A slipped or bulging disc, more formally known as a herniated disc, occurs when the soft inner portion of a spinal disc protrudes through a tear in its tougher outer casing. This condition can result in various symptoms, depending largely on the location of the herniation and the degree of nerve root involvement.
The most common symptom is pain, which can occur at the site of the herniation or radiate to other areas of the body. For instance, a herniated disc in the lower back can cause pain that radiates down the back of the leg, a condition known as sciatica.
Other symptoms may include numbness or tingling in areas served by the affected nerves, weakness in the muscles served by the affected nerves, and, in severe cases, loss of bladder or bowel control.
How herniated discs impact spinal nerve roots
Direct compression
When a disc herniates or bulges out from its intended position, it can come into direct contact with the spinal nerve roots. These nerve roots are extremely sensitive, and even mild compression can lead to significant pain. Depending on the location and severity of the herniation, this compression can also disrupt normal nerve function, leading to symptoms like muscle weakness, numbness, or tingling in the body area served by the affected nerve (3).
Chemical irritation
In addition to physical compression, herniated discs can also irritate spinal nerve roots chemically. When a disc herniates, the gel-like nucleus pulposus inside may leak out. This substance contains inflammatory proteins, which can induce inflammation when they come into contact with a nerve root.
This inflammation can further irritate the nerve, potentially causing intense pain and other neurological symptoms (1). Over time, if untreated, this chemical irritation can contribute to nerve damage and result in persistent symptoms.
Read More: The best treatment of PLID/ Disc herniation / Disc prolapse in Bangladesh
Symptom 1: Chronic Back or Neck Pain
Disc protrusion can press on nerves surrounding the disc, leading to pain that can be severe. This condition typically arises in the lower back (lumbar spine) or the neck (cervical spine). While many herniated discs cause no symptoms, others can lead to chronic and persistent pain. This pain is generally felt in the area of the body that corresponds to the affected nerve.
When a disc herniates in the lower back, for instance, it can cause lower back pain. If it’s pressing on a nerve, it can also cause pain radiating down the leg. A herniated disc in the neck can cause neck pain, and if a nerve is involved, the pain may also radiate down the arm.
Types of pain that may indicate a slipped or bulging disc
The pain associated with a herniated disc often varies depending on the location and nature of the disc damage.
Sharp, Stabbing Pain: This type of pain is usually sudden and intense. It might be experienced as a jolt or shock, typically occurring in the area where the disc has herniated. This may indicate nerve root irritation from direct compression or chemical irritation (8).
Persistent Ache: This is a continuous, dull pain that may indicate a bulging disc. It usually localizes to the region of the spine where the herniation occurred. This chronic discomfort can impact daily activities and quality of life.
Radiating Pain: A herniated disc can cause pain that radiates, or spreads, from the point of origin to other parts of the body. For instance, if a disc herniates in the lower back, the pain may radiate down the buttock and leg (5). This is often indicative of nerve irritation or compression.
Pain Exacerbated by Movements or Coughing: Certain movements, such as bending over, lifting, or twisting, can increase the pressure on a herniated disc and cause pain to worsen (8). Even activities like coughing or sneezing, which increase intra-abdominal pressure, can intensify the pain.
Referred Pain: Referred pain occurs when discomfort is perceived in a location different from where the actual damage is (6). This happens because the nerves in the spinal cord share sensory pathways, leading to a miscommunication of the location of the pain. An example of this is sciatica, where a herniated disc in the lower back causes pain to be felt along the path of the sciatic nerve, which runs from the lower back, through the buttocks, and down the legs.
Read More: The best treatment of PLID/ Disc herniation / Disc prolapse in Bangladesh
Symptom 2: Numbness or Tingling
A herniated disc, can cause symptoms like numbness and tingling due to the irritation or compression of the spinal nerves. The spinal nerves are extensions of the central nervous system that convey sensory and motor information to and from the body. When these nerves are compressed or irritated, it disrupts this normal flow of information, leading to abnormal sensations like numbness (loss of sensation) or tingling (a pins-and-needles sensation).
