Herniated Disk (Slipped, Ruptured or Bulging Disk)
What is a herniated disk?
A herniated disk is an injury of the spine (backbone). 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. When one of these disks tears or leaks, it’s called a herniated disk.
Are herniated disks common?
Every year, up to 2% of people get a herniated disk. Herniated disks are a leading cause of neck and/or arm, and back and/or leg pain (sciatica). They can happen anywhere along the spine, but herniated disks most often occur in the lower back or the neck. It’s rare for a herniated disk to be in the mid-back.
Who gets herniated disks?
People ages 30 to 50 are most likely to get a herniated disk. The problem affects men twice as often as women. Other risk factors include:
- Sitting for long periods in the same position.
- Being overweight.
- Lifting heavy objects.
- Repetitive bending or twisting motions for work, sports or hobbies.
Symptoms and Causes
What causes a herniated disk?
Disks have soft, gel-like centers and a firmer outer layer, 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. The leaked material may press on nearby spinal nerves.
Several factors can contribute to a disk rupture, including:
- Excessive weight.
- Repetitive motions.
- Sudden strain from improper lifting or twisting.
What are the symptoms of a herniated disk?
Herniated disk symptoms vary depending on where the problem is in your spine. Symptoms worsen with movement and get better with rest.
Herniated or slipped disk in the back (herniated lumbar disk)
It’s common for a herniated disk in the lower back to cause “sciatic nerve” pain. This sharp pain usually shoots down one side of your buttocks into your leg and sometimes the foot. Other symptoms of a herniated disk in your lower back include:
- Back pain.
- Tingling or numbness in the legs and/or feet.
- Muscle weakness.
Herniated or disk in the neck (herniated cervical disk)
Symptoms of a herniated disk in your neck 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.
Diagnosis and Tests
How is a herniated disk diagnosed?
Your healthcare provider will do a thorough exam. During the physical, your provider will assess your pain, muscle reflexes, sensation and muscle strength. Your provider may also order tests such as:
- Magnetic resonance imaging (MRI): The most common and accurate imaging test for a suspected herniated disk is an MRI.
- X-rays: Getting X-rays helps rule out other causes of back or neck pain.
- Computed tomography (CT): A CT scan show the bones of your spine. Herniated disks can move into the space around your spinal cord and nerves and press on them.
- Myelogram: A myelogram involves an injection of dye into your spine using X-ray guidance for a CT scan. The dye can reveal a narrowing of the spinal canal (spinal stenosis) and location of your herniated disk.
- Electromyogram (EMG): This test involves placing small needles into various muscles and evaluate the function of your nerves. An EMG helps determine which nerve a herniated disk affects.
Management and Treatment
What can I do at home to relieve herniated disk pain?
In most cases, pain from a herniated 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 important to avoid long periods of bed rest to prevent stiffness.
- Take an over-the-counter pain reliever, such as ibuprofen or acetaminophen.
- Apply heat or ice to the affected area.
When should I see a doctor?
Initially, you can treat herniated disk pain at home. But you should see your doctor 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 is the best slipped disk treatment?
You may need more advanced treatments 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 an exercise program to help relieve pressure on your nerves. Exercise 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. The medication reduces swelling and inflammation of the nerve from the disk herniation. This will allow your body to heal and return to activity faster.
- Surgery: In rare cases, a large herniated disk might injure nerves to the bladder or bowel. That may require emergency surgery. For nonemergency cases, surgery is an option when other treatments fail. There are various ways to perform spinal decompression surgery, but the goal is to relieve pressure on the nerve.
Will I need to have spinal 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 the spinal cord and nerves, including:
- Diskectomy to remove your herniated disk.
- Laminectomy to remove part of the bone around a herniated disk and expand your spinal canal.
- Artificial disk surgery to replace a damaged herniated disk with an artificial one.
- Spinal fusion to directly join two or more vertebrae together to make your spine more stable.
How can I avoid getting a herniated disk?
It's not always possible to prevent a herniated 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. Excess weight puts pressure on the 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.
- Exercising regularly. Focus on workouts that strengthen your back and abdomen muscles to support your spine.
- Stopping smoking. Smoking can weaken disks, making them vulnerable to rupture. Consider quitting smoking.
Outlook / Prognosis
What is the outlook for people with herniated disks?
For up to 90% 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 your healthcare provider. Some people need more aggressive medical measures, such as spinal injections or surgery.
Will a herniated 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 your healthcare provider if you still have symptoms after four to six weeks of conservative care.
What should I ask my doctor?
Questions to ask your doctor include:
- Do I need to rest? For how long?
- How much walking or other activities should I be doing?
- Are there any exercises that can help?
- What pain medication should I take?
- Will ice or heat help?
- If considering spine injections, what injection is likely to help relieve my pain? What are the risks?
- If considering surgery, what are my surgical options? What are the risks?
A note from Cleveland Clinic
Having a herniated disk can make you reluctant to move. But don’t head to bed — too little movement can make pain worse when you get up again because muscles stiffen. Try to stay active and follow your healthcare provider’s recommendations for stretching. Gentle movement coupled with an over-the-counter pain reliever helps most people feel better in a few weeks.
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