Herniated discs are very common, but they’re not always the true cause of back pain. Join Airrosti’s Dr. Wallace as he defines what a disc herniation is, why it’s misunderstood, and explores the various treatment options available for resolving this condition.
The spine is made up of a series of connected bones called “vertebrae.” The vertebral disc is a combination of strong connective tissues which hold one vertebra to the next and acts as a cushion between the vertebrae. These discs are made of a tough outer layer called the “annulus fibrosus” and a gel-like center called the “nucleus pulposus.” When the nucleus pulposus bulges or ruptures, it can press on the various nerve roots in your spine and can cause pain, numbness, or muscle weakness in the arms or legs. A herniated disc may also cause back pain, but back pain alone (without leg pain) can have many causes other than a herniated disc. This condition is often known as a bulging disc or slipped disc, but its medical term is “herniated nucleus pulposus,” or more commonly, a “herniated disc.”
Disc injuries can be separated into three categories:
• Disc Bulge/Protrusion – The disc begins to bulge from between the vertebrae. Although the disc remains attached, the bulging tissue can press on the spinal nerves.
• Disc Extrusion – The outer layer of the disc begins to tear, allowing the nucleus pulposus to leak outside the disc. With this type of herniation, the extruded tissue is still attached to the disc.
• Disc Sequestration – The nucleus pulposus bursts, completely separating from the disc. This is a rare type of disc injury but it’s also the most severe.
Although a disc injury can happen to anyone, there are a few factors that can increase your risk of getting a disc injury.
• Age – As you age, the disc may start to lose water content, making it less effective as a cushion for your vertebrae. Disc herniations are more commonly found in people over 40 years old.
• Smoking Habits – Smoking can increase the rate of disc degeneration by constricting your arteries and reducing the supply of oxygen to the spine.
• Weight – Those who are overweight or obese have a higher risk of suffering from disc injuries due to the increased pressure placed on bones and joints.
• Occupation – Wear and tear from physically demanding can put excessive stress on the spine, especially if you’re repetitively lifting, pushing, or pulling.
Due to the complex nature and anatomy of the spine, you might have a herniated disc without even knowing. A disc herniation can appear with multiple symptoms or no symptoms at all. Its symptoms can also vary dramatically based on the severity of the injury and its location within the spine.
Cervical Disc Herniation
The cervical spine is made up of seven vertebrae in the neck. The cervical vertebrae give the neck its mobility. If you’re suffering from a cervical disc herniation, you’ll likely experience a few of these symptoms:
• Dull or sharp pain in the neck or upper back
• Pain, numbness, or tingling in the shoulder and upper arm
• Arm and hand weakness
• Pain may increase with certain neck positions and movements
Thoracic Disc Herniation
The thoracic spine consists of the 12 vertebrae of the mid back, below the cervical spine. It’s considered the most complex region of the spine since it is the only region where the vertebrae are also attached to the rib cage. Due to this specific location and structure, a thoracic disc herniation is likely to cause symptoms in the chest, abdomen, and mid back.
• Pain in the mid back, especially if the herniation is compressing a spinal nerve
• Chest pain
• Numbness or tingling that travels from the mid back to the chest or upper abdomen
• Weakness or numbness in the legs
Lumbar Disc Herniation
The lumbar spine is made up five large vertebrae in the lower back. Because these vertebrae are more mobile than the others and will endure the most force from activities like lifting and jumping, they are also the most vulnerable to spinal and disc injuries.
• Burning, tingling, or pain in the buttocks, legs, and feet
• Lower back pain that worsens when standing, sitting, or walking
• Pain, numbness, or tingling in the legs
If you’re experiencing back pain, or any of the symptoms describing a herniated disc, your doctor may perform a physical and neurological exam to check your reflexes, muscle strength, range of motion, and pain levels. If you’ve suffered from a back injury or have been experiencing chronic lower back pain, imaging tests may be used to find and diagnose the possible causes.
Conservative treatment is usually the first and best option for a bulging disc. Your doctor will likely suggest bed rest, physical therapy, massage, and pain medications to treat your symptoms. For more severe and painful disc injuries, your doctor may prescribe steroid injections, ultrasound therapy, and surgery.
Some studies indicate that herniated discs often have no direct association with low back pain. In fact, according to the New England Journal of Medicine, 60% of people with a herniated disc have no presenting back pain. People often assume that everyone who has back pain has a ruptured disc, but a true herniated nucleus pulposus is not very common.
At Airrosti, we are experts at accurately diagnosing the true cause of your back pain. In many cases, a herniated disc is not the actual cause of pain, and a proper diagnosis is critical to effectively treating the condition and permanently eliminating the pain. In most cases, back pain can be resolved in as few as three visits based on patient-reported outcomes, with little to no down time. We also help many patients avoid unnecessary back surgeries. If you or a loved one is suffering from back pain, schedule an appointment with Airrosti today.