Herniated Disk (Slipped or Bulging Disk)

What is a herniated disk?

A herniated disk is a condition that occurs when one of the disks in your spine (backbone) tears or leaks due to natural wear and tear or injury. This puts pressure on your spinal cord and irritates your spinal nerves, leading to pain, numbness and weakness.

You have a series of bones (vertebrae) in your spine, stretching from the base of your skull to your tailbone. Between your vertebrae are round cushions called disks. The disks act as buffers between your bones, allowing you to bend and move with ease. Over time, the disks become less effective and may become displaced. When this occurs, it’s called a herniated disk.

Other names for a herniated disk include:

• Bulging disk.
• Slipped disk.
• Ruptured disk.
• Protruding disk.

Every year, more than 3 million people in the U.S. get a herniated disk. Bulging disks are a leading cause of neck, back and leg pain. They can happen anywhere along your spine, but they most often occur in your lower back (lumber spine) or your neck (cervical spine). It’s rare for a herniated disk to be in your upper-to-mid back (thoracic spine).

If you’ve experienced a slipped disk, you know the pain can be severe. The good news is that most cases resolve on their own without the need for surgical treatment. If you’ve had symptoms for more than a few weeks, reach out to a healthcare provider. They can explain your treatment options and get you back to enjoying the activities that you love.

What does a bulging disk feel like?

Herniated disk symptoms vary depending on where the problem is in your spine. Although pain is a common symptom throughout your back, the location of the slipped disk may lead to additional, different symptoms.

Symptoms of a herniated disk in your lower back (herniated lumbar disk)

It’s common for a herniated disk in your lower back to cause “sciatic nerve” pain (sciatica). This sharp pain usually shoots down one side of your buttocks into your leg and sometimes your foot. Other symptoms of a slipped disk in your lower back may include:

• Back pain.
• Tingling or numbness in your legs and/or feet.
• Muscle weakness.

Symptoms of a herniated disk in your neck (herniated cervical disk)

Symptoms of a bulging disk in your neck may include:

• Pain near or between your shoulder blades.
• Pain that travels to your shoulder, arm and sometimes your hand and fingers.
• Neck pain, especially in the back and on the sides of your neck.
• Pain that increases when bending or turning your neck.
• Numbness or tingling in your arms.

What causes a bulging disk?

Each disk in your spine has a soft, gel-like center and a firmer outer layer, kind of like a jelly doughnut. With time, the outer layer weakens and can crack. A herniated disk happens when the inner “jelly” substance pushes through the crack and presses on your spinal cord. The leaked material may press on nearby spinal nerves, causing the symptoms of a herniated disk.

Several factors can contribute to a disk rupture. Herniated disk causes include:

• Aging.
• Traumatic injuries, like falls.
• Performing repetitive bending or twisting motions.
• Improper lifting of heavy objects.

What are the risk factors for a slipped disk?

People ages 30 to 50 are most likely to get a herniated disk. The problem affects people assigned male at birth (AMAB) twice as often as people assigned female at birth (AFAB). In addition, the condition tends to run in families. Other risk factors include:

• Smoking.
• Sitting for long periods in the same position.
• Having overweight or obesity.
• Having diabetes.
• Having a connective tissue disorder.

How is a herniated disk diagnosed?

Your healthcare provider will do a thorough physical exam. During the exam, your provider will assess your pain, muscle reflexes, sensation and muscle strength. They may also perform a neurological exam and a straight leg raise test. With this test, your provider will have you lie on your back. Then, they’ll raise your leg straight in the air. If you experience any pain down your leg, you likely have a ruptured disk.

Your provider may also order imaging tests, including:

• Magnetic resonance imaging (MRI) scan.
• X-rays.
• Computed tomography (CT) scan.
• Myelogram.
• Electromyogram (EMG).
• Nerve conduction study.

What can I do at home to relieve herniated disk pain?

In most cases, pain from a slipped disk can go away in time. To ease pain while your disk heals, you can:

• Rest for one to three days if the pain is severe, but it’s important to avoid long periods of bed rest to prevent stiffness.
• Take an over-the-counter pain reliever, like ibuprofen or acetaminophen.
• Apply heat or ice to the affected area.

What is the treatment for a herniated disk?

You may need more advanced herniated disk treatment if your symptoms aren't getting better. Your healthcare provider might recommend:

• Medication: Your provider may prescribe an anti-inflammatory pain reliever or muscle relaxant.
• Physical therapy: A physical therapist teaches you a fitness program to help relieve pressure on your nerves. Physical activity loosens tight muscles and improves circulation.
• Spinal injections: Called an epidural or nerve block, a spinal injection is a shot of steroid medication directly into your spine.

When might I need herniated disk surgery?

Herniated disks get better on their own over time or with nonsurgical treatment for 9 out of 10 people. If other treatments don’t relieve your symptoms, your healthcare provider may recommend surgery. There are multiple surgical techniques for relieving pressure on your spinal cord and nerves.

In rare cases, a large ruptured disk might injure nerves to your bladder or bowel. That may require emergency surgery. For non-emergency cases, herniated disk surgery is an option when other treatments don’t work. There are various ways to perform spinal decompression surgery, but the goal is to relieve pressure on the nerves.

The most commonly used procedure is called a microdiskectomy. With this minimally invasive spine surgery, your provider will make a small cut (incision) through the skin near the slipped disk. They’ll insert a microscope and small tools in the incision to remove the herniated part of the disk.

Other surgical treatment options include:

• Diskectomy.
• Laminotomy.
• Laminectomy.
• Artificial disk surgery.
• Spinal fusion.

How can I avoid getting a herniated disk?

It’s not always possible to prevent a bulging disk. But you can reduce your risk by:

• Using proper lifting techniques. Don’t bend at the waist. Bend your knees while keeping your back straight. Use your strong leg muscles to help support the load.
• Maintaining a healthy weight for you. Excess weight puts pressure on your lower back.
• Practicing good posture. Learn how to improve your posture when you walk, sit, stand and sleep. Good posture reduces strain on your spine.
• Stretching. It’s especially important to take stretching breaks if you often sit for long periods.
• Avoiding wearing high-heeled shoes. This type of shoe throws your spine out of alignment.
• Getting regular physical activity. Focus on workouts that strengthen your back and abdomen muscles to help support your spine.
• Stopping smoking. Smoking can weaken disks, making them vulnerable to rupture. Consider quitting smoking.

How long does it take to recover from a herniated disk?

For the majority of people, herniated disk pain gets better on its own or with simple medical care. You’ll probably feel better within a month. If you don’t, you should see a healthcare provider. Some people need more aggressive medical measures, like spinal injections or herniated disk surgery.

Will a slipped disk get worse?

An untreated herniated disk can get worse. That’s especially true if you continue the activities that caused it — for instance, if it developed because of your work. A worsening ruptured disk may cause chronic (ongoing) pain and loss of control or sensation in the affected area. See a healthcare provider if you still have symptoms after four to six weeks of conservative care.

When should I see my healthcare provider?

Initially, you can treat ruptured disk pain at home. But you should see a healthcare provider if:

• Pain interferes with daily life, like going to work.
• Symptoms aren’t better after four to six weeks.
• Symptoms get worse.
• You develop loss of bladder or bowel control.
• You notice tingling, numbness or loss of strength in your arms, hands, legs or feet.
• You have trouble standing or walking.

What questions should I ask my healthcare provider?

Questions to ask your provider include:

• How long should I stay off my feet?
• How much walking or other activities should I be doing?
• What pain medication should I take?
• Will ice or heat help?
• If considering surgery, what are my surgical options?