If you are one of thousands of people across the U.S. who suffer from back pain, you know how debilitating it can be. Moving your torso is impossible without engaging your back. Every bend, twist, lift, and stretch uses muscles of the back and abdomen, which work in concert to allow movement, maintain posture, and provide flexibility.
Back pain can be caused by several underlying problems. Muscle strain is common, especially when overexerting or lifting inappropriately, as is arthritis, when protective cartilage breaks down and allows bones to grind against each other. But pain can also originate from the discs in between vertebrae. Therefore, let's examine what these discs are, why they are prone to herniation, and what you can do to improve the overall health of your back.
What Purpose Do Discs Serve?
The discs between our lumbar vertebrae are the same as those throughout the spine. Discs provide cushion for the vertebrae, help distribute load, and allow flexibility of the spine. They are composed of a tough outer ring, called the annulus fibrosus, that surrounds the soft inner core, the nucleus pulposus. The discs are composed primarily of water, but over time, as a person ages, the discs tend to dehydrate and function less efficiently. Not only does this reduce the cushioning support of the disc, but the loss of compliance in the disc can result in the disc being injured more easily and potentially leaking disc material which can chemically irritate the surrounding nerves.
The disc itself can bulge, or herniate, which also puts pressure on nerves. Because discs lack a blood supply, they cannot repair themselves like normal tissue, and therefore, a tear or bulge can take a long time to heal. Herniation can be the result of natural degenerative processes, known as degenerative disc disease, that occur with age, even though it is more a condition than a true disease.
Am I at Risk for a Herniated Disc?
Unfortunately, everybody is at risk for developing degenerative disc disease resulting in herniation. That's because discs begin losing fluid during a person’s 20s and progresses with age. In fact, approximately 30 percent of people age 30-50 have some form of disc degeneration, and by age 60, it is considered a normal consequence of the aging spine.¹
But other contributing factors can lead to a herniated disc. Obesity can place overwhelming burdens on the lumbar discs, thus causing them to bulge. Obese individuals are usually less fit, which leads to weak muscles that are unable to help support the back. Genetics also play a role, as do physically demanding jobs. Lifestyle choices, such as smoking and sedentary behavior, contribute to poor disc health that can result in disc dysfunction and potentially tearing or herniation of the disc.
The good news is that many of these risk factors can be controlled. By exercising, keeping your weight down, and not smoking, you can reduce your risk of lumbar disc herniation. Consult your physician before beginning an exercise routine to ensure you don't cause further injury to your back.
What Are the Symptoms of a Herniated Disc?
A herniated disc can cause much more than back pain. As the damaged disc puts pressure on surrounding nerves—in effect, pinching them (thus the term "pinched nerve")—it can cause radiating pain down the legs, known as sciatica. The pain, which normally comes on quickly, can be sharp, searing, or electric in nature, thus causing severe discomfort and loss of mobility.
You may also experience a tingling sensation through the legs, with weakness and loss of muscle control. The inability to lift your foot while you walk or stand, known as "foot drop," can occur with severe compression of the nerve and is a worrisome sign which should prompt immediate specialist evaluation.
How Is a Herniated Disc Diagnosed?
If you suspect a herniated lumbar disc, seek medical treatment from a trained specialist, who can obtain a thorough history, evaluate your symptoms, and diagnose the underlying problem. Advanced imaging with an MRI, will be used to confirm the diagnosis and enable your doctor to determine the best course of treatment for the herniation.
There are several non-surgical treatment options for a herniated lumbar disc, such as rest, pain management, anti-inflammatories, and physical therapy. If these treatments don't work, then surgery may be indicated.
Who Should Treat My Herniated Disc?
You will want a board-certified specialist to treat your herniated disc. Board certification ensures your physician has the proper education, training, and experience to treat spinal disorders. You will also want a surgeon trained in minimally invasive spinal surgery (MISS) who can offer the most advanced surgical options. MISS has several advantages over conventional spinal surgery, including:
- Smaller incisions, thus resulting in less scarring and faster healing
- Faster turnaround, because procedures are performed on an outpatient basis
- Less tissue trauma, because the operation is performed via high-powered microscopes
- Less blood loss
- More rapid recovery, as patients are typically up and walking the day of surgery
The symptoms of a herniated disc go far beyond back pain, but there are many ways you can reduce your chances of developing a herniated disc, address your symptoms, and treat the cause. Non-surgical options may alleviate your pain, minimize your symptoms, and allow your body to heal, but should your condition require surgery, be sure your provider offers a minimally invasive approach.
¹2013 Ullrich, Peter F.
Lumbar Degenerative Disc Disease (DDD), SpineHealth.com, https://www.spine-health.com/conditions/degenerative-disc-disease/lumbar-degenerative-disc-disease-ddd
About the author
Grant D. Shifflett, MD Dr. Grant D. Shifflett is a fellowship-trained orthopedic spine surgeon. Handpicked by Dr. Robert S. Bray Jr. to join DISC Sports & Spine Center, Dr. Shifflett specializes in the application of minimally invasive and microsurgical techniques to the entire spectrum of cervical, thoracic and lumbar spinal conditions, from the simple to the most complex. Whether treating a patient with chronic pain or an acute injury, his ultimate goal is to restore function and quality of life with minimal tissue disruption. Read more articles by Grant D. Shifflett, MD.