We may often dismiss that sudden back pain to tiredness, or those extra miles on the treadmill. Not until the shooting pain becomes more frequent- in fact, it is a sharp, stinging pain accompanied by unexplained weakness. That’s when you realise it could be something more serious, like a slipped disc.
In medical terms, a slipped disc is called a disc herniation. But, what exactly is a disc herniation and why does it occur even in healthy people?
In this blog, we demystify disc herniation, its causes, symptoms and what treatments are available to reduce the painful effects of this condition.
What is Disc Herniation
A herniated disc is a condition affecting the spine which originates in the back of the neck. The spine is made up of 24 vertebrae which are connected by numerous joints. In between the bones, there are discs present. Each disc has a nucleus pulposus or a jelly-like centre. Due to age-related degeneration, heavy physical work like lifting or pulling or sudden trauma, the discs get affected and become weak.
Due to this, tears may be formed in the discs. It is through these tears that the jelly-like centre starts to leak out. Often, there may be a reduced water content in this area also due to degeneration.
This bulging out or leaking of the nucleus pulposus, is referred to as a disc herniation. This leads to pressure on the spinal area and the nerves, causing excruciating pain or even leading to spinal cord dysfunction.
Types of Disc Herniation
Herniation of disc is broadly categorised into three types. Here is a discussion on them.
Protrusion
This occurs when due to the pressure of the vertebrae, the weak discs start to bulge outwards, like a sack being pushed out. Subsequently, there is pressure on the surrounding nerves and this causes back pain. The herniated disc here does not spill over into the spine but stays ‘contained’ like a sack.
Disc Extrusion
In this herniation, there is intense pressure on the nerves. As the term extrusion implies, the nucleus pulposus is pushed out through the outer layer, also called the annulus fibrosus. This results in inflammation in the body.
Furthermore, disc extrusion also causes intense back pain and swelling. In certain cases, it may even cause tingling and numbness. If you witness any of these symptoms, you should consult a doctor immediately and not mistake it for a common back ache. This kind of uncontained disc herniation has a larger possibility of getting healed compared to protrusion herniation.
Sequestered Herniation
This is also referred to as a free fragment. A step further than the disc extrusion stage. Here the nucleus pulposus is not only pushed outwards, but it breaks away entirely from the annulus fibrosus. Resultantly, it becomes a free fragment that floats around the spinal nerves, albeit causing tremendous pain and inflammation.
For instance, if there is herniation in the neck region, it can cause intense pain in the arm.
Disc Herniation Causes
A herniated disc can occur due to degeneration of the discs present in the spinal area. The degeneration can be due to numerous reasons. Let us understand these causes:
Overuse of the back area
People who have the occupation of lifting heavy objects, frequently, are at a high risk of getting a slipped disc. This is due to the pressure caused on the nerves in the lower back area.
Sudden turning or twisting to lift heavy objects
This is especially true in the case of people who are usually more sedentary and not accustomed to physical activity.
Vigorous physical movement
In a few cases, starting a rigorous exercise regime without a proper warm-up or learning period can cause injuries like herniation of the disc.
Ageing process
Degeneration of the disc with age, along with a reduction in the water content that envelopes it, can also cause herniation of the disc.
Excess weight
If you are overweight, there is added pressure on the back muscles and the spine. This can result in a higher chance of a slipped disc.
Poor muscle strength or low fitness level
Being thin, but not necessarily fit can lead to poor stamina or strength. Instead, individuals who follow a regular fitness regime along with a balanced diet, are more likely to have good muscle and bone health. Hence, their body can sustain heavier physical activity and the risk of a ruptured disc is lesser.
Trauma
An injury sustained at any time, such as a fall or a back injury, can have repercussions later, in the form of a ruptured disc.
Disc Herniation Symptoms
Although extreme pain in the back area is the main disc herniation symptom, there are many others as well. Let us find out what signs to watch out for.
- A sudden mild to severe pain in the back.
- Pain in the neck, shoulder and arm
- Pain could even be in the lower back, hips or arm
- Sharp or a stinging sensation accompanying the pain
- Numbness or muscle weakness around the pain area
- Unusual tiredness
The pain could even spread towards the hip and the thigh area. It would increase with more activity.
4 Stages of Disc Herniation
Disc herniation occurs progressively. As the disc nucleus pulposus gets pushed out, beyond the annulus fibrosus, the condition tends to worsen for the person. Let us understand how this progression occurs and the 4 stages of disc herniation.
Stage 1: Disk Protrusion
This is the initial stage when the central jelly-like substance starts bulging out of the disc. Such protrusion can happen due to sudden jerky movements, trauma, suddenly picking heavy objects etc.
Stage 2: Prolapsed Disc
In the second stage, the disc starts to prolapse and lose its shape, which can be due to reduced water content. Further, it starts to push against the nerves in the spinal cord area. This results in acute pain and inflammation.
Stage 3: Disc Extrusion
By this stage, the nucleus pulposus or the jelly-like middle of the disc starts to disintegrate and move out. It is a free fragment that can move into other parts.
Stage 4: Sequestered Disc
This is a more difficult stage of herniation. Here, the gelatinous substance moves into a completely different area, such as the spine canal. This causes immense pain and even swelling in the area.
Disc Herniation Treatment
As the first step, the doctor would opt for a physical examination and also prescribe an X-ray, an MRI or even a CT scan, to study the extent of the injury. After diagnosis, here are the treatments that may be suggested.
OTC Pain Relief Medication
The spine specialist would initially prescribe medicines to bring immediate relief from the intense pain. Besides muscle pain relief, nerve pain medication may also be suggested. At times, injections for pain relief may also be administered. However, this would not be a long-term solution.
Physiotherapy
A physiotherapist can review the symptoms and condition of the patient and suggest specific exercises to improve the spinal condition. You can even take a free demo with a physiotherapist at Flexifyme.
Surgery
In case the condition of the patient does not improve in 6 weeks time, the doctor may reassess and suggest surgery. In this case, the protruding part of the disc may be removed and this is called a microdiscectomy.
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Herniation Based on Location
Disc herniation occurs in different locations in the spinal area. Here are a few key points on locational disc herniation. We consider two of the common locations.- cervical and lumbar disc herniation.
Cervical Disc Herniation
In a cervical disc herniation, the location is in the neck area and the pain would radiate down to the arm and shoulder areas. The person may also feel piercing pins and needles kind of pain, spasms, stiffness or numbness in this region. In extreme cases, there could also be a loss of bladder control.
Lumbar Disc Herniation
The weak area in the lumbar region is directly below the spinal nerve root. So, a herniation in this area will impinge the nerves and cause pain in the lower back, down the leg and the hip.
The pain may worsen with standing or while sneezing or coughing. Furthermore, the person may suffer from numbness in the legs and may feel the reflexes being slow in the knees. Bowel or bladder function changes can also occur here.
Sciatica is also a result of lumbar disc herniation. In this case, the pain originates at the back or hip and goes down the leg.
Conclusion
Disc herniation can be painful and draining physically and mentally. However, unlike many other health issues, it can be treated and managed if one consults a doctor at the right time. It is imperative to take note of acute pain in the back, neck area or leg. Tingling pains and inflammation can be other signs of disc herniation and they should not be ignored. You can even book a demo with a physiotherapist at Flexifyme, to learn the right exercises for treating a disc herniation.
