may be necessary to evaluate the bones of your neck or low back. A myelogram is another imaging procedure similar to a CT scan, but dye is injected into the spinal fluid or nerve to see if there is narrowing. These tests are not always necessary and may not be done.
Treatment for a herniated disc
Herniated discs may heal on their own and may not need any treatment. If the herniation does not heal, you may need treatment. Unfortunately, conservative treatments or ways to reduce pain without surgery are limited.
Medications that can assist with pain management include:
- Nonprescription pain medications available over the counter like acetaminophen, ibuprofen, or naproxen sodium
- Muscle relaxers may reduce muscle spasms; these can cause tiredness or dizziness
- Opioids may be considered if other medications do not work; these drugs place someone at risk for addiction and can cause tiredness, nausea, vomiting, confusion, and constipation
- Neuropathic medicines like gabapentin, duloxetine, or venlafaxine can reduce pain in the nerves
- Corticosteroid injections given directly into the space are an option to decrease pain; this can reduce inflammation around the nerve and decrease pain
Physical therapy is another option and may be attempted before your doctor considers surgery. Physical therapists provide exercise and stretches that can help reduce pain.
If these alternatives do not work and the herniation does not resolve on its own, surgery may be required. Surgery may be necessary if you have:
- Pain that does not improve
- Numbness or weakness that continues or does not improve
- Difficulty standing, walking, lifting, or holding objects
- Loss of bowel or bladder control
Types of surgery
Surgery relieves the pressure the herniated disc puts on the nerves or spinal cord. There are different types of surgeries:
- Discectomy is the removal of the entire disc or just the herniated part
- Laminectomy is the removal of bone around the herniation, which makes more room for the spinal cord
- Spinal fusion permanently connects two vertebrae to prevent movement and make them more stable
- Artificial disc surgery involves replacing the injured disc with an artificial one
Can I prevent a herniated disc?
You can work to prevent herniated discs from happening. You can lower your risk of herniated disc by doing the following:
- Exercising to strengthen your core, back, and stomach muscles, which all protect your spine
- Stretching regularly, especially if you sit for long periods
- Using good posture when walking, sitting, and standing to decrease pressure on your spine
- Keeping a healthy weight to reduce pressure on your low back
- Using proper lifting techniques and body mechanics to reduce your risk of injury. Lift with your legs, not your back. Bend your knees, not your back. Use your legs to support lifting, not your back.
- Wearing flat shoes and avoiding high-heeled shoes, which prevent proper spinal alignment
- Quitting smoking or using tobacco products
Complications of herniated discs
An untreated herniated disc can get worse. Symptoms can progress if the herniation is not treated. If you continue to do activities that aggravate the herniation, it could get worse. Especially if those activities are the ones that initially caused the injury.
Rarely the herniation can cause pressure on the nerve and increase weakness or paralysis. This is an emergency and must be treated immediately.
Increasing pain and weakness can affect your daily activities. It could also affect your ability to control your bowel and bladder. Plus, it causes pain in your buttock, upper legs, and rectum.
Contact your healthcare provider if you have symptoms of a herniated disc. If you experience numbness or weakness in your arms or legs, let your provider know. Your pain may resolve on its own but it also may not. Don’t forget to rest. Do not continue activities that aggravate your pain. If the pain continues, contact your provider.
A herniated disc can put pressure on the nerves or spinal cord and can cause pain, tingling, or numbness.
In some cases, herniations do not cause any symptoms.
Herniated discs occur in people ages 30 to 50.
Herniated discs may heal on their own and not need any treatment.
Conservative treatments or ways to reduce pain without surgery are limited.
Exercises that strengthen your core, back, and stomach muscles will support your spine.
Proper lifting techniques and body mechanics reduce your risk of injury.
Mayo Clinic. Herniated Disk
Cleveland Clinic. Herniated Disk (Slipped, Ruptured or Bulging Disk)
National Library of Medicine. Disc Herniation
Mount Sinai. Herniated disk