Herniated Disc: Back, Neck and Leg Pain and Numbness

What it involves

MedlinePlus explains that a herniated, or slipped, disc occurs when all or part of a disc is forced through a weakened part of the disc, which may press on nearby nerves or the spinal cord. The discs cushion the bones of the spine. The lower back is the most commonly affected area, then the neck, while the upper and mid back are rarely involved.

Who this is for

• Adults with sharp pain that runs from the lower back or buttock down one leg
• Patients with neck pain that spreads into the shoulder blade, arm or fingers
• People with numbness, tingling or weakness in one leg or arm after lifting or twisting
• Anyone whose back pain gets worse with sitting, coughing or sneezing and has not improved in a few weeks

What to expect

• Questions about where the pain travels, what makes it worse and whether you have numbness or weakness
• An exam of the spine, posture, reflexes and muscle strength, and how you walk on your toes and heels
• Simple movement tests, such as lifting a straight leg while seated or tipping the head to one side
• A referral for an MRI, CT scan or physical therapy when your symptoms or the exam call for it

What happens inside the spine

MedlinePlus explains that the spine is made of 26 bones called vertebrae, with soft discs filled with a jelly-like substance between them. As people age the discs break down and lose their cushioning. A herniated disc is one that ruptures, letting the jelly-like center leak and irritate nearby nerves, which can cause sciatica or back pain. A herniated disc is also a cause of radiculopathy, a condition that affects a spinal nerve root. The sciatica guide explains that leg pain on its own.

Symptoms by location

With a herniated disc in the lower back, the encyclopedia describes sharp pain in part of the leg, hip or buttock, numbness elsewhere, and sometimes a weak leg. With a disc in the neck, there may be pain when moving the neck, deep pain near the shoulder blade, and pain or numbness running into the upper arm, forearm and fingers. The pain is often on one side. The low back pain guide, the neck pain guide and the numbness and tingling guide cover the wider picture.

What makes the pain worse

MedlinePlus says the pain often starts slowly and may get worse after standing or sitting, at night, when sneezing, coughing or laughing, when bending backward or walking more than a few yards, and when straining, such as during a bowel movement. Weakness may not be noticed until a provider examines you, though some people have trouble lifting a leg or arm, standing on their toes on one side or squeezing with one hand. The muscle weakness guide explains how that is assessed.

Who is more likely to have one

The encyclopedia says herniated discs occur more often in middle-aged and older men, usually after strenuous activity. Other risk factors include lifting heavy objects, being overweight, repeated bending or twisting of the lower back or neck, sitting or standing in the same position for long hours, an inactive lifestyle and smoking. The obesity and BMI guide and the quitting smoking guide describe how a provider approaches two of the risks you can change.

How a provider examines it

A careful history and physical exam come first. MedlinePlus says the provider checks for numbness, reflexes, muscle strength, posture and the ability to bend the spine, and may ask you to walk on your toes and heels. Leg pain when the straight leg is lifted while seated usually suggests a herniated disc in the lower back. Tests that may follow include a spine MRI or CT, nerve studies and an x-ray, though an x-ray alone cannot diagnose a herniated disc. Imaging and nerve tests are arranged by referral.

Treatment, recovery and prevention

MedlinePlus says the first treatment is a short period of rest and pain medicines, usually followed by physical therapy, and that most people who follow it recover. Steroid injections near the disc can relieve pain for months but do not solve the underlying problem, and surgery is an option if symptoms persist. Avoid heavy lifting or twisting for the first six weeks after the pain starts. Using proper lifting technique, keeping a healthy weight and strengthening the core and back muscles help prevent injury. Spinal injections and surgery are arranged by referral. Back stiffness that is worst at night and after sitting, without leg pain, may have a different cause, covered in the ankylosing spondylitis guide.

Sources

• MedlinePlus: Herniated Disk (health topic)
• MedlinePlus: Herniated disk (medical encyclopedia)