The vertebral bodies that make up the spine are separated by round, fluid filled soft discs that act like shock absorbers. As we grow older, these discs lose some of their fluid and their ability to serve as a shock absorber. In addition, tiny tears or cracks in the outer layer of the disc may occur as a result of injuries to the spine. If these discs become damaged, they may bulge abnormally or rupture. This is referred to as a herniated disc, which can press against the spinal cord or directly against spinal nerve roots. Pressure on the spinal cord and/or nerve roots can lead to a variety of symptoms. Lumbar discs lie between the vertebrae of the low back. The majority of disc herniations occur in the bottom two discs of the lumbar spine, just below the waist.
Symptoms
- Pain, numbness, tingling or weakness of the leg
- This is known as “sciatica”.
- Back pain (without leg pain)
- Loss of bladder or bowel control
Causes
- Degeneration
- Sharp bending or twisting
- Improperly lifting a heavy object
- Repetitive motion
- Trauma such as a fall or car accident
Risk Factors
- Age
- Weight lifting
- Obesity
Diagnosis: Your doctor with discuss your symptoms, review your medical history, and perform a thorough physical examination of your back.
- Magnetic resonance imaging (MRI) scan: Identify damage to soft tissue such as intervertebral disks.
Treatment
After determining the severity of your condition, your doctor will discuss your treatment options. Approximately 80-90% of new (acute) disc herniations will resolve with conservative treatments and do not require surgery. Conservative methods including activity modification, pain medication, and physical therapy, are normally pursued as a first course of treatment.
Conservative treatment options typically include
- Short period of rest
- If you are told to rest, follow your doctor’s directions on how long to stay in bed. Too much bed rest may give you stiff joints and weak muscles, which will make it harder to do activities that could help reduce the pain.
- Using non-steroidal anti-inflammatory medication (NSAIDs) to decrease swelling and relieve pain.
- For example, ibuprofen or naproxen.
- Analgesics to control pain
- For example, aspirin, ibuprofen, naproxen or acetaminophen.
- Narcotic pain medication is generally avoided but may be prescribed for a short period of time if the pain is severe and persistent.
- An epidural steroid injection may be performed in cases of severe leg pain
- Often relieves the symptoms to such a degree that other treatment measures can then be comfortably performed.
- Corticosteroid is injected into the epidural space (the area around the spinal nerves)
- Trigger point injections
- Local anesthetics are injected directly into the painful soft tissue or muscles along the spine or over the back of the pelvis.
- It is important to note that trigger point injections do not help a herniated disc heal, they may simply help with pain control.
- Physical therapy
- Physical therapy may include: exercises, traction, ultrasound, electrical muscle stimulation, and whirlpool treatment.
Consult your doctor whether you should continue to work while you are being treated. Typically, the doctor will try using nonsurgical treatments for the first few weeks. If the pain still keeps you from your normal lifestyle after completing treatment, your doctor might recommend surgery.
