What is lumbar herniated disc?
Spinal discs play a crucial role in the lower back, serving as shock absorbers between the vertebrae, supporting the upper body, and allowing a wide range of movement in all directions.
If a disc herniates and leaks some of its inner material, though, the disc can quickly go from easing daily life to aggravating a nerve, triggering back pain and possibly pain and nerve symptoms down the leg.
Disc herniation symptoms usually start for no apparent reason. Or they may occur when a person lifts something heavy and/or twists the lower back, motions that put added stress on the discs.
How common is lumbar herniated disc?
Lumbar herniated discs are a widespread medical problem, most often affecting people age 35 to 50. Please discuss with your doctor for further information.
What are the symptoms of lumbar herniated disc?
The common symptoms of lumbar herniated disc are:
- Leg pain. The leg pain is typically worse than low back pain. If the pain radiates along the path of the large sciatic nerve in the back of the leg, it is referred to as sciatica or a radiculopathy.
- Nerve pain. The most noticeable symptoms are usually described as nerve pain in the leg, with the pain being described as searing, sharp, electric, radiating, or piercing.
- Variable location of symptoms. Depending on variables such as where the disc herniates and the degree of herniation, symptoms may be experienced in the low back, buttock, front or back of the thigh, the calf, foot and/or toes, and typically affects just one side of the body.
- Neurological symptoms. Numbness, a pins-and-needles feeling, weakness, and/or tingling may be experienced in the leg, foot, and/or toes.
- Foot drop. Neurological symptoms caused by the herniation may include difficulty lifting the foot when walking or standing on the ball of the foot, a condition known as foot drop.
- Lower back pain. Lower back pain may be present, but not always. The low back pain may be described as dull or throbbing, and may be accompanied by stiffness. If the herniated disc causes lower back muscle spasm, the pain may be alleviated somewhat by a day or two of relative rest, applying ice or heat, sitting in a supported recliner or lying flat on the back with a pillow under the knees.
- Pain that worsens with movement. Pain may follow prolonged standing or sitting, or after walking even a short distance. A laugh, sneeze, or other sudden action may also intensify the pain.
- Pain that worsens from hunching forward. Many find that positions such as slouching or hunching forward in a chair, or bending forward at the waist, makes the leg pain markedly worse.
- Quick onset. Lumbar herniated disc pain usually develops quickly, although there may be no identifiable action or event that triggered the pain.
Lumbar herniated disc symptoms are usually more severe if the herniation is extensive. Pain can be milder and limited to the low back if the disc herniation does not affect a nerve.
In some cases, low back pain or leg pain that occurs for a few days then goes away is the first indication of a herniated disc.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes lumbar herniated disc?
Pain caused by a lumbar herniated disc can seem to occur suddenly, but it is usually the result of a gradual process.
The spinal discs in children have a high water content, which helps the discs stay flexible as they act as cushions between the vertebrae. Over time as part of the normal aging process, the discs begin to dry out. This leaves the disc’s tough outer ring more brittle and vulnerable to cracking and tearing from relatively mild movements, such as picking up a bag of groceries, twisting the lower back while swinging a golf club, or simply turning to get in the car.
A less common cause of lumbar herniated discs is a traumatic injury, such as a fall or car accident. An injury can put so much pressure on a disc in the lower back that it herniates.
What increases my risk for lumbar herniated disc?
There are many risk factors for lumbar herniated disc, such as:
- The most common risk factor is being between the ages of 35 and 50. The condition rarely causes symptoms after age 80.
- Men have roughly twice the risk for lumbar herniated discs compared with women.
- Physically demanding work. Jobs that require heavy lifting and other physical labor have been linked to a greater risk of developing a lumbar herniated disc. Pulling, pushing, and twisting actions can add to risk if they’re done repeatedly.
- Excess weight makes one more likely to experience a lumbar herniated disc and 12 times more likely to have the same disc herniate again, called a recurrent disc herniation, after a microdiscectomy surgery. Experts believe that carrying extra weight increases the stress on the lumbar spine, making people who are obese more prone to herniation.
- Nicotine limits blood flow to spinal discs, which speeds up disc degeneration and hampers healing. A degenerated disc is less pliable, making it more likely to tear or crack, which can lead to a herniation. The medical literature is mixed on whether people who smoke are at greater risk for a new herniation following a discectomy.
- Family history. The medical literature has shown a hereditary tendency for disc degeneration, and disc degeneration is associated with an increased risk for a herniation. One extensive study found that a family history of lumbar herniated discs is the best predictor of a future herniation.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is lumbar herniated disc diagnosed?
