Herniated Disc

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What is Herniated Disc

Herniated disc, also called a ruptured disk or slipped disk, occurs when a disk in the spine bulges out too far. Between the bones in the spine (vertebrae), there are oval disks that are made of a soft, spongy center that is surrounded by a tough outer ring.

The disks connect your vertebrae, help your spine move, and absorb shocks from your movement.

When you have a herniated disk, the spongy center of the disk bulges out or breaks through the outer ring. It can press on a nerve between the vertebrae and cause pain. This can occur anywhere in the back or neck area, but the lower back is most commonly affected.

What are the causes?

This condition may be caused by:

  • Age-related wear and tear. The spongy centers of spinal disks tend to shrink and dry out with age, which makes them more likely to herniate.
  • Sudden injury, such as a strain or sprain.

What increases the risk?

Aging is the main risk factor for a herniated disk. Other risk factors include:

  • Being a man who is 30–50 years old.
  • Frequently doing activities that involve heavy lifting, bending, or twisting.
  • Frequently driving for long hours at a time.
  • Not getting enough exercise.
  • Being overweight.
  • Smoking.
  • Having a family history of back problems or herniated disks.
  • Being pregnant or giving birth.
  • Having poor nutrition.
  • Being tall.

What are the signs or symptoms?

Symptoms may vary depending on where your herniated disk is located.

  • A herniated disk in the lower back may cause sharp pain in:
    • Part of the arm, leg, hip, or buttocks.
    • The back of the lower leg (calf).
    • The lower back, spreading down through the leg into the foot (sciatica).
  • A herniated disk in the neck may cause dizziness and vertigo. It may also cause pain or weakness in:
    • The neck.
    • The shoulder blades.
    • Upper arm, forearm, or fingers.
  • You may also have muscle weakness. It may be difficult to:
    • Lift your leg or arm.
    • Stand on your toes.
    • Squeeze tightly with one of your hands.
  • Other symptoms may include:
    • Numbness or tingling in the affected areas of the hands, arms, feet, or legs.
    • Inability to control when you urinate or when you have bowel movements. This is a rare but serious sign of a severe herniated disk in the lower back.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms.
  • Your medical history.
  • A physical exam. The exam may include:
    • Straight-leg test. You will lie on your back while your health care provider lifts your leg, keeping your knee straight. If you feel pain, you likely have a herniated disk.
    • Neurological tests. This includes checking for numbness, reflexes, muscle strength, and posture.
  • Imaging tests, such as:
    • X-rays.
    • MRI.
    • CT scan.
    • Electromyogram (EMG) to check the nerves that control muscles. This test may be used to determine which nerves are affected by your herniated disk.

How is this treated?

Treatment for this condition may include:

  • A short period of rest. This is usually the first treatment.
    • You may be on bed rest for up to 2 days, or you may be instructed to stay home and avoid physical activity.
    • If you have a herniated disk in your lower back, avoid sitting as much as possible. Sitting increases pressure on the disk.
  • Medicines. These may include:
    • NSAIDs to help reduce pain and swelling.
    • Muscle relaxants to prevent sudden tightening of the back muscles (back spasms).
    • Prescription pain medicines, if you have severe pain.
  • Steroid injections in the area of the herniated disk. This can help reduce pain and swelling.
  • Physical therapy to strengthen your back muscles.

In many cases, symptoms go away with treatment over a period of days or weeks. You will most likely be free of symptoms after 3–4 months. If other treatments do not help to relieve your symptoms, you may need surgery.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not drive or use heavy machinery while taking prescription pain medicine.

Activity

  • Rest as directed.
  • After your rest period:
    • Return to your normal activities and gradually begin exercising as told by your health care provider. Ask your health care provider what activities and exercises are safe for you.
    • Use good posture.
    • Avoid movements that cause pain.
    • Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says this is safe.
    • Do not sit or stand for long periods of time without changing positions.
    • Do not sit for long periods of time without getting up and moving around.
  • If physical therapy was prescribed, do exercises as instructed.
  • Aim to strengthen muscles in your back and abdomen with exercises like crunches, swimming, or walking.

General instructions

  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These products can delay healing. If you need help quitting, ask your health care provider.
  • Do not wear high-heeled shoes.
  • Do not sleep on your belly.
  • If you are overweight, work with your health care provider to lose weight safely.
  • To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
    • Drink enough fluid to keep your urine clear or pale yellow.
    • Take over-the-counter or prescription medicines.
    • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
    • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Maintain a healthy weight.
  • Try to avoid stressful situations.
  • Maintain physical fitness. Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
  • When lifting objects:
    • Keep your feet at least shoulder-width apart and tighten your abdominal muscles.
    • Keep your spine neutral as you bend your knees and hips. It is important to lift using the strength of your legs, not your back. Do not lock your knees straight out.
    • Always ask for help to lift heavy or awkward objects.

Contact a health care provider if:

  • You have back pain or neck pain that does not get better after 6 weeks.
  • You have severe pain in your back, neck, legs, or arms.
  • You develop numbness, tingling, or weakness in any part of your body.

Get help right away if:

  • You cannot move your arms or legs.
  • You cannot control when you urinate or have bowel movements.
  • You feel dizzy or you faint.
  • You have shortness of breath.

Herniated Disc Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your back. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Prone extension on elbows

  1. Lie on your abdomen on a firm surface.
  2. Prop yourself up on your elbows.
  3. Use your arms to help lift your chest up until you feel a gentle stretch in your abdomen and your lower back.
    1. This will place some of your body weight on your elbows. If this is uncomfortable, try stacking pillows under your chest.
    1. Your hips should stay down, against the surface that you are lying on. Keep your hip and back muscles relaxed.
  4. Hold for __________ seconds.
  5. Slowly relax your upper body and return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Standing extension

  1. Stand with your feet shoulder width apart.
  2. Place your hands on your lower back, with your palms on your back.
  3. Gently arch your back and press forward with your hands.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise__________ times a day.

Strengthening exercises

These exercises build strength and endurance in your back. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Pelvic tilt

  1. Lie on your back on a firm surface. Bend your knees and keep your feet flat.
  2. Tense your abdominal muscles. Tip your pelvis up toward the ceiling and flatten your lower back into the floor.
    1. To help with this exercise, you may place a small towel under your lower back and try to push your back into the towel.
  3. Hold for __________ seconds.
  4. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Alternating arm and leg raises

  1. Get on your hands and knees on a firm surface. If you are on a hard floor, you may want to use padding to cushion your knees, such as an exercise mat.
  2. Line up your arms and legs. Your hands should be below your shoulders, and your knees should be below your hips.
  3. Lift your left leg behind you. At the same time, raise your right arm and straighten it in front of you.
    1. Do not lift your leg higher than your hip.
    1. Do not lift your arm higher than your shoulder.
    1. Keep your abdominal and back muscles tight.
    1. Keep your hips facing the ground.
    1. Do not arch your back.
    1. Keep your balance carefully, and do not hold your breath.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position and repeat with your right leg and your left arm.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Bridge

  1. Lie on your back on a firm surface with your knees bent and your feet flat on the floor.
  2. Tighten your abdominal and buttocks muscles and lift your bottom and abdomen off the floor until your trunk is level with your thighs.
    1. You should feel the muscles working in your buttocks and the back of your thighs.
    1. Do not arch your back.
    1. If this exercise is too easy, try doing it with your arms crossed over your chest.
  3. Hold this position for __________ seconds.
  4. Slowly lower your hips to the starting position.
  5. Let your muscles relax completely between repetitions.

Repeat __________ times. Complete this exercise __________ times a day.

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