Lumbar Herniated Disc
Lumbar Herniated Disc
Is this topic for you?
This topic is for a people who have a herniated disc in the lower
back. If you are looking for information on a herniated disc in the neck, see
the topic Cervical Disc
What is a herniated disc?
The bones (vertebrae) that form the
spine in your back are
cushioned by small, spongy discs. When these discs are healthy, they act as
shock absorbers for the spine and keep the spine flexible. But when a disc is
damaged, it may bulge or break open. This is called a
herniated disc. It may also be called a slipped or ruptured disc.
You can have a herniated disc
in any part of your spine. But most herniated discs affect the lower back
(lumbar spine). Some happen in the neck (cervical spine) and, more rarely, in
the upper back (thoracic spine).
What causes a herniated disc?
A herniated disc may be caused by:
- Wear and tear
of the disc. As you age, your discs dry out and aren’t as flexible.
- Injury to the spine. This may cause tiny tears or cracks in the hard outer
layer of the disc. When this happens, the thick gel inside the disc can be
forced out through the tears or cracks in the outer layer of the disc. This
causes the disc to bulge or break open.
What are the symptoms?
herniated disc presses on nerve
roots, it can cause pain, numbness, and weakness in the area of
the body where the nerve travels. A herniated disc in the lower back can cause
pain and numbness in the buttock and down the leg. This is called
“sy-AT-ih-kuh”). Sciatica is the most common symptom of a herniated disc in the
If a herniated disc isn’t pressing on a
nerve, you may have a backache or no pain at all.
If you have weakness
or numbness in both legs along with loss of bladder or bowel control, seek
medical care right away. This could be a sign of a rare but serious problem
called cauda equina
How is a
herniated disc diagnosed?
Your doctor may diagnose a herniated disc by
asking questions about your symptoms and examining you. If your symptoms
clearly point to a herniated disc, you may not need tests.
How is it treated?
Symptoms from a herniated disc
usually get better in a few weeks or months. To help you recover:
- Rest if you have severe pain. Otherwise, stay active. Staying in bed
for more than 1 or 2 days can weaken your muscles and make the problem worse.
Walking and other light activity may help.
- Try using a heating
pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try
a warm shower in place of one session with the heating pad. You can also buy
single-use heat wraps that last up to 8 hours. You can also try an ice pack for
10 to 15 minutes every 2 to 3 hours.
- Do the exercises that your
doctor or physical therapist suggests. These will help keep your back muscles
strong and prevent another injury.
- Ask your doctor about
medicine to treat your symptoms. Medicine won’t cure a herniated disc, but
it may help with pain and swelling.
Usually a herniated disc will heal on its own over time. Be patient, and keep
following your treatment plan. If your symptoms don’t get better in a few
months, you may want to talk to your doctor about surgery.
Can a herniated disc be
After you have hurt your back, you are more likely to have
back problems in the future. To help keep your back healthy:
- Protect your back when you lift. For example, lift with your legs,
not your back. Don’t bend forward at the waist when you lift. Bend your knees,
- Use good posture. When you stand or walk, keep your
shoulders back and down, your chin back, and your belly in. This will help
support your lower back.
- Get regular exercise.
at a healthy weight. This may reduce the load on your lower back.
- Don’t smoke. Smoking increases the risk of a disc
Learning about herniated disc:
Health Tools help you make wise health decisions or take action to improve your health.
tear, also called disc
degeneration, is the usual cause of a
herniated disc. As we age,
the discs in our back lose some of the fluid that helps them stay flexible. The
outer layer of the discs can form tiny tears or cracks. The thick gel inside
the disc may be forced out through those cracks and cause the disc to bulge or
This can also happen when you injure your back. Injury can
- A sudden heavy strain or increased pressure to the
lower back. Sometimes a sudden twisting movement or even a sneeze will force
some of the material out.
