What Causes a Herniated Disc?
how we can help
An Overview of Herniated Disk
The functionality of the human body, which has evolved over millions of years, is nothing short of spectacular. Nowhere is this amazing engineering feat more evident than on the spine.
The fact that individuals can stand erect, maintain balance, move laterally, run without falling, and meet hundreds of other mobility challenges is part and parcel to the evolution of the spine. This is nature’s mechanical triumph. However, like any finely tuned machine, the spine is subject to the wear and tear of daily living, and when this happens, problems such as a herniated disc can occur and debilitating pain – an urgent “check engine” light – flashes in the brain.
A quick look at the spine suggests the challenges of a herniated disc. According to an explanation found in “Medline Plus,” a publication of The National Library of Medicine, “The vertebral column provides protection to the spinal cord that runs through its central cavity. Between each vertebra is an intervertebral disk. The disks are filled with a gelatinous substance, called the ‘nucleus pulposus,’ which provides cushioning to the spinal column. The annulus fibrosus is a fibrocartilaginous ring that surrounds the nucleus pulposus, which keeps the nucleus pulposus intact when forces are applied to the spinal column. The intervertebral disks allow the vertebral column to be flexible and function as ‘shock absorbers’ during everyday activities such as walking, running and jumping.”
Everything is great in this finely tuned machine until one of these disks is damaged. Then, the flashing lights of pain begin showing up in the brain! This suggests it is time for repairs and this means getting an examination from a spine specialist
Table of Contents
Symptoms
Diagnosing
Treatments
Patients Ask:
How many people in the US experience a herniated disc each year?
Texas Back Institute Responds: According to the National Institute of Health, “the incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually (more than 3 million each year) and is most common in people in their third to the fifth decade of life.”
What Causes a Herniated Disk?
Age-related wear and tear are the primary cause of a herniated disk. This is usually a gradual process that spine specialists at Texas Back Institute call “disk degeneration.” With age, the disks become dehydrated, less flexible, and more prone to tearing or rupturing with even a minor strain or twist. Interestingly, most people can’t pinpoint the cause of their herniated disk.
Injuries associated with work or recreation activities can also cause a herniated disc. Something as simple as using the back muscles instead of the leg and thigh muscles to lift heavy objects can lead to a herniated disc. Twisting and turning while lifting also can cause a herniated disk. In rare instances a traumatic event such as a fall or blow to the back can cause this condition.
Spinal disk herniation, which is also known as a “slipped disk” or “ruptured disk” and sometimes is referred to as “bulging disk” occurs when the soft center of a spinal disk pushes through a crack in the tougher exterior casing. Most herniated disks occur in the low (lumbar region) back area. A herniated disk in the lower back is very common and often leads to chronic pain, particularly affecting the lower back and leg area or may not cause any symptoms.
Even a healthy, well-hydrated disc can be injured. Stretching or tearing of the annulus may result in back or neck pain. The discs are immediately in front of the spinal cord and exiting nerves, so when the herniated disc or protrusion compresses the spinal cord or nerves, leg or arm pain and numbness or weakness may occur.
Patients Ask:
Does surgery fix a herniated disc?
Texas Back Institute Responds: If the symptoms and management require surgical removal of the fragment or portion of the disc, the vast majority of the disc is often left untouched. As such, a return to normal functioning is possible when the pressure is alleviated.
While the goal of surgery is to take the pressure away; it does not make the disc normal. If the damage to the disc is more extensive, other procedures such as vertebrae fusion or artificial disc replacement (link to TBI blog post on ADR with three doctors) may be necessary.
How Does a Herniated Disc Differ from a Bulging Disc?
Because of many similarities, the term “herniated disc” is often used interchangeably with “bulging disc“. Of course, this is understandable. Both conditions affect those “shock absorbers” or cushions that are found between the vertebrae and these discs show signs of wear and tear with age and become less flexible. These changes can cause the outer layer of the disk to bulge out.
Plus, just to make things even more confusing, a patient can have a bulging disc or herniated disc without any symptoms. In some cases, a person will find they have these disc changes only after having an imaging test, such as an MRI for another medical issue.
However, there is a difference between a herniated disc and a bulging disc.
Spine specialists at Texas Back note that a bulging disc doesn’t always affect the entire disc. Usually, at least a quarter to a half of the disc’s circumference is affected. And only the outer layer of tough cartilage is involved.
A herniated disc, on the other hand, results when a crack in the tough outer layer of cartilage allows some of the softer inner cartilage to stick out of the disk. Herniated disks also are called “ruptured discs” or “slipped discs.” The whole disc does not rupture or slip. Only a small area of the crack is affected. A herniated lumbar disk is commonly associated with sciatic nerve pain, causing sharp discomfort radiating down the leg. Diagnostic imaging tests such as MRI and CT scans are often used to identify the condition.
