Disk herniation is a relatively common condition. It affects up to three percent of U.S. adults at some point. 

Although some cases of a herniated disk won’t present with any symptoms, some cases can lead to severe back pain. Knowing the symptoms can help patients understand when to seek immediate medical treatment. 

This guide from HealthTap breaks down everything patients should know about disk herniation, including the symptoms, causes, and prevention of this painful condition. 

What is a spinal disk?

A spinal disk is a round, flat structure between the vertebrae. The vertebrae are the bones that make up the spine.

Disks include a soft, spongy material that cushions the vertebrae and prevents painful friction between the vertebrae. Disks also help to absorb shock in the spine, so all kinds of movement involving the spine are pain-free.

There are 23 disks in the spine. Six are in the neck (also known as the cervical region), 12 are in the middle back (also known as the thoracic region), and five are in the lower back (also known as the lumbar region or lumbar spine). 

What is a herniated disk?

A herniated disk (also called slipped, bulged, or ruptured disk) occurs when the substance that makes up the disk bulges. The disks in the spinal canal have limited space to accommodate the extra material. This means that a herniated disk may press on spinal nerves, leading to pain. 

Patients who experience pain from a herniated disk describe the pain as burning or stinging. The pain may also radiate into the lower body and affect parts such as the hips, glutes, and hamstrings. 

In some cases, a herniated disk can compress the spinal cord, leading to a condition known as myelopathy. Myelopathy is a serious condition that can lead to permanent nerve damage. 

Many cases of disk herniation heal within just a few weeks. In some cases, patients may not even experience symptoms and may not even know they have a herniated disk.

In patients who experience symptoms, a herniated disk may resolve independently. However, more difficult cases may persist and require treatment with medication, corticosteroid injections, or surgery. 

For a chronic herniated disk, it’s important to be continually monitored by a doctor. Doing otherwise may lead to permanent changes, such as nerve damage, and require more invasive treatment procedures. 

What causes a herniated disk?

An intervertebral disk is composed of the annulus fibrosus and the nucleus pulposus. The annulus fibrosus is the outer “ring” of tough, elastic tissue. Its job is to hold the nucleus pulposus in place, which is the soft, gelatinous substance that gives the spine its cushioning. 

Normal wear-and-tear and degeneration that comes with aging can cause the annulus fibrosus to weaken, which makes it less able to hold the nucleus pulposus in place. As a result, the substance that makes up the nucleus pulposus can begin to seep out, leading to disk herniation.

Other factors like frequent driving and sitting for long periods can also cause decreased muscle strength and disk issues.

Injury can also lead to a herniated disk. For example, car accidents can cause the spine to jerk, putting extreme pressure on a spinal disk. This jerking motion can lead to herniation. Lifting heavy objects and other normal activities like sneezing can also lead to a “slipped disk,” as it’s colloquially called.

More commonly, however, the combination of normal wear-and-tear and a traumatic event result in a herniated disk. 

Weakened spinal disks are less able to withstand injury, which makes them more prone to herniation. In those with weakened spinal disks, something seemingly mild as a sneeze may lead to disk herniation.

How common is a herniated disk? 

Disk herniation is fairly common. It may affect up to 20 adults per 1,000 every year. 

It is more common in people in their 30s and beyond. Males are twice as likely to develop disk herniation than females. 

The most common type of disk herniation is a ruptured disk in the lower back (or the lumbar region). Disk herniation is less common in the middle back, followed by the neck. 

Those who smoke or have a history of type 2 diabetes have a higher chance of developing a herniated disk than the rest of the population. 

What are the symptoms of a herniated disk?

The symptoms of a herniated disk depend on where in the spine the problem occurs. 

If disk herniation happens in the lower back, the symptoms will most closely mimic sciatica. Sciatica happens when the sciatic nerve that stretches along the lower back, glutes, and hamstrings gets pinched. 

If disk herniation happens in the cervical region (around the neck), a patient will feel the pain between the shoulder blades. It may travel to the shoulder, arm, and even the hands. The pain may get worse when bending or turning the neck. 

For all cases of disk herniation, the pain usually gets worse with movement and better with rest. 

How is a herniated disk diagnosed?

A doctor will typically do an imaging test to look at the spine after discussing symptoms with the patient, reviewing their patient’s medical history, and performing a physical exam. 

Here are some of the imaging tests that can help with getting a diagnosis: 

• X-rays
  X-ray is an imaging technique mostly used to look at bones, such as the spinal column. It sends radiation through the body to provide a rough view of the spine. It’s a very common imaging test, which makes it widely available at many clinics.  

• CT Scan
  A computerized tomography (CT) scan works similarly to X-rays — by sending radiation through the body. However, it can provide a much more detailed view, which makes it an excellent test for small defects in the spine. 

