Your spinal column, or backbone, consists of several discs, which are situated between the bony vertebrae. The discs are made of soft tissue and their main function is to absorb any shock that your spine suffers on an ongoing basis.
A herniated disc, much like the textbook definition of a hernia, is a condition in which one of these soft tissue discs bulges out, causing the disc to rupture, thus disrupting the nerves and causing a whole world of pain to the patient. An easy way to think about it is if you think about a donut filled with jelly. The outside of the disc (the dough layer) is the annulus fibrosus, while the inside of the disc (the jelly) is the nucleus pulposus. When a herniation takes place, it’s similar to what would happen if a jelly donut had a crack on the surface. The jelly inside would get pushed out and flow out of the donut through the crack. Similarly, the nucleus pulposus will flow out through a rupture in the annulus fibrosus and this causes adjacent nerves to feel a lot of pain, which leads to loss of feeling, weakness and high sensitivity.
Herniated discs are seen in one in eight Americans between 30 to 50 years of age, but out of these only a small percentage actually go in for a treatment, mainly because the rest do not diagnose that they are suffering from this condition.
The reason why some people are unable to correctly have this condition diagnosed is because there may not be a lot of pain that they feel, as the location of the disc may not be in an area where it is causing a lot of exposed nerves. The only way to actually know if you are suffering from one is to carry out a spinal imaging test which will be able to detect the presence of a herniated disc.
Some of the indications of a herniated disc are:
- Radiating pain in the outermost regions: Radiating pain in the arms is called radiculopathy, while radiating pain in the legs is called sciatica. In case you feel a dull or stabbing pain that starts in the back and then gradually goes down into your arms and legs reaching to your feet and hands, you may be suffering from a herniated disc.
- Loss of sensation, or tingling feeling: A person suffering from a herniated disc can either have a tingling sensation in their arms and legs or they may suffer loss of feeling in their limbs. This sensation is akin to that of feeling your arms or legs going to sleep.
- Muscle weakness: Any sort of muscle vulnerability should be tested for presence of a herniated disc.
If you experience any of these symptoms, you should visit your doctor who will be able to diagnose your condition after running a series of tests. You should also consult a physician in case you are facing any changes in your bladder or bowel movements.
Normally, the space between your discs contains 80% water. As you grow older, more of this water content is lost and your discs may be subject to wear and tear, or disc degeneration. The disc may then develop a rupture on it which can stretch out over time.
Time and age are the primary causes for herniation; it is very seldom for this condition to result from an accident or physical injury. As long as there is a small rupture to the disc present as a result of normal wear and tear, the herniation event can be triggered by something as small as a sneeze, or abrupt movement.
A herniated disc can be the result of several reasons that include the kind of physical activities a person performs as part of their job, their age as well as their weight. The American Pain Society/American College of Physicians, in a study by Chou R, Huffman et al., 2007, stated that herniated discs are found specifically in populations of men in their middle ages or older and can occur after a lot of physical activity. Normal muscle degeneration can make the problem worse.
While age has a huge part to play in degeneration, weight can also lead to the formation of a herniated disc. The added stress that excess weight places on the lower back can cause pressure on the spine and this can lead to a tear in the disc, which can further lead to herniation.
If a person works in a job that involves doing a lot of physical activity such as lifting heavy things, they are subject to the risk of developing this condition.
A doctor investigating a potential case of herniated disc will first do a thorough check of the patient’s medical history, followed by a physical examination. A test like the straight leg raise test, can help detect if there is herniation in the disc as there will be pain resulting from the pressure placed on the nerve roots in the lumbar spine. A full test of a person’s motor and sensory function can also help. Other diagnostic tests include:
- Spinal CT scan
- Spinal MRI
- X-rays of the spine
- Nerve conduction velocity exam
Primary treatment for a herniated disc should be complete bed rest along with application of hot and cold packs to the affected area. Of course, the rest should be limited to only 24 – 48 hours so as not to worsen the pain. During this time, painkillers like NSAIDs and Tylenol can also be administered to the patient. Other drugs that can be used include narcotics, muscle relaxants, and neurogenic drugs like Lyrica or Neurontin.
Initial treatment should consist of rest, ice and heat, over the counter NSAID’s and Tylenol, along with no more than 24-48 hours of bed rest. Studies have shown it is better to get back up and stay active as soon as possible. A single dose of Medrol Dose Pak can also act as an anti inflammatory agent, but should not be taken along with NSAIDs or the patient may develop an ulcer.
Spinal decompression therapy may also be done along with physiotherapy and chiropractic, and a TENS unit. Steroids may also be injected into the region for pain relief over a period of weeks or months. The patient should keep in mind that none of these treatments will cure the condition, but are only effective for pain relief. Over time, the body itself will dispose of the herniated portion of the disc.
If a person does not respond to this treatment, they may have to undergo invasive procedures to have it corrected.
Over 95% of patients with a herniated disc are able to use traditional methods of treatment for the pain without having to undergo surgery. In 75 – 90% of cases, steroid injections did the trick, which in over 85% of cases, spinal decompression therapy was found to yield good results. Using an ideal mix of these various therapies has also helped a lot of patients.