- Activities that are done over and over again
that may stress the lower back, including poor lifting habits, prolonged
exposure to vibration, and sports-related
If the herniated disc isn’t pressing on a nerve, you may have an ache in the
low back or no symptoms at all.
Only a few people who have herniated
discs have severe or troublesome symptoms.
When the disc does press on a
nerve, symptoms may include:
- Pain that travels through the buttock
and down a leg to the ankle or foot because of pressure on the
sciatic nerve. Low back
pain may accompany the leg pain.
- Tingling (“pins-and-needles”
sensation) or numbness in one leg that can begin in the buttock or behind the
knee and extend to the thigh, ankle, or foot.
- Weakness in certain muscles in one or
- Pain in the front of the thigh.
- Severe deep muscle
pain and muscle spasms
Cauda equina syndrome
Weakness in both legs and the loss of bladder and/or bowel control are
symptoms of a specific and severe type of nerve root compression called
cauda equina syndrome.
This is a rare but serious problem. A person with these symptoms should see a
doctor right away.
age, injury, or both, the outer layer of a
spinal disc may dry out
and form tiny cracks. Sometimes this causes a:
- Bulging disc.
Some of the thick gel in the disc may leak into the cracks. The disc may begin
to bulge out from between the bones of the spine (vertebrae).
- Ruptured disc. The gel breaks through the capsule.
fragment. Fragments of a ruptured disc may break completely free of the
disc and lodge in the spinal
Any of these stages can cause pressure on a
nerve root and symptoms
of pain and numbness.
The cracks in the disc don’t repair themselves,
but the pain usually fades over time. More than half of the people who have a herniated disc recover in the first 3 months.footnote 1
It’s important to see your doctor
if you’ve had constant or increasing pain for more than 4 to 6 weeks. Getting
help early on can lower your chance of having lasting problems, such as the
- Pain may come and go. Pain-free periods happen less and
- Long-lasting (chronic) and recurring pain can develop because
of continued tissue irritation caused by the disc pressing on a nerve.
- Chronic pain syndrome
can result from having ongoing pain, causing depression, anxiety, and trouble
coping with daily life.
- Symptoms caused by long-term nerve root
compression include loss of agility, strength, or sensation in one or both legs
What Increases Your Risk
Risk factors are things that increase your risk of having a herniated disc.
Some risk factors you can change, and some you can’t.
Risk factors that you cannot change
- Getting older.
- Being male.
- Having a history of back injury,
previous herniated disc, or back surgery.
Risk factors that you can change
- Your job
or other activities. These may include:
- Long periods of
- Lifting or pulling heavy objects.
- Frequent bending or
twisting of the back.
- Heavy physical exertion.
- Exposure to constant vibration (such as
- Long periods of
- Not exercising regularly, doing strenuous
exercise for a long time, or starting to exercise too strenuously after a long
period of inactivity.
- Smoking. Nicotine and other toxins from
smoking can keep spinal discs from absorbing all the nutrients they need from
the blood, making disc injury more likely. Smoking also increases your
sensitivity to pain.
- Being overweight. Carrying extra body
weight (especially in the stomach area) may put additional strain on the lower
back, although this hasn’t been proved. But being overweight often also means
being in poor physical condition, with weaker muscles and less flexibility.
These can lead to low back
When To Call a Doctor
Call 911 or other emergency services
- An injury causes numbness or weakness in one
or both legs.
your doctor now if:
- You have
a new loss of bowel or bladder control.
- Leg pain is
accompanied by persistent weakness, tingling, or numbness in any part of the
leg from the buttock to the ankle or foot.
- New low back pain is
accompanied by vomiting and/or fever [101Â°F (38.5
C) or higher] that lasts longer than 48 hours.
- Leg pain or
intermittent weakness, tingling, or numbness lasts longer than 1 week despite
- You have back pain that either won’t go away or builds
in intensity over a few weeks.
- A back injury is work-related, and
symptoms don’t improve in 2 to 3 days.