There is another difference between the two conditions. Specialists note that compared with a bulging disk, a herniated disk is more likely to cause pain. The inner cartilage of the disk sticks out farther and is more likely to irritate nerve roots. The irritation can be from pushing on the nerve or, much more commonly, herniation causes a painful inflammation of the nerve root.
Patients Ask:
Is a herniated disc treated in the same way as a bulging disc?
Texas Back Institute Responds: Yes. The most common surgical treatment for a bulging or herniated disc is a discectomy. This is a minimally invasive procedure in which the spine surgery specialist removes the damaged part of the disc.
What Are the Symptoms of a Herniated Disk?
The patients who present with this quite common condition of a herniated disk can experience several herniated disk symptoms. These symptoms can vary depending on whether the disc is pressing on nerves. If this condition occurs in the low back they often complain of back pain, leg pain, leg weakness, numbness, and, in some cases, difficulties with bowel and bladder usage.
A herniated disk in the neck, or cervical spine area, can cause neck pain, arm pain and arm weakness. Herniated disk symptoms in this area may worsen with movement and subside with rest.
If the damage is severe, surgery is necessary almost immediately and this procedure is typically a discectomy. The Texas Back Surgeons typically use a minimally invasive procedure, which enables patients to heal quicker. With less-damaged discs, the treatment is conservative and entails physical therapy, injections, and other non-surgical treatments.
In some cases, a patient does not have obvious symptoms and is experiencing no pain, and the herniated disk is discovered when an MRI scan is completed while diagnosing a completely different condition. If there is no pain and the patient can continue with normal daily activities, we advise regular checkups to ensure the disk does not worsen.
On the other hand, in some cases, especially with a herniation in the cervical (neck) area, the disk herniation can be so large that it can cause compression of the spinal cord. These patients require more aggressive treatment.
For example, one of the most common locations for bulging disk conditions is found in the C5-C6 spinal area. This disc bulge can result in weakness in the biceps muscles of the arms and the wrist extensor muscles as well as numbness and tingling along with pain that radiates to the thumb and fingertips.
Patients Ask:
Can herniated disks heal on their own?
Texas Back Institute Responds: In most cases Herniated disks get better on their own over time or with nonsurgical treatment for nine out of ten people.
(Insert stock or TBI image of operating room with patient on the table)
How Does a Spine Surgeon Diagnose a Herniated Disc?
While herniated discs are one of the most common back injuries, the combination of the vertebrae, spinal cord, and nerves connected to the spine presents many diagnostic challenges. The experts at Texas Back Institute undergo rigorous, on-going training, using the latest imaging and surgical technology, to ensure accurate diagnosis.
The first step of this diagnostic process includes a physical examination. A neurological examination is also performed to identify the involved nerve root. Because certain nerves consistently supply muscles and areas of sensation, physical examination and the patient’s specific symptoms give valuable clues to the source of the symptoms. Herniated disc material can exert pressure on spinal nerves, leading to symptoms such as pain, numbness, or weakness. The preferred imaging test is magnetic resonance imaging (MRI) because it can visualize soft tissues including the disc, spinal fluid, and neural elements.
In a few cases, there are emergency indicators for a herniated disc and patients experiencing them should seek immediate medical attention. The most common symptoms are severe back and neck pain which can be worsened by sneezing, coughing, going to the toilet, or lifting heavy objects. Other symptoms include leg and arm pain, difficulty with bowel control, pain in the abdomen, chest, or stomach, and tingling or numbness in different areas of the body.
Patients Ask:
After treatment or surgery will I need more surgery down the road?
Texas Back Institute Responds: The initial findings on the physical exam and imaging will provide a good framework to understand the nature of the disc problem. If a discectomy is a choice provided (often for low back disc herniations) the initial rehab requires avoiding aggressive bending, stooping, and prolonged car rides to keep from having a new recurrence of the herniation.
Often with good rehabilitation and strengthening, the remaining disc is sufficient to allow for a return to normal activities. By the nature of the fact that a normal disc does not herniate, there can be degeneration down the road that may warrant further conservative management or surgical treatment.
There is no one rule, and some patients remain asymptomatic indefinitely while others may have a recurrence that one day may require a more aggressive reconstruction with artificial disc replacement (link to most recent ADR blog post) or a fusion.
Less-Common Conditions Caused by a Herniated Disc
Herniated discs are usually the result of age-related wear-and-tear from daily living, or in some cases from traumatic injuries. However, there are a few herniated disc conditions that are outliers and affect a small group of patients.
Radicular syndrome is caused by compressed or irritated nerve roots resulting in pain, numbness, tingling, or weakness in the arms or legs. The nerve roots are branches of the spinal cord that carry nerve signals out to the rest of the body at each level along the spine.