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, 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:
- An electromyogram and nerve conduction test may be done in some cases for people who have signs of prolonged pressure on a nerve root.
- A myelogram may be done if you can’t have an MRI (for example, if you have a pacemaker) or if the results of an MRI aren’t clear.
- Discography can help diagnose disc problems but is rarely used.
- A nerve block may show which nerve is causing a problem.
How is lumbar herniated disc treated?
Most cases of lumbar herniated disc symptoms resolve on their own within six weeks, so patients are often advised to start with non-surgical treatments. However, this can vary with the nature and severity of symptoms.
Initial pain control for a lumbar herniated disc
Controlling the intense pain is the most urgent need when symptoms first appear. Initial pain control options are likely to include:
- Ice application. Application of ice or a cold pack may be helpful to ease initial inflammation and muscle spasms associated with a lumbar herniated disc. An ice massage can also be helpful. Ice is most effective for the first 48 hours after the back pain has started.
- Pain medications. The doctor may recommend non-prescription non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen to treat pain and inflammation.
- Muscle relaxants. Muscle spasms may accompany a lumbar herniated disc, and these prescription medications may offer relief from the painful spasms.
- Heat therapy. Applying heat can help relieve painful muscle spasms after the first 48 hours. Heating pads, a hot compress, and adhesive heat wraps are all good options. Moist heat, such as a hot bath, may be preferred.
- Heat and ice. Some people find alternating hot and cold packs provides the maximum pain relief.
Bed rest for severe pain is best limited to one or two days, as extended rest will lead to stiffness and more pain. After that point, light activity and frequent movement—with rest breaks as needed—is advised. Heavy lifting and strenuous exercise should be avoided.
Additional therapies for lumbar herniated disc
These other therapies are often helpful for longer-term pain relief:
- Physical therapy is important in teaching targeted stretching and exercises for rehabilitation. The program may also teach the patient safer ways to perform ordinary activities, such as lifting and walking.
- Epidural injections of steroid medications can offer pain relief in some cases. An epidural steroid injection is intended to provide enough pain relief for the patient to make progress with rehabilitation. The effects vary, and pain relief is temporary.
- Spinal manipulations performed by a chiropractor or osteopath may also ease pain and provide a better healing environment.
- Acupuncture uses hair-thin needles inserted into the skin near the area of pain. The U.S. Food and Drug Administration has approved acupuncture as a treatment for back pain.
- Cognitive behavior therapy can be helpful in managing sciatica pain. The therapy helps people control and change self-defeating behaviors. A therapist helps the patient in face-to-face or online sessions. A therapist may also be helpful in teaching techniques such as mindful meditation and visualization to reduce pain.
- Massage therapy can ease back pain by increasing blood circulation, relaxing muscles, and releasing the body’s natural pain relievers, called endorphins.
The treatment options for a lumbar herniated disc will largely depend on the length of time the patient has had symptoms and the severity of the pain. Specific symptoms (such as weakness or numbness), and the age of the patient may also be factors.
If the pain and other symptoms of a lumbar herniated disc persist after six weeks, surgery is often considered. A lumbar herniated disc is the most common reason for spine surgery in adults during their working years.
Surgery may be recommended if:
- There is severe pain and the person is having difficulty maintaining a reasonable level of daily functions, such as standing or walking.
- The person is experiencing progressive neurological symptoms, such as worsening leg weakness. and/or numbness
- There is a loss of bowel and bladder functions.
- Medication, physical therapy, and/or other nonsurgical treatments have not significantly eased symptoms.
In some cases, surgery is needed before the patient has completed six weeks of nonsurgical care.
Microdiscectomy procedures for a lumbar herniated disc
Two minimally invasive procedures, microdiscectomy and endoscopic microdiscectomy, are most commonly recommended for lumbar herniated discs. These procedures take the pressure off the nerve root and provide a better healing environment for the disc.
Usually, only the small portion of the disc that is pushing against the nerve root needs to be removed, and the majority of the disc remains intact.
Small incisions are used in a microdiscectomy. For endoscopic microdiscectomy surgery, instruments are inserted through a thin tube or tubes to minimize disruption to the surrounding tissue. A tiny camera can be inserted through a tube to provide visualization for the surgeon.
Both types of surgery are usually performed on an outpatient basis or with one overnight stay in the hospital. Most patients can return to work and their regular routines in one to three weeks.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage lumbar herniated disc?
The following lifestyles and home remedies might help you cope with lumbar herniated disc:
- 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.
- 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 is severe.
- 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.
- 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.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.