Your activity: 2 p.v.

Patient education: Herniated disc (The Basics)

Patient education: Herniated disc (The Basics)

What is a herniated disc? — A herniated disc is a condition that affects the back. It can cause pain, numbness, or tingling down 1 or both legs.

To understand what a herniated disc is and how it causes symptoms, it's helpful to first learn a little about the back and spine.

The back is made up of (figure 1):

Vertebrae – These are your "back bones." They sit on top of one another like a stack of coins. Each bone has a hole in the center. When stacked, the holes in the bones form a hollow "tube" that protects the spinal cord.

Spinal cord and nerves – The spinal cord is like a highway of nerves that connects the brain to the rest of the body. The spinal cord runs through holes in the vertebrae. Spinal nerves branch out from the spinal cord and pass in between each vertebrae. From there, they connect to the arms, legs, and organs. (This is why problems in the back can cause leg pain or bladder problems.)

Muscles, tendons, and ligaments – Together, the muscles, tendons, and ligaments are called the "soft tissues" of the back. These soft tissues support the back.

Discs – Rubbery discs sit in between each of the vertebrae to add cushioning and allow movement.

The discs have a tough outer shell and jelly-like center. The outer shell of the discs can sometimes break open, spilling the jelly material inside. This is what doctors call a herniated disc.

Herniated discs can cause symptoms, because the jelly material that spills out of them can irritate nearby nerves. Plus, the disc itself can bulge and press on nerves (figure 2).

This article discusses herniated discs only in the lower back. Other parts of the back can have herniated discs, but that is less common.

What are the symptoms of a herniated disc in the lower back? — Herniated discs do not always cause symptoms. When they do, the most common symptoms are tingling, pain, or numbness that spreads down 1 leg. These symptoms affect different parts of the leg, depending on which disc in the lower back is herniated.

Will I need tests? — Probably not. There are tests that can check for a herniated disc, but most people do not need them. That's because most people who have symptoms of a herniated disc get better on their own, regardless of what the tests show.

Imaging tests, such as an MRI or a CT scan, can show what the tissues inside the back look like. These tests can find a herniated disc if you have one. But doctors do not usually order this test until you have had symptoms for at least 4 to 6 weeks. In most cases, it does not make sense to order the test sooner, because the treatment for herniated disc during those first few weeks is the same no matter what the tests might show.

Should I see a doctor or nurse? — See your doctor or nurse right away if you have:

New back pain that goes into the groin or down the leg

Back or leg pain along with leg weakness or problems controlling your bowels or bladder

A problem called "foot drop," which is when you cannot seem to hold your foot up. You might notice this especially while walking.

Back or leg pain along with a fever or other symptoms that worry you

How is herniated disc treated? — A small number of people need surgery to treat a herniated disc. But most people do well with simpler treatments, such as:

Pain medicines that you can get without a prescription

Medicines to relax the muscles (called muscle relaxants)

Injections of medicines that numb the back or reduce swelling

Physical therapy to teach you special exercises and stretches

Spinal manipulation, which is when someone like a physical therapist or a chiropractor moves or "adjusts" the joints of your back

Acupuncture, which is when someone who knows traditional Chinese medicine inserts tiny needles into your body to block pain signals

Massage

How do I know if surgery is right for me? — Your doctor will tell you if surgery could help you. Then, you can decide together if surgery is right for you.

Surgery to treat a herniated disc usually involves removing the part of the disc that is damaged. Sometimes, the entire disc is removed. It could help you feel better faster than you would without surgery. But, like any surgery, it also comes with risks.

Although surgery can speed up recovery, it is not usually necessary for a herniated disc. That's because, over time, the body absorbs the jelly from a damaged disc and heals on its own. But this can take months.

People who have a lot of discomfort or who want to get better fast sometimes choose surgery. People who are afraid of surgery or who feel like they can cope with their symptoms sometimes decide against surgery.

If your doctor suggests surgery to treat your herniated disc, ask:

How likely is it that surgery will help or completely fix my symptoms?

How quickly will I recover from surgery?

What are the risks of surgery?

What happens if I do not have surgery?

Is there anything I can do on my own to feel better? — Yes. One of the most important things you can do to feel better is to stay as active as possible. Even if you have some pain or discomfort, you should not stay in bed or rest too long.

People used to think that bedrest was the best thing for an injured back. The truth is, bedrest can actually make back problems worse. That's because the back can get weak and stiff with too much rest.

Do not worry that you will do yourself harm by being active. It might hurt a bit more when you move around, but activity will do you good.

Can herniated discs be prevented? — Probably not. People sometimes think that they got a herniated disc because they lifted something the wrong way or strained their back somehow. The truth is, there is not much proof that moving or lifting the wrong way can cause a herniated disc.

More on this topic

Patient education: Low back pain in adults (The Basics)
Patient education: Spinal stenosis (The Basics)
Patient education: Cauda equina syndrome (The Basics)
Patient education: Do I need an X-ray (or other test) for low back pain? (The Basics)

Patient education: Low back pain in adults (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 03, 2023.
This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
Topic 83078 Version 15.0