Herniated Disk

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KEY POINTS

• A herniated disk is when the cushion of tissue between the bones of your spine bulges out of place.
• A herniated disk may be treated with physical therapy, a brace, or sometimes with medicine or surgery.
• Keeping your muscles strong and using good posture can help prevent disk problems.

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What is a herniated disk?

A herniated disk is a disk that has bulged out from its proper place in your neck or back. Disks are rubbery cushions between the bones of the spine (vertebrae). Disks act as shock absorbers between each of the bones of the spine. When a disk bulges out, it may press on nearby nerves and cause pain and other symptoms.

Sometimes a herniated disk is called a ruptured disk.

What is the cause?

A herniated disk most often results from wear and tear on the spine as you get older. Sometimes it’s caused by an injury. You may be more likely to have a herniated disk if you keep straining your neck or back. This could happen, for example, from not using proper technique when you lift, push, or pull something heavy. Being overweight can also put extra stress on your back. You may also be at higher risk for a herniated disk if:

• You are a smoker.
• You sit for long periods of time without lower back support.
• You often work on a laptop computer.
• You drive a lot--for example, you are a truck driver.

What are the symptoms?

Symptoms of a herniated disk may start slowly or suddenly. Where you have symptoms depends on where the herniated disk is in your spine. The most common symptoms are numbness, tingling, pain, or weakness in your buttocks, shoulders, legs, or arms. You may also have trouble controlling your bowel or bladder.

How is it diagnosed?

Your healthcare provider will ask about your symptoms, activities, and medical history. Your provider will examine your spine. Tests may include:

• Tests of the strength, feeling, and reflexes in your arms and legs
• X-rays
• CT scan, which uses X-rays and a computer to show detailed pictures of the spinal cord and the tissues around it
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the spinal cord and tissues around it
• Electromyogram, which is a test of electrical activity in your muscles

How is it treated?

Your healthcare provider may recommend:

• Rest. It's best to try to stay active, so try not to rest in bed longer than 1 to 2 days or the time your provider recommends.
• Medicine. Several types of medicines may help lessen back pain. It may be medicine you take by mouth, or your provider may give a steroid shot into your spine. Take all medicine as recommended by your healthcare provider.
• Physical therapy. This may include massage, traction (force applied to your spine to help relieve pressure on your nerves), or other treatments. You may be given exercises to help strengthen your back so you are less likely to hurt it. You may learn how to protect your back when you are working or playing sports.
• A neck collar or back brace. Wearing a brace for a short time may help keep your neck in the right position while it is healing.

With treatment, the pain should get better within a few weeks, but you may keep having some pain for a few months. If you keep having pain, your provider may give you a shot of a steroid medicine. If your symptoms continue, your provider may recommend surgery, but usually surgery isn’t needed.

How can I take care of myself?

To help relieve pain:

• Take pain medicine according to your healthcare provider’s instructions.
• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the painful area every 3 to 4 hours for up to 20 minutes at a time. After a few days, a heating pad set on low, or a covered hot water bottle, may also help.

Always use good posture to keep extra pressure off your spine.

• Stand up straight with your shoulders back and your belly in. If you have to stand for a long time, move around often and shift your weight from one foot to another. If possible, put one foot up on a footrest that is about 6 to 8 inches high. This keeps your back straight and puts less pressure on your spine.
• Sit in chairs that give good support for your lower back. Keep your feet flat on the floor or up on a foot rest. Get up every 20 minutes or so and stretch.

When you need to lift something heavy, don't bend from your waist. Bend your knees and squat down by the thing you are lifting. Keep your back as straight as possible. Use your thigh muscles instead of your back to do the lifting. Don’t twist. Always keep things close to your body when you lift, lower, or carry them.

When you sleep, find the position that’s most comfortable for you and that supports your back. For example:

• Lie flat on your back on a firm mattress or on a mattress with a stiff board under it. Put a pillow under your knees when you lie on your back.
• Lie on your belly with a pillow under your chest
• Lie on your side with a pillow between your legs.
• If you cannot get comfortable, try lying flat on your back with your legs raised so that your knees are bent at a 90-degree angle. This is the same angle they would be if you were sitting up straight in a chair. One way to rest in this position is to lie on the floor, bend your knees, and rest your lower legs on the seat of a chair.

Follow your healthcare provider's instructions, including any exercises recommended by your provider. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent a herniated disk?

• Keep your muscles strong so that they can help support your spine better. Walking and swimming are examples of good exercise for strengthening and protecting your spine.
• Lose weight if you are overweight.
• Practice good posture.