Radicular syndrome is often caused by direct pressure from a herniated disc or degenerative changes in the spine that cause irritation and inflammation of the nerve roots by bone spurs or collapse of the nerve root tunnels (foramen). Sensory symptoms are more common than motor symptoms, and muscle weakness is usually a sign that nerve compression is more severe. The quality and type of pain resulting from radicular syndrome can vary, from dull, aching, and difficult to localize, to sharp and burning.
In the lumbar spine and low back area a few patients experience what is called Sciatica/Radiculopathy. This condition frequently results from a herniated disc in the lower back.
Pressure on one or several nerves contributes to pressure on the sciatic nerve, which is the longest and widest single nerve in the human body, going from the top of the leg to the foot on the posterior aspect. This nerve provides the connection to the nervous system for the skin of the lateral leg and the whole foot, the muscles of the back of the thigh, and those of the leg and foot.
Sciatica/Radiculopathy can cause pain, burning, tingling and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually, one side (either left or right) is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking, or sitting. Straightening the leg on the affected side can often make the pain worse. Along with leg pain, one may experience low back pain; however, for acute sciatica the pain in the leg is often worse than the pain in the low back.
Another less-common condition caused by disc herniation is found in the cervical spine (neck) area. According to the online encyclopedia Wikipedia, cervical radiculopathy is the symptoms of nerve compression in the neck, which may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. The pain may increase with certain positions or movements of the neck.
Patients Ask:
How long does it take for recovery before a patient is able to walk after herniated disk surgery?
Texas Back Institute Responds: Patients are encouraged to walk and move the day after surgery and it’s likely they will be discharged 1 to 4 days afterwards. It will take about 4 to 6 weeks for you to reach your expected level of mobility and function (this will depend on the severity of your condition and symptoms before the operation).
What Are the Treatment Options for a Herniated Disc?
With every patient, the spine specialists at Texas Back Institute recommend a surgical procedure as the final option. As such, the process of treatment begins with a very conservative approach with suggestions for over-the-counter medications and some behavior (restricting lifting and vigorous activities) modifications.
If this initial plan does not reduce the discomfort or pain from the herniation, the next step includes prescription-strength anti-inflammatory and muscle-relaxer medications along with physical therapy to promote strength and range-of-motion in the back or neck, depending on where the herniation is located.
If that fails, the next step would be to get an MRI scan to see where the herniation is located, how large it is and to assess its character. After this, some patients require spinal injections, which are a combination of local anesthetics and steroids which are delivered under X-ray guidance into the spinal canal. This will hopefully allow us to reduce the inflammation associated with the hernia condition.
A very small percentage of patients with a herniated disc will require surgery. This procedure is called a discectomy and is used to decrease the pressure on the nerve by removing the disc fragment in the low back. It is minimally invasive to enable faster healing and recovery time for the patient.
In the neck area of the cervical spine, an approach in front of the spine requires removal of the entire disc and treatment may require replacing the disc or positioning a bone graft to replace the space within the vertebral bodies to achieve fusion. In the thoracic spine, options may include an approach from the back or the side of the chest to remove the fragment away from the spinal cord with or without a fusion.
Patients Ask:
What activities should be avoided after having surgery for a herniated disc?
Texas Back Institute Responds: Avoid strenuous activities such as bicycle riding, jogging, weightlifting or aerobic exercise until your doctor says it is okay. Ask your doctor when you can drive again. Avoid riding in a car for more than 30 minutes at a time for 2 to 4 weeks after surgery.
What Does Reducing Body Weight Have to Do with Herniated Discs?
Millions of people worldwide have decided that now is the time to lose those extra pounds. The popularity of the prescription drugs originally developed for treating diabetes but which many people, young and old, are taking to lose substantial body weight, is helping to drive this trend. In most cases, this decision to lose weight is based on vanity. However, excess weight is also a cause of stress on the spine, and ultimately can lead to conditions such as a herniated disc.
Athletic trainers and nutritionists along with coaches who work with professional and amateur athletes know that carrying extra weight can put a strain on the spine because the disks are struggling to support it. Changing the diet and exercise plan could help everyone, from little leaguers to weekend warriors drop excess pounds and perhaps avoid surgery.
As noted above, a herniated disk can heal on its own, and patients should always consult with experts such as the specialists at Texas Back Institute to get the best treatment plan. And, while weight loss may not completely heal the disk, it may be a part of a comprehensive plan to help anyone recover faster.
With regards to preventing or treating a herniated disk, losing extra weight will relieve extra stress put on the disk supporting that weight which can perhaps lead to the issue resolving itself.
(stock photo of healthy foods – fruits, vegetables, grains, etc.)
