Lower Back Pain
Lower back pain is one of the most common musculoskeletal complaints among adults. One possible cause of persistent back or leg pain is a herniated lumbar disc, sometimes referred to as a bulging or protruding disc. While this diagnosis can sound alarming, many cases improve with conservative treatment and do not require surgery.
What is a Herniated Lumber Disc?
The spine is made up of a series of bones called vertebrae that are separated by intervertebral discs. These discs act as shock absorbers, helping cushion the spine and allowing it to move and bend.
A lumbar disc herniation occurs when the gel part of the disc protrudes outward, generally posteriorly (backwards) into the spinal canal where the nerves are located. A great way to picture this is like the jelly coming out of a jelly donut.
The lumbar spine (lower back) is the most common location for disc herniations because it bears much of the body’s weight and is heavily involved in bending and lifting movements.
What Causes a Herniated Disc?
There are several factors that may contribute to a lumbar disc herniation. Common causes and risk factors include:
- Repetitive heavy lifting
- Lifting with improper form (lifting with the back and not the legs)
- Sedentary lifestyle or poor posture
- Muscle imbalances of the low back
In many cases, it develops gradually rather than from a single injury.
Symptoms of a Herniated Lumbar Disc
Symptoms of a herniated disc can vary depending on whether nearby nerves are affected. Common symptoms include:
- Low back pain that can radiate into the buttocks or even down the legs to the toes (commonly referred to as sciatica)
- Lower extremity pain without any back pain
- Numbness or tingling in the lower extremities
- Weakness in the lower extremities
- Worsening pain with bending forward
- Muscle spasms of the low back
- Low back or gluteal muscle tightness or aching
- Possible bowel or bladder dysfunction
How a Herniated Disc is Diagnosed
Diagnosis typically begins with a detailed medical evaluation. X-rays will be ordered, but an MRI of the lumbar spine is needed in order to see the discs and fully evaluate them.
Treatment Options
Herniated discs do have the potential to heal, shrink, and eventually decrease their pressure on the nerve roots. This can take months to happen. During this time lifting heavy objects and performing twisting movements while holding objects should be avoided.
Treatment options to improve more quickly include physical therapy to strengthen the low back muscles and lower core, a back brace for support and to prevent extreme ranges of motion, various medications for pain and symptoms, and possibly epidural cortisone injections.
If there are concerning neurological symptoms (weakness, numbness, tingling, worsening pain, or loss of bladder or bowel function) then surgery may be warranted.