What Is a Herniated Disc?
In between each of the bony vertebrae that make up our spine lies a spongy disc that serves as a shock absorber. Each disc contains a fibrous outer wall (annulus) surrounding a soft jelly-like core (nucleus). The nucleus can extrude if the annulus becomes weakened and ruptures under pressure. This is what is called a herniated disc.
Herniated discs can happen in the neck (cervical spine) but most often develop in the lower back (lumbar spine) because that part of the back takes on the most stress. Herniated discs are among the most common back problems among people in the United States, especially older individuals.
What Causes a Herniated Disc?
Normal wear and tear on the spine as you age can weaken the spinal discs. This is a type of degenerative spine disorder. Excessive strain or injury to the back can also herniate a disc, such as lifting a heavy item using the back (rather than the leg) muscles or just improper twisting to pick up an ordinary object. Being overweight, living a sedentary lifestyle, and sitting for long periods of time also put excess strain on the discs of the spine.
What Are the Stages of a Herniated Disc?
Spinal disc herniation typically progresses through four stages before full herniation occurs.
Stage 1: Degeneration. The spinal disc wears down over time and weakens, but its contents remain intact.
Stage 2: Prolapse. The nucleus begins to push out against the annulus, causing the disc to bulge. A bulging spinal disc can cause symptoms if the disc presses on a nearby nerve.
Stage 3: Extrusion. The nucleus begins to extrude through a small tear in the annulus.
Stage 4: Sequestration. The disc ruptures and the nucleus spills out from the disc center, often causing nerve inflammation and irritation and resulting in severe pain.
What Are the Symptoms of a Herniated Disc?
The symptoms of a herniated disc vary depending on its location and severity. Lumbar herniated disc symptoms may include:
- Back pain which feels worse with prolonged sitting, standing, and driving.
- Muscle spasms in the back.
- Pain that radiates down into the buttocks, leg, and foot—a form of sciatica.
- Muscle weakness and/or numbness and tingling in the leg and foot, which can also make it challenging to walk or stand.
- Reduced reflexes in the knee or ankle.
Cervical herniated disc symptoms are similar but affect a different area:
- Dull or sharp pain between the shoulder blades.
- Pain that radiates down the arms and into the hands.
- Muscle spasms in the neck.
- Numbness, tingling, or weakness affecting the arms, hands, or fingers that may make it difficult to pick up or grasp objects.
- Increasing clumsiness in the hands
- Worsening of balance with possible falls
- Brisk reflexes
Thoracic herniated discs do not occur often. When they do, they may cause:
- Pain in the middle back.
- Pain or numbness that radiates around the rib cage from the back to the front of the chest or upper abdomen.
- Stiffness or weakness in the legs if a large disc herniation presses on the spinal cord.
- Worsening of balance with possible falls
- Brisk reflexes
Herniated Disc Prevention
There are steps you can take to prevent a herniated disc from developing or happening again.
- Lift using your leg muscles rather than your low back, and avoid lifting while bending or twisting.
- Watch your weight, make sure to eat a healthy diet, and get regular exercise to achieve and maintain a healthy weight.
- Maintain good posture when you are sitting, standing, moving, and sleeping.
- Get regular physical activity, including cardiovascular workouts and strength training. Strengthen the abdominal muscles to support the back and improve posture.
- Stretch regularly to reduce stiffness and improve mobility in the back and hips. Reduce stress to avoid tension in your back.
- Avoid smoking, which causes damage to the blood vessels and can increase the risk of degenerative diseases of the spine.
- Set up a spine-friendly workspace, with the top of your computer monitor at eye level and your knees slightly lower than your hips when sitting. Use a desk chair with a seat that supports your back.
- Change positions frequently when working or sitting for prolonged periods.
- Avoid wearing high-heeled shoes, which force the curve of the spine into an unnatural position.
Who is at risk for developing a herniated disc?
You may have an increased risk of developing a herniated disc if you:
- Are a young adult or in middle age.
- Are overweight, which places extra stress on the lower back.
- Work in a job that requires you to do a lot of heaving lifting (such as a hospital aide) and you do not lift properly, or a job where you are sitting for long periods (such as a truck driver).
- Have other family members who have had spinal disc problems, indicating you may have a shared inherited spine anatomy that makes you more prone to herniated discs.
- Had a herniated disc previously; your spinal anatomy or lifestyle may predispose you to disc problems, or you may be moving in a way that promotes herniated discs. Ask your doctor how to reduce your risk of recurring herniation.
What Happens if a Herniated Disc Is Left Untreated?
If a disc is bulging but has not herniated, your doctor may want to monitor it and give you exercises to prevent it from getting worse. If a disc has herniated and you do not treat it with rest, physical therapy, or other treatment, it may continue to cause you pain. The pain will likely subside in a few weeks and not be as bad as it was when the rupture first happened, but it may persist. You may also be at risk of another herniated disc if you don't take care of the problem that caused the first one; a spine specialist can let you know what you need to do.Learn more about herniated disc treatment.
When to Seek Help for Herniated Discs
Sometimes a large disc herniation can lead to spinal cord compression. There may be edema (swelling) of the cord that requires immediate medical attention. Symptoms may come on suddenly or gradually and may include:
- Changes in bladder or bowel function.
- Difficulty walking or balancing.
- Dropping things or having difficulty with fine-motor skills such as buttoning, handwriting, or picking up small objects (in the case of a cervical disc herniation).
- Arm or leg weakness or cramping.
Find Treatment for Herniated Discs at Och Spine at NewYork-Presbyterian
A herniated disc is one of the most painful injuries you can experience and can significantly impact your ability to do everyday activities like sitting, grooming, walking, and standing.
If you are experiencing any of the symptoms above—especially pain or weakness that may be caused by a compressed spinal nerve—call the experts at Och Spine right away for an appointment. We know how serious and debilitating herniated discs can be and we'll see you as soon as possible to start you on the path to recovery.
Contact us to make an appointment for a consultation.