What is a herniated disc?
As the spinal disc becomes less elastic, it can rupture. When the disc ruptures, a portion of the spinal disc pushes outside its normal boundary. This is called a herniated disc.
When a herniated disc bulges out from between the vertebrae, the spinal nerves and spinal cord can become pinched. There is normally a little extra space around the spinal cord and spinal nerves, but if enough of the herniated disc is pushed out of place, then these structures may be compressed.
What causes symptoms of a herniated disc?
When the herniated disc ruptures and pushes out, the nerves may become pinched. A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine. Often people who experience a herniated disc already have spinal stenosis, a problem that causes narrowing of the space around the spinal cord and spinal nerves.
When a herniated disc occurs, the space for the nerves is further diminished, and irritation of the nerve results.
What are the symptoms of a herniated disc?
When the spinal cord or spinal nerves become compressed, they don’t work properly. This means that abnormal signals may get passed from the compressed nerves, or signals may not get passed at all.
Common symptoms of a herniated disc include:
- Electric Shock Pain
Pressure on the nerve can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shocks go down your arms, when the compression is in the lumbar (low back) region, the shocks go down your legs. This may be severe and cause immobility due to the pain.
- Tingling & Numbness
Patients often have abnormal sensations such as tingling, numbness, or pins and needles. These symptoms may be experienced in the same region as painful electric shock sensations.
- Muscle Weakness
Because of the nerve irritation, signals from the brain may be interrupted causing muscle weakness. Nerve irritation can also be tested by examining reflexes.
- Muscle Spasms
If the nerve irritation or compression is severe this may lead to muscles going in to spasm causing pain and discomfort.
- Bowel or Bladder Problems
These symptoms are important because it may be a sign of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency, and your should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals.
All of these symptoms are due to the irritation of the nerve from the herniated disc. By interfering with the pathway by which signals are sent from your brain out to your extremities and back to the brain, all of these symptoms can be caused by a herniated disc pressing against the nerves.
How is the diagnosis of a herniated disc made?
Most often, your physician can make the diagnosis of a herniated disc by physical examination. By testing sensation, muscle strength, and reflexes, your physician can often establish the diagnosis of a herniated disc.
An MRI is commonly used to aid in making the diagnosis of a herniated disc. It is very important that patients understand that the MRI is only useful when used in conjunction with examination findings. It is normal for a MRI of the lumbar spine to have abnormalities, especially as people age. Patients in their 20s may begin to have signs of disc wear, and this type of wear would be expected on MRIs of patients in their 40s and 50s. This is the reason that your physician may not be concerned with some MRI findings noted by the radiologist.
Making the diagnosis of a herniated disc and coming up with a treatment plan depends on the symptoms experienced by the patient, the physical examination findings, and the x-ray and MRI results. Only once this information is put together can a reasonable treatment plan be considered.
Most often, treatments of a herniated disc begin conservatively, and become more aggressive if the symptoms persist. After diagnosing a herniated disc, treatment usually begins with:
- Rest & Activity Modification
The first treatment is to rest and avoid activities that aggravate your symptoms. Many disc herniations will resolve is given time. In these cases, it is important to avoid activities that aggravate your symptoms.
- Ice & Heat Applications
Ice and heat application can be extremely helpful in relieving the painful symptoms of a disc herniation. By helping to relax the muscles of the back, ice and heat applications can relieve muscle spasm and provide significant pain relief.
- Physical Therapy
Physical therapy and lumbar stabilization exercises do not directly affect the herniated disc, but they can stabilize the lumbar spine muscles. This has an effect of decreasing the load experienced by the disc and vertebrae. Stronger, well balanced muscles help control the lumbar spine and minimize the risk or injury to the nerves and the disc.
- Orthoses and bracing solutions
If physical therapy or other treatments are contraindicated then immobilisation for periods of exercise or work, which reduce load on the affected site may be used to reduce risk of further damage or promote any healing. These may be a simple elastic or lycra support, or a more robust brace with additional compressive and adjustable support options.
- Anti-Inflammatory Medications
Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed, and often help relieve the pain associated with a disc herniation. By reducing inflammation, these medications can relieve some pressure on the compressed nerves. NSAIDs should be used under your doctor’s supervision.
- Oral Steroid Medications
Oral steroid medications can be very helpful in episodes of an acute (sudden) disc herniation. these powerful anti-inflammatory medications reduce inflammation around the compressed nerves, thereby relieving symptoms.
- Other Medications
Other medications often used include narcotic pain medications and muscle relaxers. Narcotic pain medications are useful for severe, short-term pain management. Unfortunately, these medication can make you drowsy and can be addictive. It is important to use these for only brief periods of time. Muscle relaxers are used to treat spasm of spinal muscles often seen with disc herniations. Often the muscle spasm is worse than the pain from the disc pressing on the nerves.
- Epidural Steroid Injections
Injections of cortisone can be administered directly in the area of nerve compression. Like oral anti-inflammatory medications, the idea is to relieve the compression on the nerves. When the injection is used, the medication is delivered to the area of the disc herniation, rather than being taken orally and travelling throughout your body.
Is surgery necessary in the treatment of a disc herniation?
As mentioned, treatment of a disc herniation usually begins with the steps listed above. However, surgical treatment of a herniated disc may be recommended soon after the injury if there is a significant neurological deficit to your problem. Symptoms on pain and sensory abnormalities usually do not require immediate intervention, but patients who have significant weakness, any evidence of cauda equina syndrome, or a rapidly progressing problem may require more prompt surgical treatment.
Most often surgery is recommended if more conservative measures do not relieve your symptoms. Surgery is performed to remove the herniated disc, and free up space around the compressed nerve. Depending on the size and location of the herniated disc, and associated problems (such as spinal stenosis, arthritis, etc.), the surgery can be done by several techniques. In very straightforward cases, endoscopic or microscopic excision of the herniated disc may be possible. However, this is not always recommended, and in some cases, a more significant surgery may need to be performed.
How can OLAB help?
Orthotic Consultation for treatment or prevention of Herniating discs or related spinal conditions can be arranged with our trained clinical team – contact us for more information on what is available or to book.