What is a herniated lumbar disc?
A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall (annulus). The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if low back and/or leg pain is going to resolve it will do so in about 6 weeks.
Different terms may be used to describe a herniated disc. A bulging disc (protrusion) occurs when the disc annulus remains intact but forms an outpouching that can press against the nerves. A true herniated disc (also called a ruptured or slipped disc) occurs when the disc annulus cracks or ruptures, allowing the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal.
Most herniated discs occur in the lumbar spine, where spinal nerves exit between the lumbar vertebrae, and then join together again to form the static nerve, which runs down your leg.
What causes a herniated lumbar disc?
Discs can bulge or herniate because of injury and improper lifting or can occur spontaneously. Aging plays an important role. As you get older, your discs dry out and become harder. The tough fibrous outer wall of the disc may weaken. The gel-like nucleus may bulge or rupture through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking, and a number of occupational and reactional activities may lead to early disc degeneration.
Herniated discs are most common in people in their 30s and 40s, although middle aged and older people are slightly more at risk if they’re involved in strenuous physical activity.
Lumbar disc herniation is one of the most common causes of lower back pain associated with leg pain and occurs 15 times more often than cervical (neck) disc herniation. Disc herniation occurs 8% of the time in the cervical (neck) region and only 1 to 2% of the time in the upper-to-mid-back (thoracic) region.
What are symptoms of a herniated lumbar disc?
Symptoms of a herniated disc vary greatly depending on the location of the herniation and your own response to pain. If you have a herniated lumbar disc, you may:
- Feel pain that radiated from your low back area, down one or both legs, and sometimes into your feet (called sciatica)
- Feel a pain like an electric shock that is severe whether you stand, walk or sit.
- Have pain with activity such as bending, lifting, twisting, and sitting
- Lying flat on your back with knees bent may be the most comfortable because it relieves the downward pressure on the disc.
Sometimes the pain is accompanied by numbness and tingling in your leg or foot. You may experience cramping or muscle spasms in your back or leg.
In addition to pain, you may have leg muscle weakness, or knee or ankle reflex loss. In severe cases, you may experience foot drop (your foot flops when you walk) or loss of bowel or bladder control. If you experience extreme leg weakness or difficulty controlling bladder or bowel function, you should seek medical help immediately.
How is a herniated lumbar disc diagnosed?
Diagnosing a herniated lumbar disc typically begins with a physical exam by your doctor. This exam will evaluate reflexes, strength and sensation. Additionally, your doctor will want to know any previous history of injury in the problem area. If it is determined that additional testing is needed following the exam, there are a few options.
Your doctor may recommend:
- MRI
- X-ray
- CT scan
- Electrodiagnostic testing to test the nerves.
How is a herniated lumbar disc treated?
There is not a one size fits all treatment for a herniated lumbar disc. Surgery is not always the answer to help you feel better. The treatment option that fits your situation best will be determined based on the severity of the herniation.
The easiest treatment is conservative therapy which allows you to heal from home with no surgery. This involves lots of rest, physical therapy and anti-inflammatory medication as needed.
If needed, the next step would be to receive epidural steroid injections (ESI). This would provide you comfort by reducing inflammation and pain more than a typical over-the-counter anti-inflammatory medication would.
Surgery is the final option for those with severe herniations. Typically, a laminotomy and discectomy procedure is only done if the herniated disc blocks over 50% of the central spinal canal. When surgery is complete, the full disc will have been removed.
What is recovery like from a herniated lumbar disc?
Rehabilitation of the spine will be important to get back to living your normal pain-free life. You will want to regain strength and mobility either through physical therapy or by doing at-home exercises. If you choose to do exercises at-home, please be cautious that you are not straining the spine as this can re-agitate the disc. To help further prevent any injuries, we recommend continuing your strengthening exercises, practice proper lifting techniques, maintain a healthy weight and lean body mass, practice good posture at all times and upgrade your workspace to be ergonomic.
How do I avoid a recurrence?
Back pain affects 8 of 10 people at some time in their lives and usually resolves within 6 weeks. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If your regular job cannot be done initially, it is in the patient’s best interest to return to some kind of modified (light or restricted) duty. Your physician can give prescriptions for such activity for limited periods of time.
The key to avoiding recurrence is prevention:
- Proper lifting techniques
- Good posture during sitting, standing, moving, and sleeping
- Appropriate exercise program to strengthen weak abdominal muscles and prevent re-injury
- An ergonomic work area
- Healthy weight and lean body mass
- A positive attitude and stress management
- No smoking