A common source of back pain is a herniated disc. Sometimes called a “slipped” or “ruptured” disc, this condition most often occurs in the lower back. Although a herniated disc can sometimes be very painful, most people feel much better with just a few months of simple, nonsurgical treatments.

Cause

A disc herniates or ruptures when part of the center nucleus pushes through the outer edge of the disk and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs.

Risk Factors

In children and young adults, discs have high water content. As people age, the water content in the disks decreases and the disks become less flexible. The disks begin to shrink and the spaces between the vertebrae get narrower. Conditions that can weaken the disk include:

• Improper lifting
• Smoking
• Excessive body weight that places added stress on the disks (in the lower back)
• Sudden pressure (which may be slight)
• Repetitive strenuous activities

Symptoms

Low back pain affects many people. Pain alone is not enough to recognize a herniated disk. See your doctor if back pain results from a fall or a blow to your back. The most common symptom of a herniated disc is sciatica—a sharp, often shooting pain that extends from the buttocks down the back of one leg. It is caused by pressure on the spinal nerve. Other symptoms include:

• Back pain
• Weakness in the leg and/or foot
• Tingling (a "pins-and-needles" sensation) or numbness in the leg and/or foot
• Loss of bladder or bowel control (This is rare and may indicate a more serious problem called cauda equina syndrome. This condition is caused by the spinal nerve roots being compressed. It requires immediate medical attention.)

Treatment

Nonsurgical Treatment

Nonsurgical treatment is effective in treating the symptoms of herniated discs in the majority of patients. Most neck back pain will resolve gradually with simple measures.

• Rest and over-the-counter pain relievers may be all that is needed.
• Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
• Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time.
• After any spasms settle, gentle heat applications may be used.
• Physiotherapy

Any physical activity should be slow and controlled, especially bending forward and lifting. This can help ensure that symptoms do not return, as can taking short walks and avoiding sitting for long periods. For the lower back, exercises may also be helpful in strengthening the back and abdominal muscles.

Injection may be beneficial for this condition. These injections are given on an outpatient basis over a period of weeks. They may include:

• Cortisone (Corticosteroid)
• Platelet Rich Plasma (PRP)
• Prolotherapy
• Botox
• Trigger Point Injections

Surgical Treatment
Only a small percentage of patients with disc herniations require surgery. Spine surgery is typically recommended only after a period of nonsurgical treatment has not relieved painful symptoms.

• Lumbar microdiscectomy. This is the most common procedure for a herniated disk in the lower back. Microdiscectomy involves removing the herniated part of the disc and any fragments that are putting pressure on the spinal nerve.