When the discs in your back are healthy they act as shock absorbers for the spine, but when they become damaged it can lead to symptoms of pain, muscle weakness or numbness if they start to compress the nerves or spinal cord in your spine.
Anatomy of the spine
Your spine consists of 33 individual vertebrae, these vertebrae help to support the weight of your body and allow you to stand upright, bend and twist your back, and protect the spinal cord from
Sandwiched between each of these vertebrae is a small disc. These discs keep the vertebrae from rubbing together and help cushion the spine. They are made up of a tough outer shell and a softer gel like center.
These discs can become damaged in a number of ways. They can start to dry out, they can bulge out into the spinal canal, or they can rupture into the spinal canal. All of these injuries could lead to various symptoms that would make it harder for you to go about your daily activities.
What happens when you have a herniated disc is a portion of the disc pushes out of its normal space and into the spinal canal. When this happens it is possible for your nerves or spinal cord to become pinched or compressed.
While there is a small amount of extra space in the spinal canal, if enough disc material where to bulge out you would begin to have symptoms of pain, weakness and numbness.
It is possible to have a herniated disc and no symptoms at all; there have been many times where these herniated discs are only found during other diagnostic tests.
Herniated Disc Causes
Oftentimes a herniated disc occurs as a result of aging. The older we get the more worn out the structures in our spine become. Your discs start to lose fluid and become less flexible and more prone to damage. Once the degenerative spine cascade begins a disc herniation can happen by just bending or twisting the back.
Your spine is there to help provide support for your body, because of this the heavier you are the more stress you place on your back. If your tendons, ligaments or muscles cannot do their job properly due to this added load it could lead to a disc herniation.
3. Hereditary disposition
If anyone in your immediate family has or had a herniated disc in the past, you are at an increased risk of developing one yourself.
An injury to the back, such as a fall or car accident can lead to a herniated disc.
If you are a smoker the toxins in cigarettes can lead to a decrease in the amount of fluid in your discs. This makes the discs no longer as flexible and cushiony as they used to be, leading to a possible rupture or disc herniation.
Herniated Disc Symptoms
What types of herniated disc symptoms you experience will depend on where your disc problem is located. There are three areas in your spine where a disc can herniate, the cervical (neck), the thoracic (middle back) and the lumbar (lower back).
Cervical Herniated Disc Symptoms
1. A dull or sharp pain that starts in your neck
2. Pain that radiates into your shoulders and arms
3. Muscle spasms or cramping
4. Weakness or numbness in your arms and hand
Thoracic Herniated Disc Symptoms
1. Upper back pain
2. Difficulty breathing
3. A sharp burning pain in the arms accompanied with numbness
4. Pain that gets worse if you where to sneeze or cough
5. Pain that radiates around the rib cage and into the belly
6. Weakness or numbness in the lower extremities
7. Difficulty with balance and walking
8. Heart palpitations
9. Loss of bowel or bladder functions; this is a very serious symptom.
If you are having any problems with your bodily functions you should seek immediate medical attention.
Lumbar Herniated Disc Symptoms
1. Pain that radiates down the legs
2. A shooting or stabbing pain that is felt in the legs
3. Pain that radiates into the groin or thigh area
4. Numbness or tingling in the lower extremities
5. Muscle weakness in the lower extremities
6. Pain that decreases with short walks and increases if there is extended amounts of sitting or longer walks.
It is possible to have a herniated disc with no symptoms. If there is no compression of the nerves or spinal cord there would be no pain or numbness.If you are experiencing these symptoms you should consult with your doctor so they can correctly diagnose your condition.
The key to a successful treatment is an accurate diagnosis.To do this your doctor would review your medical history and perform a full physical examination as well as a few tests that can be done in their office.
If these tests do not conclusively diagnosis your condition as a herniated disc your doctor may order additional diagnostic tests be performed.The following tests can be used to rule out other conditions or to see what nerves are being impinged.
MRI scans (magnetic resonance imaging)
This test would use strong magnetic fields and radio waves to create highly detailed images of your muscles, joints and nerves. This can help to confirm the location of your herniated disc and where your nerves or spinal cord are being compressed.
CT scans (computerized tomography)
Very similar to an x-ray, this machine would rotate around the body and create cross-sectional images of the spine and structures near it.
This is like an x-ray but a contrast dye would be injected into the spinal fluid. The dye makes any problems show up better on the x-ray and can be used to show the amount of pressure on your spinal cord or nerves.
This test is oftentimes done first, and while it cannot detect a herniated disc, it is useful for ruling out any tumors, bone spurs, or other injuries that may be causing you pain. It can also show if there is any narrowing of the spaces in-between your vertebrae.
Herniated Disc Pain Management
It can be hard to treat a herniated disc when you are in pain. That’s why it is always best to treat your pain first and then move on to physical therapy.
There are many ways to go about decreasing the amount of pain you are in, it would really depend on how severe your symptoms are and what types of pain treatment you could attempt.
Inexpensive treatments that can help those who are suffering from a herniated disc are:
1. Cold therapy
This type of therapy is best used in the first few days of pain, if you are experiencing pain and swelling. Ice the area for about 5 minutes then allow adequate time for your skin to warm back up and never apply ice directly to the skin as this can cause frostbite. You can use ice cubes or crushed ice that is in a bag or towel, cold packs or wraps that can be purchased at a drug store. If you cannot manage to find any of the above, you could wet a towel and freeze it.
2. Heat therapy
This therapy can be used to reduce pain, it should never be used if there is any inflammation or swelling as the heat will make it worse. There are inexpensive heat therapies that are only applied to the surface of the skin and a more expensive treatment that can penetrate the deep tissues.