Nutritionists have said that losing even 5–10% of your total body weight can lead to overall health benefits. In addition to helping relieve pain from a herniated disk, weight loss can also lead to these health benefits:
- Improved blood sugar
- Lower blood pressure
- Improved cholesterol
- Increased energy
- Reduced stress
- Improved immune health
- Improved complexion
- Reduced joint pain
- Reduced perspiration
- Improved hormonal balance
Weight loss can positively impact your life beyond reducing back pain. While you may begin your weight loss journey to help with this issue, you may find that healthy living is a path you choose to continue down long after your herniated disk has been healed.
Exercise and especially diet plays a key role for patients who have had a procedure for treating a herniated disk. Diet plays a key role in the recovery process. To build a balanced and healthy meal for patients after surgery for herniated disc, it is important to note the following foods:
- Protein-rich foods are important. Protein is one of the important components that form a healthy diet. It plays a role in promoting the formation of new tissues (muscle, bone) and shortening the healing time of the incision. Therefore, patients after surgery for herniated disc and spine should eat protein-rich foods, especially healthy and easily digestible protein groups such as beans, fish, eggs, mushrooms, and milk.
- Patients should note that red meat should be limited, because it contains a lot of saturated fat and has a high concentration of uric acid, which increases the body’s inflammatory response and causes more joint pain.
- Don’t forget foods with high calcium and phosphorus content. Calcium and phosphorus are two essential minerals, ensuring the maintenance of bone density. It is necessary to ensure a balanced ratio between these two minerals when supplementing the body after surgery for herniated discs and spine stability. The reason is that if you provide too much phosphorus, it will upset the balance, causing the body to mobilize calcium from the bones into the blood to regulate and thereby reduce the amount of calcium in the bones.
- Foods that patients should add to their daily diet include milk, dairy products, green leafy vegetables, shellfish, bok choy, radishes, cabbage, broccoli, cashews, and bone broth.
Patients Ask:
Which amateur sports are more likely to lead to a herniated disk?
Texas Back Responds: Contact sports are the most dangerous activities for potentially causing a herniated disk. Football, wrestling, hockey, gymnastics, tennis, and golf are some sports in which this injury mechanism commonly occurs. In the presence of a disc herniation, forward flexion worsens the herniation.
Do You Suspect a Herniated Disc?
Medical diagnostics and treatment for conditions such as a herniated disc have come a long way in a short amount of time. The world-class surgeons and doctors at Texas Back Institute are ready to treat any type of back pain. If you suspect you might have a problem with one of your discs, they can help.
When you’re ready to feel better, click here to set a time for your examination.
Learn more
Frequently Asked Questions
According to the National Institute of Health, “the incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually (more than 3 million each year) and is most common in people in their third to the fifth decade of life.”
If the symptoms and management require surgical removal of the fragment or portion of the disc, the vast majority of the disc is often left untouched. As such, a return to normal functioning is possible when the pressure is alleviated.
While the goal of surgery is to take the pressure away; it does not make the disc normal. If the damage to the disc is more extensive, other procedures such as vertebrae fusion or artificial disc replacement may be necessary.
The most common surgical treatment for a bulging or herniated disc is a discectomy. This is a minimally invasive procedure in which the spine surgery specialist removes the damaged part of the disc.
In most cases Herniated disks get better on their own over time or with nonsurgical treatment for nine out of ten people.
The initial findings on the physical exam and imaging will provide a good framework to understand the nature of the disc problem. If a discectomy is a choice provided (often for low back disc herniations) the initial rehab requires avoiding aggressive bending, stooping, and prolonged car rides to keep from having a new recurrence of the herniation.
Often with good rehabilitation and strengthening, the remaining disc is sufficient to allow for a return to normal activities. By the nature of the fact that a normal disc does not herniate, there can be degeneration down the road that may warrant further conservative management or surgical treatment.
There is no one rule, and some patients remain asymptomatic indefinitely while others may have a recurrence that one day may require a more aggressive reconstruction with artificial disc replacement or a fusion.
Patients are encouraged to walk and move the day after surgery and it’s likely they will be discharged 1 to 4 days afterwards. It will take about 4 to 6 weeks for you to reach your expected level of mobility and function (this will depend on the severity of your condition and symptoms before the operation).
Avoid strenuous activities such as bicycle riding, jogging, weightlifting or aerobic exercise until your doctor says it is okay. Ask your doctor when you can drive again. Avoid riding in a car for more than 30 minutes at a time for 2 to 4 weeks after surgery.
Contact sports are the most dangerous activities for potentially causing a herniated disk. Football, wrestling, hockey, gymnastics, tennis, and golf are some sports in which this injury mechanism commonly occurs. In the presence of a disc herniation, forward flexion worsens the herniation.
Locations