• MRI
  Magnetic resonance imaging (MRI) can provide the most detailed view of the spine. However, its downside is that it requires an MRI machine, which is often not readily available at all primary care offices. Many patients will need to get their MRI done at a separate clinic or in a hospital.

How is a herniated disk treated?

In up to 80 percent of patients, a herniated disk can resolve independently without any specific treatments. However, if the symptoms persist (or worsen) after three months, treatment may be necessary.

People with herniated disks can try the following surgical and nonsurgical treatments: 

1. Pain medication 

Nonsteroidal anti-inflammatory drugs (NSAIDs) — like Advil (ibuprofen) — are first-line treatments for herniated disks. They can help temporarily relieve severe pain, are available over-the-counter (OTC), and have minimal side effects. Taking NSAIDs increases the risk of bleeding ulcers in some people, which is one of the reasons it’s best to speak with a doctor before taking any OTC medications.

Steroid injections and injections that block pain signals from the spine can work for those who don’t respond to pain relieving medication — especially if the symptoms last at least one month.

There is little evidence to suggest that muscle relaxers can help with pain from a herniated disk. 

2. Physical therapy 

Physical therapy can involve massage, heat and cold application, and stretching and strengthening exercises. A doctor may also suggest a few days of bed rest.

Physical therapy is not recommended as initial treatment because many herniated disk cases resolve independently. So, symptoms should last about three or four weeks before physical therapy. 

3. Surgery 

Spine surgery is always the last resort for a patient whose symptoms don’t resolve after many months of treatment. 

Most types of surgery for a herniated disk have the same goal: to remove small fragments of disk, bone, and ligament to take pressure off the nearby nerves. 

In some cases, a surgeon may place an artificial disk into the spine. Patients who may require surgery need to consult a specialist in-person. 

What happens if you don’t treat a herniated disk?

An untreated herniated disk can lead someone to develop chronic back pain or significant disability. Although rare, some cases of disk herniation can lead to severe nerve root compression and permanent nerve damage. 

As with most medical procedures, surgery for disk herniation has risks and may lead to severe side effects, such as paralysis. However, such severe side effects are not common. For this reason, if a patient experiences symptoms of disk herniation, they should seriously consider all their treatment options. It’s best to consult a specialist, who can provide an individual recommendation of a patient’s risk and benefits for surgery based on their unique situation.

Seven tips for preventing a herniated disk 

A herniated disk can happen due to the normal wear and tear of aging. However, there are many things that someone can do to decrease their chances of developing this condition.

Here are seven tips to help prevent a herniated disk: 

1. Good posture is key

Poor posture can put increasing pressure on the spine, weakening some parts — including the spinal disks. Maintaining good posture is key to preventing future spinal problems. In addition to consciously holding oneself upright, having a strong core can make it easier to maintain good posture. 

2. Strong muscles are less likely to get injured

Strong muscles in the back and surrounding regions can make someone much less likely to develop spinal conditions. Stretching and strength training are incredibly important for overall back health. 

3. Extra weight may put stress on the back 

Being overweight is associated with back pain. Maintaining a healthy weight isn’t only important for overall health but for back health, as well. 

4. Smoking is a major risk factor for disk herniation 

Amongst all the possible risk factors for disk herniation, smoking may be one of the most important. Those who smoke should seek cessation support to reduce their chances of developing a herniated disk. 

5. Stress management can reduce disk herniation risk 

Stress makes everything worse, including the body’s ability to repair itself. In addition, stress can lead to tight muscles and increasing pressure on the spine. Practicing stress reduction techniques (like meditation) or discussing stress management with a primary care provider can help patients bring stress levels to a healthy range.

6. There’s a right and wrong way to lift things 

More often than not, people try to lift heavy items by bending at the waist. However, this is very damaging to the back. Patients should keep the back straight and use their legs and glutes to lift heavy things. Squatting low and bending the knees before lifting an object may help prevent back strain. Better still, avoid lifting heavy items as much as possible.

7. It’s important to change positions frequently

Sitting or standing in the same position for long periods of time can put pressure on the spine. For those with jobs that don’t include much movement (such as desk jobs), it’s important to get up and move around approximately every hour. 

Getting help from HealthTap 

Many cases of herniated disks resolve on their own — without the need for medical treatment. 

However, sometimes a herniated disk may persist for months, causing severe pain and increasing a patient’s risk of enduring permanent nerve damage. 

If you think you have a herniated disk, it’s important not to delay diagnosis and treatment. To make it more convenient, HealthTap can connect you with a healthcare provider over our virtual platform.

Schedule your first visit today.