- Back pain is accompanied by
pain during urination or blood in the urine.
- You have back pain that
is worse when you are resting than when you are active.
- You notice a
gradual increase in problems with bowel or bladder control.
waiting is a wait-and-see approach. If you get better on your own, you won’t
need treatment. If you get worse, you and your doctor will decide what to do
If you have pain, numbness, or tingling in one leg that gets worse
with sitting, standing, or walking (without any obvious leg weakness):
- You may try a brief period of bed rest-usually no more than 1 to 2
days-then gradually begin activities if the pain is manageable.
- Avoid movements and positions that increase pain or
For diagnosis and nonsurgical treatment of a herniated disc, you
- A family medicine
- An internist.
- A physiatrist (a
specialist in physical medicine and rehabilitation).
For diagnosis and surgical treatment of a herniated disc, specialists
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Your doctor will do a
medical history and physical
exam. If this suggests that you have a herniated disc, you
probably won’t need other tests.
aren’t useful or needed. But if your medical history and physical exam suggest
a more serious condition (such as a tumor, infection, fracture, or severe nerve
damage), or if your leg pain and other symptoms don’t get better after 4 weeks
of nonsurgical treatment, your doctor may order X-rays.
Other tests, such as blood tests, may be done to rule
out other conditions.
The following tests aren’t used as often as an MRI
or a CT scan, but they may give your doctor more information:
electromyogram and nerve conduction
test may be done in some cases for people who have signs of
prolonged pressure on a nerve
- A myelogram may be done if you can’t have
an MRI or if the results of an MRI
- Discography can help diagnose disc
problems but is rarely used.
- A nerve block may show which nerve is
causing a problem.
Your doctor may recommend a short period of rest or reduced activity
followed by a gradual increase in activity.
Usually a herniated disc
heals on its own. So most of the time nonsurgical treatment is tried first,
- Heat or ice, exercise, and other steps at home to help
with pain and make your back stronger. For more information, see
- Physical therapy. For more information, see
- Pain medicine. For more information, see
to get the most benefit if you have treatment before you’ve had more than 6
months of symptoms.footnote 2
Surgery can be a good choice for
people who have nerve damage that is getting worse or pain that hasn’t improved
after several weeks of nonsurgical treatment.footnote 1 For more information, see
To help prevent low back pain or a herniated disc:
- Stay at a
healthy body weight. This may reduce the load on your lower back.
- Exercise regularly.
- Quit smoking. Nicotine can harm
the discs in your back, because it lowers the ability of the discs to absorb
the nutrients they need to stay healthy. And it may cause them to become dry
- Use proper lifting techniques.
- Think about your posture. Slumping or slouching alone may not cause
low back pain. But after the back has been strained or injured, bad posture can
make pain worse.
- Use good
posture while standing or walking. “Good posture” generally
means that your ears, shoulders, and hips are in a straight line.
- Protect your back while
sitting. Try putting a small pillow or rolled towel between your
back and the chair.
- Keep your back in the
neutral position while
sleeping. Place a pillow
between your knees when sleeping on your side.
- Use good
To reduce pain
The following steps may help to reduce pain:
- Relax. Find
a comfortable position for rest. You might prefer lying on the floor or a
medium-firm bed with a small pillow under your head and another under your
knees. Or you can try lying on your side with a pillow between your knees.
Don’t stay in one position for too long.
- Walk. Take a short walk
(10 to 20 minutes) on a level surface (no slopes, hills, or stairs) every 2 to
3 hours. Walk only distances you can manage without pain, especially leg
- Take pain medicine if needed. These
medicines usually work best if you take them on a regular schedule instead of
waiting until the pain gets worse.
- Try heat or ice. There is not strong evidence that
either heat or ice will help, but you can try them to see if they help you. You
may also want to try switching between heat and cold. You can try:
heating pad on a low or medium setting for 15 to 20 minutes every 2 to 3 hours.
