Herniated Disc: Common Causes and Treatments

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Each year about 2% of adults have a herniated disc. A disc herniation can be very painful and is a common cause of neck and back pain. While it can happen in anyone, a herniated disc is more common among middle-aged adults.

A disc is a gel-like cushion between the bones of the spine (vertebrae) that help support it. A disc can herniate when it slips from its normal position. This may cause pain if it presses on the nerve roots and spinal cord or due to inflammation in the area.

A disc herniation most commonly occurs in the lumbar area (lower back), but it may occur in the neck as well. It can also happen in the mid back or thoracic area, but this isn't very common.

What causes a disc herniation?

Several factors can lead to a disc herniation. These can include:

• Age: Most cases of disc herniation occur due to aging. Aging increases inflammation and impairs the ability of the disc to repair itself. With age, the disc loses water and weakens, causing it to bulge.

• Injuries: Trauma is the second most common cause. Some people may have injuries from lifting or twisting that can lead to a disc herniation.

• Genetics: Disc disease can run in families. The risk of disc disease may increase when a parent or sibling has it.

What are the symptoms of a disc herniation?

A disc herniation that is not compressing a nerve may cause sharp neck or back pain. But if it's compressing or irritating a nerve root, this can cause radiculopathy. There may be symptoms of:

• Neck pain down the arm or back pain down the leg

• Numbness or tingling

• Weakness

In a lot of cases, a herniated disc does not cause any symptoms. In fact, many disc herniations are found on MRI by accident when looking for something else.

How do you diagnose a disc herniation?

A medical history and physical exam can give your healthcare provider clues about a disc herniation. But imaging is necessary to make the diagnosis.

MRI is the preferred imaging to visualize the disc, nerves, and ligaments. X-rays and CT scans may also be useful, especially in cases of trauma.

Your healthcare provider may recommend an MRI in the following circumstances:

• After 6 weeks of persistent symptoms

• You have symptoms of a pinched nerve

• Your symptoms aren't improving or keep getting worse

What is the treatment for back pain caused by a disc herniation?

Most people who have a herniated disc heal with rest and physical therapy. Those who do not improve may need other interventions, such as:

• Ice and heat therapy

• Manipulation and manual therapy

• Medications

• Injections

• Surgery

Ice and heat therapy

Ice and heat therapy may be useful for herniated discs. Many people get confused about whether to use heat or cold for treatment. Cold packs may help for the first 2 or 3 days after an injury. Heating pads help after that initial period.

Cold therapy helps decrease inflammation, swelling, pain, and muscle spasms. Heat helps to increase blood flow, decreases pain, and promotes healing. But you have to be careful not to burn your skin with ice or heat. Your provider will let you know if this type of therapy is appropriate for you.

Manipulation and manual therapy

Spinal manipulation may help improve pain and mobility. But it's not for everyone. In some cases, it may worsen your symptoms and increase the need for surgery. There may be safety concerns if you have:

• An age over 50 years

• Repeated or long-standing low back pain with sciatica (pain down the leg)

• Symptoms down both legs

• Severe disc herniation on MRI

Medications

There are several medications that treat pain due to herniated discs. These include:

• Over-the-counter medications, such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatories (NSAIDs)

• Muscle relaxants to treat muscle spasms

• Oral steroids, like prednisone, especially if you have radiculopathy

• Antiepileptics, like gabapentin and pregabalin, to help relieve nerve pain

Injections

Interventional procedures can be useful in some cases. Injections that may help with pain due to a herniated disc include:

• Epidural steroid injections: These may help if you have a pinched nerve. Your provider will inject a mix of a steroid with a local anesthetic in the space surrounding the spinal cord and nerve roots. X-rays help to make sure the needle is in the correct position.

• Trigger point injections: These are injections in the muscle to decrease muscle spasms. You may feel the muscle twitch during the procedure.

• Selective nerve root blocks: Your provider will inject a steroid very close to the affected nerve root. It's very effective and can relieve symptoms for about 1 year if you have lumbar disc herniation.

Surgery

Surgery may be an option for people with debilitating pain who are seeking faster relief. It may also be helpful for those who do not improve with conservative treatment. You might also need surgery if you have bowel or bladder incontinence or severe weakness.

The procedure your surgeon recommends will depend on your symptoms and MRI findings.

The most common surgeries for lumbar disc herniation are:

• Microdiscectomy: Your surgeon removes the disc or part of the disc, along with any fragments putting pressure on the nerve.

• Endoscopic microdiscectomy: This is a microdiscectomy that uses a small tube with a camera attached to observe the area. This procedure allows for smaller incisions.

• Laminectomy or laminotomy with discectomy: This is the classic open surgery where your surgeon removes a bone fragment. It relieves pressure in the area of the disc herniation.

Most people have good, long-term results with all three techniques.

The most common surgical options for cervical disc herniation are:

• Anterior cervical discectomy and fusion: Your surgeon removes the herniated disc and uses metal plates and screws to stabilize the spine. They perform the surgery from the front of your neck.

• Disc replacement: Your provider replaces the herniated disc with an artificial one.

• Posterior cervical laminoforaminotomy: This is like the classic lumbar open surgery. The surgeon does it from the back of your neck.

Will a herniated disc heal on its own?

Most people improve within a few weeks. Sometimes a herniated lumbar disc returns to its original position.

Herniated discs that do not heal may result in long-term complications, such as:

• Chronic pain

• Nerve damage

• Loss of work

• Disability

What are the best exercises for someone with a herniated disc?

Therapeutic exercise can relieve pain and improve function in people with herniated disc. There are better studies for lumbar disc herniation.

Your provider may recommend different types of exercise for herniated disc symptoms. These may include:

• Aerobic exercise

• Directional preference exercise (exercise in the direction that relieves the pain)

• Flexibility and stretching exercise

• Coordination and balance

• Strengthening exercise (6 to 12 weeks of core-strengthening exercises)

If you need surgery, prehab may help you prepare your body in advance. It may also help youhave a positive attitude toward surgery.

How can I prevent a disc herniation?

There are no specific prevention protocols, but stretching may help. Stability and flexibility exercises might help prevent disc herniation injuries in elite athletes. Other tips that may help include:

• Strengthening your back muscles

• Doing moderate exercise (this may help to protect and repair the spine)

• Not smoking (decreases inflammation)

• Using proper lifting technique (using your leg muscles instead of your back)

• Avoiding repetitive lifting, pulling, bending, or twisting

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