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A tear in the tough, fibrous ring surrounding the disc is a herniated disc. Some of the soft, gelatinous material inside breaks up, bulges into the spinal canal, and may or may not put pressure on a nerve. Anyone can develop a herniated disc, but older adults are especially susceptible.
A bulging disc (as opposed to a herniated disc) has been described as similar to having low air in a tire. Some of the cushion in the middle of the ring is lost, the disc collapses, and the fibrous ring bulges out. A bulging disc is a normal phenomenon and generally does not cause symptoms, except when it presses on the nerve roots.
Lower back and/or leg pain is a commonly reported symptom of a herniated disc. The discomfort, numbness, and tingling can radiate from the buttocks all the way to the toes. The pain worsens with walking, standing, and doing anything that causes intra-abdominal pressure, such as coughing, sneezing, or straining with a bowel movement. Muscle weakness can occur in the affected leg, and muscle spasms are common. The pain resolves itself with or without treatment in up to a third of all cases, but the process can take weeks.
A herniated disc in the back is not usually associated with a specific traumatic event. It is caused by wear and tear on the spine and can manifest after a simple activity such as bending over, heavy lifting, or any strenuous activities that generate abdominal pressure. That pressure is transmitted to the disc, often in the L4/L5 vertebrae area. Prolonged sitting and repetitive lifting and twisting are risk factors, as is reduced muscle tone caused by a lack of physical activity.
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The initial treatment for a herniated disc is rest (including bed rest), ice, and anti-inflammatory and pain medications. Apply ice for the first 48 to 72 hours, and then switch to moist heat. There is increasing evidence that mild activity is better than complete or extended periods of bed rest. A type of physical therapy known as the McKenzie Back Program, which involves a series of stretches, is often prescribed to reduce leg pain. It appears to be effective in the short-term, but it should be prescribed as part of a comprehensive treatment program in order to have long-lasting effects.
Longer-term treatment under a physician’s care includes physical therapy, medications, epidural steroid injections, and the use of transcutaneous electrical nerve stimulation devices (TENS units) that send electrical impulses into the area to reduce inflammation. An epidural steroid injection is a way of delivering the steroid medications around the compressed or irritated nerve root. There is evidence that this technique is effective in improving pain and functionality, as well as decreasing disability. It might, in special cases, save patients from having unnecessary surgery.
A growing body of evidence suggests that tissue engineering in the form of harvesting and reintroducing the body’s own stem cells may be a promising way to treat herniated discs in the lower back.
Herniated Disc Surgery
Surgery may be needed when the disc clearly will not heal by itself, when there is loss of bowel or bladder function, progressive leg or foot weakness, or an emergency situation. There is a five percent risk of the condition recurring and a greater risk of future back pain, with or without surgery. Not all herniated discs cause pain or require treatment. That happens only if the herniated disc is pinching on one or more nerves in the spinal canal.
Prevention is not always possible, but a systematic program of stretching and strengthening is a good place to start. Proper lifting and bending techniques will help you avoid putting your back in a vulnerable position. Warm up before lifting a heavy object, and bend at the knees instead of the waist. Keep your back straight and head forward, maintain a wide stance, test the load before you lift, and hold the load close to your body.
A herniated disc in the neck is a degenerative condition, sometimes confused with pain from bone spurs or arthritis in the area. It occurs when the material that constitutes a disc breaks up and puts pressure on the surrounding nerves. In most cases, no specific event triggers the herniated disc.
A herniated disc in the neck can cause neck pain, slowed arm reflexes, numbness, tingling, weakness, and pain that radiates down the arm. Elevating the affected arm, bending the elbow, and placing the hand behind the head often relieves the pain. This maneuver eases the pressure on the nerve and enlarges the opening through which the nerve exits the spine. Immediate treatment includes rest, NSAIDs, and physical therapy. A heating pad may help relieve muscle spasms.
Long-term relief comes with using a heating pad, taking prescription analgesics and pain relievers, and participating in physical therapy that includes traction. A physician may prescribe a systematic series of exercises developed specifically for this type of problem.
Surgery is reserved for persistent arm pain or progressive arm weakness. When it is required, the procedure involves removing the disc (discectomy), or a fragment of the disc (microdiscectomy), and fusing the adjacent ones.