Spinal disks are a bit like a jelly donuts in that disks have a softer center encased within a tougher exterior. A herniated disk is sometimes called a slipped disk or a ruptured disk and occurs when some of the softer "jelly" pushes out through a tear in the tougher exterior. In the spinal column disks in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). Higher up in the cervical spine (the neck),the disks are similar but smaller in size.
When a disk herniates or ruptures a part of the center nucleus pushes through the outer edge of the disk and back toward the spinal canal. The result is that this puts pressure on the nerves. This can result in pain, numbness, or weakness in one or both legs as spinal nerves are very sensitive to even slight amounts of pressure.
Disks have higher water content in children and young adults. The water content in the disks decreases and the disks become less flexible as people age. When this happens the disks begin to shrink and the spaces between the vertebrae get narrower. There are various conditions that can weaken the disk which include repetitive strenuous activities, sudden pressure (which may be slight),excessive body weight that places added stress on the disks in the lower back, smoking, and improper lifting.
In some cases there are individuals who may be more vulnerable to disc problems and, as a result, may suffer herniated discs in several places along the spine. In every instance the area in which pain is experienced depends on what part of the spine is affected. A predisposition for herniated discs may exist in families, research has shown, and several members may be affected.
While a single excessive strain or injury may cause a herniated disc, disc material degenerates naturally as one ages, and the ligaments that hold it in place begin to weaken. A relatively minor strain or twisting movement can cause a disc to rupture as this degeneration progresses.
Sometimes a patient cannot pinpoint the exact cause of their herniated disk. There are times when using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disk, as can twisting and turning while lifting anything. In other cases, rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.
Your doctor will ask you for a complete medical history and conduct a physical examination to determine whether you have a herniated disk. This physical examination will help determine which nerve roots are affected and what options may be explored for treatment.
A doctor may recommend a magnetic resonance imaging (MRI) scan to help confirm a diagnosis of herniated disk as this test can create clear images of soft tissues like intervertebral disks. It is always possible that you can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem.
In most cases the majority of herniated discs do not require surgery. In other events, though, there is a very small percentage of people with herniated, degenerated discs may experience symptomatic or severe and incapacitating low back pain. This chronic pain can significantly affect daily life.
To begin with most initial treatments for a herniated disc are usually conservative and nonsurgical. Your doctor may prescribe bed rest or advise you as the patient to maintain a low, painless activity level for a few days to several weeks as this helps the spinal nerve inflammation to decrease.
Frequently a herniated disc is treated with nonsteroidal anti-inflammatory medication if the pain is only mild to moderate. At other times the doctor may recommend physical therapy. Your therapist will perform an in-depth evaluation. That evaluation,combined with the doctor's diagnosis, will dictate a treatment specifically designed for patients with herniated discs. Your therapy might include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises.
Surgery may be required in only a small percentage of patients with disk herniations. Only after a period of nonsurgical treatment has not relieved painful symptoms would spine surgery typically be recommended. In such a case your doctor may suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to experience loss of bladder or bowel control, difficulty standing or walking, or numbness or weakness.