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A herniated disk, also called a ruptured disk or slipped disk, occurs when a disk in the spine bulges out too far. Between the bones in the spine (vertebrae), there are oval disks that are made of a soft, spongy centre filled with liquid that is surrounded by a tough outer ring. The disks connect the vertebrae, help the spine move, and keep the bones from rubbing against each other when you move.

When you have a herniated disk, the spongy centre of the disk bulges out or breaks through the outer ring. The spongy centre can press on a nerve between the vertebrae and cause pain. This can occur anywhere in the back or neck area, but the lower back is most commonly affected.

What are the causes?

This condition may be caused by:

• Age-related wear and tear. The spongy centres of spinal disks tend to shrink and dry out with age, which makes them more likely to herniate.
• Sudden injury, such as a strain or sprain.
  
  

What increases the risk?

The following factors may make you more likely to develop this condition:

• This is the main risk factor for a herniated disk.
• Being a man who is 30–50 years old.
• Frequently doing activities that involve heavy lifting, bending, or twisting.
• Not getting enough exercise.
• Being overweight.
• Using tobacco products.

What are the signs or symptoms?

Symptoms may vary depending on where your herniated disk is located.

• A herniated disk in the lower back may cause sharp pain in:
  • Part of the arm, leg, hip, or buttocks.
  • The back of the lower leg (calf).
  • The lower back, spreading down through the leg into the foot (sciatica).
• A herniated disk in the neck may cause dizziness and vertigo. It may also cause pain or weakness in:
  • The neck.
  • The shoulder blades.
  • The upper arm, forearm, or fingers.

You may also have muscle weakness. It may be difficult to:

• Lift your leg or arm.
• Stand on your toes.
• Squeeze tightly with one of your hands.

Other symptoms may include:

• Numbness or tingling in the affected areas of the hands, arms, feet, or legs.
• Inability to control when you urinate or when you have bowel movements. This is a rare but serious sign of a severe herniated disk in the lower back.
  

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam. The exam may include:
  • A straight-leg test. For this test, you will lie on your back while your health care provider lifts your leg, keeping your knee straight. If you feel pain, you likely have a herniated disk.
  • Neurologic tests. These include checking for numbness, reflexes, muscle strength, and problems with posture.
• Imaging tests, such as:
  • X-rays.
  • MRI
  • CT scan.
  • Electromyogram (EMG) to check the nerves that control muscles. This test may be used to determine which nerves are affected by your herniated disk.

How is this treated?

Treatment for this condition may include:

• A short period of rest. This is usually the first treatment.
  • You may be on bed rest for up to two days, or you may be instructed to stay home and avoid physical activity.
  • If you have a herniated disk in your lower back, avoid sitting as much as possible. Sitting increases pressure on the disk.
• These may include:
  • NSAIDs, such as ibuprofen, to help reduce pain and swelling.
  • Muscle relaxants to prevent sudden tightening of the back muscles (back spasms).
  • Prescription pain medicines, if you have severe pain.
• Ice or heat therapy.
• Steroid injections in the area of the herniated disk. These can help reduce pain and swelling.
• Physical therapy to strengthen your back muscles.

In many cases, symptoms go away with treatment over a period of days or weeks. You will most likely be free of symptoms after 3–4 months. If other treatments do not help to relieve your symptoms, you may need surgery.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your healthcare provider.
• Ask your healthcare provider if the medicine prescribed to you:
  • Requires you to avoid driving or using heavy machinery.
  • Can cause constipation. You may need to take these actions to prevent or treat constipation:
    • Drink enough fluid to keep your urine pale yellow.
    • Take over-the-counter or prescription medicines.
    • Eat foods that are high in fibre, such as beans, whole grains, and fresh fruits and vegetables.
    • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.

Managing pain, stiffness, and swelling 

• If directed, put ice on the painful area. Icing can help to relieve pain. To do this:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• If directed, apply heat to the painful area as often as told by your healthcare provider. Heat can reduce the stiffness of your muscles. Use the heat source that your healthcare provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.

Activity

• Rest as told by your healthcare provider.
• After your rest period:
  • Return to your normal activities and gradually begin exercising as told by your healthcare provider. Ask your healthcare provider what activities and exercises are safe for you.
  • Use good posture.
  • Avoid movements that cause pain.
  • Do not lift anything that is heavier than 4.5 kg, or the limit that you are told, until your healthcare provider says that it is safe.
  • Do not sit or stand for long periods of time without changing positions.
  • Do not sit for long periods of time without getting up and moving around.
• If physical therapy was prescribed, do exercises as told by your healthcare provider.
• Aim to strengthen muscles in your back and abdomen with exercises such as swimming or walking.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. These products can delay healing. If you need help quitting, ask your healthcare provider.
• Do not wear high-heeled shoes.
• Do not sleep on your abdomen.
• If you are overweight, work with your healthcare provider to lose weight safely.
• Keep all follow-up visits as told by your healthcare provider. This is important.

How is this prevented?

• Maintain a healthy weight.
• Maintain physical fitness. Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
•  When lifting objects:
  • Keep your feet at least shoulder-width apart and tighten the muscles of your abdomen.
  • Keep your spine neutral as you bend your knees and hips. It is important to lift using the strength of your legs, not your back. Do not lock your knees straight out.
  • Always ask for help to lift heavy or awkward objects.
    
    

Contact a healthcare provider if you:

• have back pain or neck pain that does not get better after 6 weeks.
• have severe pain in your back, neck, legs, or arms.
• develop numbness, tingling, or weakness anywhere in your body.

Get help right away if:

• you cannot move your arms or legs.
• you cannot control when you urinate or have bowel movements.
• you feel dizzy or you faint.
• you have shortness of breath.

• A herniated disk, also called a ruptured disk or slipped disk, occurs when a disk in the spine bulges out too far (herniates).
• This condition may be caused by age-related wear and tear or a sudden injury.
• Symptoms may vary depending on where your herniated disk is located.
• Treatment may include rest, medicines, ice or heat therapy, steroid injections, and physical therapy.
• If other treatments do not help to relieve your symptoms, you may need surgery.

This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.

References:

Jackson K.L., Devine J.G.: The effects of obesity on spine surgery: a systematic review of the literature. Global Spine J 2016; 6: pp. 394-400.

Jain S.K., Sundar I.V., Sharma V., Goel R.S., Gupta R.: Intradural disc herniation—a case report. Turk Neurosurg 2013; 23: pp. 389-391.

Luo D., Ji C., Xu H., Feng H., Zhang H., Li K.: Intradural disc herniation at L4/5 level causing cauda equina syndrome: a case report. Medicine (Baltimore) 2020; 99: pp. e19025.

Rodrigo V., Claramonte M., Martín M., Calatayud J.B.: Intradural disc herniation: how I do it. Acta Neurochir (Wien) 2018; 160: pp. 945-947.

Sarma P., Thirupathi R.T., Srinivas D., Somanna S.: Adolescent prolapsed lumbar intervertebral disc: management strategies and outcome. J Pediatr Neurosci 2016; 11: pp. 20-24.

Sharma A., Singh V., Sangondimath G., Kamble P.: Intradural disc a diagnostic dilemma: case series and review of literature. Asian J Neurosurg 2018; 13: pp. 1033-1036.

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