This topic is for a people who have a herniated disc in the lower back. If you are looking for information on a herniated disc in the neck, see the topic Cervical Disc Herniation.
The bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged, it may bulge or break open. This is called a herniated disc. It may also be called a slipped or ruptured disc.
You can have a herniated disc in any part of your spine. But most herniated discs affect the lower back (lumbar spine). Some happen in the neck (cervical spine) and, more rarely, in the upper back (thoracic spine).
A herniated disc may be caused by:
When a herniated disc presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels. A herniated disc in the lower back can cause pain and numbness in the buttock and down the leg. This is called sciatica (say "sy-AT-ih-kuh"). Sciatica is the most common symptom of a herniated disc in the low back.
If a herniated disc isn't pressing on a nerve, you may have a backache or no pain at all.
If you have weakness or numbness in both legs along with loss of bladder or bowel control, seek medical care right away. This could be a sign of a rare but serious problem called cauda equina syndrome.
Your doctor may diagnose a herniated disc by asking questions about your symptoms and examining you. If your symptoms clearly point to a herniated disc, you may not need tests.
Sometimes a doctor will do tests such as an MRI or a CT scan to confirm a herniated disc or rule out other health problems.
Symptoms from a herniated disc usually get better in a few weeks or months. To help you recover:
Usually a herniated disc will heal on its own over time. Be patient, and keep following your treatment plan. If your symptoms don't get better in a few months, you may want to talk to your doctor about surgery.
After you have hurt your back, you are more likely to have back problems in the future. To help keep your back healthy:
Learning about herniated disc:
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Wear and tear, also called disc degeneration, is the usual cause of a herniated disc. As we age, the discs in our back lose some of the fluid that helps them stay flexible. The outer layer of the discs can form tiny tears or cracks. The thick gel inside the disc may be forced out through those cracks and cause the disc to bulge or break open.
This can also happen when you injure your back. Injury can occur from:
If the herniated disc isn't pressing on a nerve, you may have an ache in the low back or no symptoms at all.
Only a few people who have herniated discs have severe or troublesome symptoms.
When the disc does press on a nerve, symptoms may include:
Weakness in both legs and the loss of bladder and/or bowel control are symptoms of a specific and severe type of nerve root compression called cauda equina syndrome. This is a rare but serious problem. A person with these symptoms should see a doctor right away.
Due to age, injury, or both, the outer layer of a spinal disc may dry out and form tiny cracks. Sometimes this causes a:
Any of these stages can cause pressure on a nerve root and symptoms of pain and numbness.
The cracks in the disc don't repair themselves, but the pain usually fades over time. More than half of the people who have a herniated disc recover in the first 3 months.footnote 1
It's important to see your doctor if you've had constant or increasing pain for more than 4 to 6 weeks. Getting help early on can lower your chance of having lasting problems, such as the following:
Risk factors are things that increase your risk of having a herniated disc. Some risk factors you can change, and some you can't.
or other emergency services immediately if:
Call your doctor now if:
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.
If you have pain, numbness, or tingling in one leg that gets worse with sitting, standing, or walking (without any obvious leg weakness):
Your family doctor, general practitioner, or chiropractor can usually diagnose and treat a herniated disc.
You may be referred to:
For diagnosis and surgical treatment of a herniated disc, specialists include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will do a medical history and physical examination. If this suggests that you have a herniated disc, you probably won't need other tests.
If your doctor needs more information, or if treatment hasn't worked after 4 weeks, you may have an MRI or a CT scan.
X-rays typically aren't useful or needed. But if your medical history and physical examination suggest a more serious condition (such as a tumour, infection, fracture, or severe nerve damage), or if your leg pain and other symptoms don't get better after 4 weeks of non-surgical treatment, your doctor may order X-rays.
Other tests, such as blood tests, may be done to rule out other conditions.
The following tests aren't used as often as an MRI or a CT scan, but they may give your doctor more information:
Your doctor may recommend a short period of rest or reduced activity followed by a gradual increase in activity.
Usually a herniated disc heals on its own. So most of the time non-surgical treatment is tried first, including:
You're likely to get the most benefit if you have treatment before you've had more than 6 months of symptoms.footnote 2
Surgery can be a good choice for people who have nerve damage that is getting worse or pain that hasn't improved after several weeks of non-surgical treatment.footnote 1 For more information, see Surgery.
To help prevent low back pain or a herniated disc:
The following steps may help to reduce pain:
Keep active and do exercises, as recommended by your doctor or physiotherapist, to help you return to your usual level of activity. Core stabilization exercises can help you strengthen the muscles of your trunk to protect your back.
Although medicine doesn't cure a herniated disc, it may reduce inflammation and pain and allow you to begin an exercise program that can strengthen your stomach and back muscles. Be safe with medicines. Read and follow all instructions on the label.
Surgery is considered if the following conditions are present:
People who have surgery may feel better faster. But in the long run, people treated with surgery and people treated without surgery have similar abilities to work and to be active.footnote 3 Some people require additional disc surgery after their first surgery.
Many people are able to gradually resume work and daily activities soon after surgery. In some cases, your doctor may recommend a rehabilitation program after surgery, which might include physiotherapy and home exercises.
Disc surgery isn't considered effective treatment for low back pain that is not caused by a herniated disc. Disc surgery is also not done if back pain is the only symptom the herniated disc causes.
A number of technologies using small incisions or injections for destroying the disc are used by some surgeons. Examples are endoscopic discectomy and electrothermal disc decompression. These techniques are experimental and unproved. If your doctor recommends one of them to treat your herniated disc, make sure to get as much information as possible about the procedure. Consider getting a second opinion.
Laser discectomy uses a focused beam of light to dissolve a herniated disc. Although this technology has been used by some surgeons for several years, it is considered experimental because of the lack of studies on its effectiveness and safety.footnote 4
Other treatments that have been tried include removing the centre of the disc and removing all or part of the disc by using suction. These treatments are not considered to be effective.
You can try other treatments besides medicine and surgery, including:
Talk to your doctor before using complementary medicine to treat a herniated disc.
Some people use complementary medicine along with standard or conventional care to treat leg and back pain caused by a herniated disc. Some examples are:
Tay BKB, et al. (2014). Disorders, diseases, and injuries of the spine. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 156-229. New York: McGraw-Hill.
Rihn JA, et al. (2011). Duration of symptoms resulting from lumbar disc herniation: Effect on treatment outcomes. Journal of Bone and Joint Surgery, 93(20): 1906-1914.
Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927-935.
Jordan J, et al. (2011). Herniated lumbar disc, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Other Works Consulted
Atlas SJ, et al. (2001). Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: Five-year outcomes from the Maine Lumbar Spine Study. Spine, 26(10): 1179-1187.
Deen GH, et al. (2003). Minimally invasive procedures for disorders of the lumbar spine. Mayo Clinical Procedures, 78: 1249-1256.
Peul WC, et al. (2007). Surgical versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 356(22): 2245-2256.
Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): A randomized trial. JAMA, 296(20): 2441-2450.
Weinstein JN, et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The spine patient outcomes research trial (SPORT): Observational cohort. JAMA, 296(20): 2451-2459.
ByHealthwise StaffPrimary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency MedicineWilliam H. Blahd, Jr., MD, FACEP - Emergency MedicineBrian D. O'Brien, MD - Internal MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerRobert B. Keller, MD - OrthopedicsRobert B. Keller, MD - OrthopedicsKenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma
Current as ofApril 21, 2017
Current as of: April 21, 2017
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Brian D. O'Brien, MD - Internal Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Robert B. Keller, MD - Orthopedics & Robert B. Keller, MD - Orthopedics & Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma
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