A herniated disc is a condition that occurs when the soft center (nucleus pulposus) of an intervertebral disc pushes through the firm outer edge of the disc (annulus fibrosus). Between every vertebra is an intervertebral disc — there are 23 in total.
A herniated disc can be caused by a traumatic injury or due to repetitive stresses over time. This could stem from a car accident (whiplash causing a disc to herniate in your neck) to an unknown event. Most people are completely unaware and uncertain of what caused their disc injury.
Not always. For most people, there is a chance the disc injury was present before the pain ever occurred. For example, let’s assume someone has back pain and they get an MRI that shows a herniated disc. Did they have an MRI showing the disc before the pain ever started? Probably not. Therefore, we can rarely be certain that the disc is the exact cause of the pain. Furthermore, scientific research has proven herniated discs don't always cause pain.
This is why it's so important to rule out other factors that may be the root cause of your pain (see below). And there are some simple movement tests we can use that will begin to help identify if a disc is the cause.
Fortunately, there are some common symptoms that should occur when a disc is herniated. These should be sensations of tingling, numbness, burning, or weakness. A disc herniation in the neck should cause these sensations into the arm, sometimes called cervical radiculopathy, a pinched nerve in the shoulder, a pinched nerve in the neck, or carpal tunnel syndrome. And a disc herniation in the lower back will be felt into the leg, sometimes called sciatica, lumbar radiculopathy, or a pinched sciatic nerve.
If you don’t have any of these symptoms it’s unlikely that your disc is the root cause of your pain, although should be verified with a medical professional.
The first step in herniated disc treatment is identifying whether a disc is to blame for the pain. The best way to identify this is with simple movements. More specifically, spinal flexion (bending forwards for the lower back and looking down for the neck) should lead to increased symptoms. This is because flexion places pressure on the disc that exacerbates the herniation.
You should also rule out things like piriformis syndrome, rotator cuff referred pain, carpal tunnel syndrome, and nerve tension testing as possible causes for your pain that are not related to a disc, but can cause similar symptoms.
Herniated disc surgery varies by severity of symptoms. Many doctors will first recommend steroid injections, gabapentin (for nerve pain), and physical therapy. If these options fail then a discectomy surgery could be next. For more severe cases, a laminectomy, or a spinal fusion may be recommended.
If you want to avoid surgery there are many different options available that we have written about. You can read more about how to heal a herniated disc naturally.
No it does not. The statistics vary, but roughly 20% of people with a herniated disc do not have any pain. In our experience, many people will be diagnosed with a herniated disc, and have symptoms consistent with a herniated disc, but the root problem is not the herniated disc. Other common problems that can mimic a herniated disc are: piriformis syndrome, nerve tension testing, referred pain from the rotator cuff, or carpal tunnel syndrome. We recommend ruling out all other causes for the pain prior to assuming the herniated disc is in fact the root problem. Surgery can be avoided for most people when this approach is taken.
Yes it can. With that said, if it's going to heal you must first avoid the activities that lead to the herniated disc in the first place — many times this is repeated spinal flexion. However, pain that is left untreated becomes harder and harder to fix the longer someone waits. Pain science has proven this and is one of many reasons why early intervention is strongly recommended.
Avoiding movements that lead to a herniation — many times this is repeated spinal flexion. Furthermore, pain free movements and exercise — such as walking — will also improve recovery due to increasing blood flow and nutrients to the damaged area. In our experience, the Mckenzie Method improves symptoms consistent with a herniated disc and is the approach we seek to use initially with clients.
Bed rest initially can help to decrease symptoms. However, it it extremely unlikely to heal a herniated disc. Once someone is able to stand, walk, or perform light exercises this should be the focus of treatment for a disc herniation.
You should feel nerve symptoms into the arm (cervical spine) or leg (lumbar spine) depending on where the herniated disc is present. Nerve symptoms include: tingling, numbness, burning, pins and needles, or weakness. Weakness is a sign that something more severe is occurring and irreversible damage may be likely. Seek a medical provider immediately if you are experiencing weakness. If you feel neck or back pain without nerve symptoms then it's likely your pain is due to something other than a herniated disc which could include osteoarthritis or something simple like a movement dysfunction which is what we help people fix every day in our clinic.
A disc will cause nerve symptoms which are: tingling, numbness, burning, pins and needles, or weakness. If the herniation is in the neck these symptoms may be felt into the arm. A herniation in the lower spine will cause symptoms into the leg. Muscular pain is more likely to cause sharp pain or a dull ache that is worse with some movements and better with others. Typically, if a disc is the cause of symptoms then symptoms are worse with spinal flexion and better with spinal extension.
It's more about the symptoms than it is about the disc. This is because some people will have a herniated disc and no pain. Therefore, a disc may require surgery if conservative treatment fails and the pain has lasted longer than 6 weeks. Surgery should be based on the symptoms and not how bad the disc is.
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