Topic Overview

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
Herniation
.

The spinal column

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?

When a
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
sciatica (say
“sy-AT-ih-kuh”). Sciatica is the most common symptom of a herniated disc in the
low back.

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
syndrome
.

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.

Sometimes a
doctor will do tests such as an MRI or a
CT scan to confirm a
herniated disc or rule out other health problems.

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
prevented?

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,
    and squat.
  • 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.
  • Stay
    at a healthy weight.
    This may reduce the load on your lower back.
  • Don’t smoke. Smoking increases the risk of a disc
    injury.

Frequently Asked
Questions

Learning about herniated disc:

Being
diagnosed:

Getting treatment:

Ongoing concerns:

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Cause

Wear and
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
break open.

This can also happen when you injure your back. Injury can
occur from:

  • 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
    injuries.

Symptoms

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
    both legs.
  • 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.

What Happens

Due to
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.
  • Free
    fragment.
    Fragments of a ruptured disc may break completely free of the
    disc and lodge in the spinal
    canal
    .

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

Long-term problems

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
following:

  • Pain may come and go. Pain-free periods happen less and
    less.
  • 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
    and feet.

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
      sitting.
    • Lifting or pulling heavy objects.
    • Frequent bending or
      twisting of the back.
    • Heavy physical exertion.
    • Repetitive
      motions.
    • Exposure to constant vibration (such as
      driving).
  • 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
    pain.

When To Call a Doctor

Call 911 or other emergency services
immediately
if:

  • An injury causes numbness or weakness in one
    or both legs.

Call
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 [101°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
    home treatment.
  • 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.

Watchful waiting

Watchful
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
next.

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.
  • Take
    short walks.
  • Avoid movements and positions that increase pain or
    numbness.

Who
to see

For diagnosis and nonsurgical treatment of a herniated disc, you
may see:

For diagnosis and surgical treatment of a herniated disc, specialists
include:

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.

If your doctor needs more information,
or if treatment hasn’t worked after 4 weeks, you may have an
MRI or a
CT scan.

X-rays typically
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

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:

Treatment Overview

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,
including:

  • Heat or ice, exercise, and other steps at home to help
    with pain and make your back stronger. For more information, see
    Home
    Treatment
    .
  • Physical therapy. For more information, see
    Other
    Treatment
    .
  • Pain medicine. For more information, see
    Medications.

You’re likely
to get the most benefit if you have treatment before you’ve had more than 6
months of symptoms.footnote 2

Surgery

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
Surgery.

Prevention

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
    and brittle.
  • 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.

Home Treatment

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
    pain.
  • 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:

    • A
      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.

Medications

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
label.

Medicine choices

Surgery

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.

Surgery
choices

Experimental procedures

A
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
opinion
.

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
effective.

Other Treatment

You can try other treatments
besides medicine and surgery, including:

Complementary medicine

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
are:footnote 4

Other Places To Get Help

Organizations

North American Spine Society
www.spine.org

American Academy of Orthopaedic Surgeons
www.orthoinfo.aaos.org

References

Citations

  1. 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.
  2. 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.
  3. 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.
  4. Jordan J, et al. (2011). Herniated lumbar disc, search date June 2010. Online version of BMJ Clinical Evidence: http://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.

Credits

ByHealthwise Staff
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