- A warm shower in place of one session with the heating pad.
- Single-use heat wraps that last up to 8 hours.
- An ice pack for 10
to 15 minutes every 2 to 3 hours. You can use an ice pack or a bag of frozen
vegetables wrapped in a thin towel.
To strengthen your back
Keep active and do
exercises, as recommended by your doctor or physical therapist, to help you
return to your usual level of activity. Core stabilization exercises can help you
strengthen the muscles of your trunk to protect your back.
Although medicine doesn’t cure a herniated disc, it may reduce
inflammation and pain
and allow you to begin an exercise program that can strengthen your stomach and
back muscles. Be safe with medicines. Read and follow all instructions on the
Surgery is considered if the following conditions are present:
- You have leg pain that hasn’t improved with at least 4 weeks of nonsurgical
treatment, and your symptoms are bad enough to interfere with normal activities
and work and to require strong pain medicine.
- You have weakness, loss
of motion, or abnormal sensitivity.
- Tests show that your herniated
disc can be treated surgically.
People who have surgery may feel
better faster. But in the long run, people treated with surgery and people
treated without surgery have similar abilities to work and to be
active.footnote 3 Some people require additional
disc surgery after their first surgery.
Many people are able
to gradually resume work and daily activities soon after surgery. In some
cases, your doctor may recommend a rehabilitation program after surgery, which
might include physical
therapy and home exercises.
Disc surgery isn’t considered
effective treatment for low back pain that is not caused by a herniated
disc. Disc surgery is also not done if back pain is the only symptom the
herniated disc causes.
- Discectomy. This may be the most
effective type of surgery for people who have tried nonsurgical treatment
without success and who have severe, disabling leg pain.
- Percutaneous discectomy
- Laminotomy and laminectomy
number of technologies using small incisions or injections for destroying the
disc are used by some surgeons. Examples are endoscopic discectomy and
electrothermal disc decompression. These techniques are experimental and
unproved. If your doctor recommends one of them to treat your herniated disc,
make sure to get as much information as possible about the procedure. Consider
getting a second
Laser discectomy uses a focused beam of
light to dissolve a herniated disc. Although this technology has been used by
some surgeons for several years, it is considered experimental because of the
lack of studies on its effectiveness and safety.footnote 4
Other treatments that have been tried
include removing the center of the disc and removing all or part of the disc by
using suction. These treatments are not considered to be
You can try other treatments
besides medicine and surgery, including:
Talk to your doctor before using complementary medicine to treat a herniated disc.
Some people use
complementary medicine along with standard or conventional care
to treat leg and back pain caused by a herniated disc. Some examples
Other Places To Get Help
- Tay BKB, et al. (2014). Disorders, diseases, and injuries of the spine. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 156-229. New York: McGraw-Hill.
- Rihn JA, et al. (2011). Duration of symptoms resulting from lumbar disc herniation: Effect on treatment outcomes. Journal of Bone and Joint Surgery, 93(20): 1906-1914.
- Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927-935.
- Jordan J, et al. (2011). Herniated lumbar disc, search date June 2010. Online version of BMJ Clinical Evidence: https://www.clinicalevidence.com.
Other Works Consulted
- Atlas SJ, et al. (2001). Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: Five-year outcomes from the Maine Lumbar Spine Study. Spine, 26(10): 1179-1187.
- Deen GH, et al. (2003). Minimally invasive procedures for disorders of the lumbar spine. Mayo Clinical Procedures, 78: 1249-1256.
- Peul WC, et al. (2007). Surgical versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 356(22): 2245-2256.
- Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): A randomized trial. JAMA, 296(20): 2441-2450.
- Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): Observational cohort. JAMA, 296(20): 2451-2459.
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Kenneth J. Koval, MD – Orthopedic Surgery, Orthopedic Trauma
Current as ofApril 20, 2017
Current as of:
April 20, 2017