3. Others Heat Therapy
Some inexpensive ways of using heat therapy are hot water bottles, a heated gel packs or wraps, electrical heating pads, or a warm bath.
For deep tissue therapy you would use a procedure like ultrasound. Ultrasound uses high frequency sound to penetrate deep inside your tissue and promote faster healing.
Can be used to treat pain and inflammation. The two types commonly used are:
Analgesics such as Tylenol for pain.NSAID’s such as Advil, Aleve or Aspirin for pain and inflammation.If your pain is not being controlled properly with these over the counter medications you may be able to have a prescription written for you by your doctor for a pain narcotic.
2. Epidural Steroid Injections
This is an injection of a very powerful anti-inflammatory medication, most often cortisone. It is administered in a doctor’s office and is usually better at controlling pain that is due to inflammation better then oral medications. The reason behind this is that the medication is delivered to the exact area that is causing your pain.
Bed rest and activity modification
Sometimes it is helpful to rest for a day or two if you are having severe back pain. You will want to limit your bed rest to no more than 2 days as it can have the opposite effect as your muscles may begin to weaken due to lack of use.TimeOften herniated disc sufferers do not give treatments enough time to work. You can expect it to take four to six weeks before you start to see a significant reduction in your back pain.
Herniated Disc Treatment
Before physical therapy can begin you will need to deal with any issues of pain that you might be having as it can be very difficult to proceed with these treatments if you are in severe pain.Many people who suffer from a herniated disc do so because of weak core muscles.
Your spinal column must hold up the weight of your body so if you’re lower back and abnormal muscles are weak and out of shape, they cannot perform this job to the best of its ability.
Herniated disc exercises, or core exercises, can be used to strengthen the oblique, abdominal, lower back and gluteus muscles. By working these muscle groups you help to develop a strong and limber core.
A core exercise routine should ideally be tailored to your specific problem and lifestyle. It is also something that you can keep doing once you no longer have back pain, as it will help to keep your core strong reducing the chance of re-injury.
Stretching also goes well with core exercises and can be very beneficial for those cramped or chronically shortened muscles.
Another way of exercising is water therapy. This combines aerobic exercise and water and is a type of resistance training. Exercising in the water is very low impact and helps to reduce the amount of stress on your joints. Because this is a near zero gravity environment, it is very helpful for those who are elderly, injured or recovering from a surgery.
Back braces or corsets can be worn to keep the spine immobile in those with weak back muscles. This form of treatment should always be combined with an exercise program as you do not want your back to start relying on the brace to keep your spine properly aligned.
To help prevent a herniated disc in the future you should always take preventative measures such as:
Studies have shown that exercise can help to slow down the age-related degeneration of the spine and its structures. Consult with your doctor before starting any exercise routine if you have had any previous back injury as they may want you to avoid certain high impact exercises or certain types of aerobics.
2. Maintain a healthy weight
For every extra pound of weight you carry, you add 3 pounds of pressure to the spinal column; this extra pressure can not only lead to herniated discs it can speed up the process of the degenerative spine cascade.
3. Learn and use proper postures
This does not only mean keeping your back straight when you sit. It is just as unhealthy for you if you lift heavy or awkward objects improperly, always use your legs and not your back when lifting up something.
4. Quit smoking
Smoking is not only unhealthy for your lungs it is unhealthy for your back. Smokers are at a higher risk of developing back problems due to the toxins in cigarettes.
Herniated disc surgery
Surgery for a herniated disc should only be required once all conservative (non-surgical) treatments have failed. It should be noted that between 5-10% of disc herniation recur due to additional disc material that has pushed out into the spinal canal.
Types of herniated disc surgeries are:
1. Percutaneous Laser Discectomy
There are four types of herniated discs, a disc bulge, a contained herniation, an extruded disc herniation and a sequestered disc herniation. A disc bulge or contained herniation means that the disc itself is still intact and there is no tear, just a bubble that has pushed out. With this herniation it is possible to remove this bubble from the inside of the disc by sucking it out, pulling it out or vaporizing it with a laser.This is a minimally invasive procedure that would require only a small incision and is most effective in those who are under the age of 50.
2. Percutaneous Nucleoplaty Coblation
This procedure is similar to a percutaneous laser discectomy, but is performed using electric radiofrequency energy and a liquid medium to create a plasma spray at a temperature much lower than a laser. This is very precise with the affects being very minimal on the normal surrounding tissue making it safe and appealing.
For this procedure your surgeon would make a small opening into the lamina. This would then allow the surgeon to remove any abnormal tissue, bone spurs, or herniated disc material that may be compressing the nerves or spinal cord.
This is the complete removal of the lamina or back side of the spine. It would only be performed if there was a massive disc herniation. A spinal fusion surgery is commonly performed alongside this operation to provide stability for the spine that is lost when the lamina is removed.
5. Transforaminal Micro Discectomy
This surgery would be performed if there is a herniated disc located within or on the outside of the foraminal canal. The foraminal canal is the opening between two of your vertebrae where the nerve root would exit.
6. Micro Discectomy
This is the same procedure as a Laminotomy but would be performed using a microscope or endoscope and a small incision in the back. This type of surgery can be successfully performed while under a local anesthesia and has very good to excellent success rates. Recovery times are shorter because of the small incision and the use of a micro or endoscope.
7. Nucleous Replacement Disc Stabilization Arthroplasty
This is one of the latest major breakthroughs when it comes to back surgery and herniated discs. It is a partial disc replacement, only the nucleus (inside of the disc) would be replaced instead of the whole disc. The main advantage to this approach is that it can be performed minimally invasively through the back, side or front.
By only replacing the inside of your disc, less of the disc structure is being altered or removed. There are a number of these implants available internationally and they are just now starting to be investigated by the FDA.