Areas where numbness or tingling might occur
The area where numbness or tingling might occur depends on the location of the herniated disc along the spine. A herniated disc in the neck (cervical spine) may lead to numbness or tingling in the arms or hands, while a herniated disc in the lower back (lumbar spine) might cause these sensations in the buttocks, legs, or feet (3). This is typically because the spinal nerve roots that serve these body regions pass by or emanate from these parts of the spine.
Symptom 3: Pain Made Worse by Certain Movements
Certain movements, especially those involving bending forward or twisting, can exacerbate the pain associated with a herniated disc. This is due to increased pressure on the affected nerve root during these movements (3).
- Bending forward or downward: This action compresses the front part of the disc, which can increase the pressure on the disc’s posterior aspect and exacerbate a herniation.
- Lifting heavy objects: When lifting, especially if done improperly, the spinal discs are subjected to significant additional pressure, which can worsen disc herniation symptoms.
- Pushing or pulling heavy objects: These actions require substantial physical effort and can increase the strain on the back, potentially exacerbating the pain from a herniated disc.
- Twisting or turning the body or neck: Sudden or forceful twisting movements can strain the spinal discs and possibly worsen the symptoms of a herniated disc.
- Prolonged sitting or standing: Staying in one position for extended periods can put constant pressure on the spine and potentially intensify herniated disc pain.
- Coughing or sneezing: These actions increase the intra-abdominal pressure, which is then transferred to the spine and can exacerbate herniated disc symptoms.
Rapid Onset of Lumbar Herniated Disc Pain
The pain from a lumbar herniated disc often has a rapid onset. This is primarily because the discs in the lumbar region, the lower part of the spine, bear a significant proportion of the body’s weight and are involved in many of our movements, such as bending and twisting. When a disc in this region herniates, the protruding disc material can quickly irritate or compress the nearby nerve roots, leading to sudden pain. This can be especially noticeable during activities that increase spinal pressure, such as lifting a heavy object, bending, or even coughing. However, the disc degeneration that leads to herniation is typically a gradual process (8).
Another reason for the rapid onset of pain is the inflammatory response triggered by the herniation. When a disc herniates, the inner material that leaks out contains inflammatory substances. These substances can cause local inflammation, which can quickly irritate the nearby nerve roots and cause pain.
Statistics on the Duration of Pain for Most People
Research shows that the majority of people with a herniated disc experience significant pain relief within six weeks, regardless of whether they receive medical treatment. Specifically, nearly 90% of people with a lumbar disc herniation report substantial improvement or complete resolution of their symptoms within this timeframe.
However, the duration of pain can vary widely among individuals, depending on factors like the size and location of the herniation, the individual’s overall health, and their physical activity levels. In a systematic review, approximately 73% of patients reported improvement in sciatica symptoms within 12 weeks of onset (4). In some cases, the pain may persist longer and require additional treatments, such as physical therapy, medications, or in rare cases, surgery. It’s important to note that while the pain may subside, the disc herniation often remains. Thus, maintaining good back health is crucial to prevent symptom recurrence.
When to Consult a doctor
It’s crucial to consult a doctor when you experience persistent pain in your back or neck, especially if it’s accompanied by other symptoms such as numbness, tingling, or weakness in the arms or legs. These can be indicative of a herniated disc. Immediate medical attention should be sought if the pain follows a traumatic event, like a fall or a blow to the back, or if the pain is severe and debilitating.
Furthermore, you should also seek immediate medical attention if you experience symptoms such as difficulty controlling bowel or bladder movements, numbness in the inner thigh and genital area, or problems starting urination. These could be signs of a serious condition called cauda equina syndrome, which is a medical emergency and can be caused by severe lower back disc herniations.
Read More: Self-diagnosis of lumbar intervertebral disc prolapse/PLID/Disc Herniation
Nonsurgical Treatments
Pain-relieving Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can often help relieve pain and reduce inflammation (2). For more severe pain, your doctor might prescribe stronger medications, such as muscle relaxants, narcotics, or even corticosteroids.
Guided Physical Therapy: A physical therapist can teach you exercises to help improve your flexibility, strength, and core stability (4). These exercises can reduce your pain, promote healing, and prevent further injury. Physical therapy may also include treatments like heat or cold therapy, massage, and electrical stimulation.
Referral to an Interventional Pain Specialist for Image-Guided Lumbar Injections: In cases where pain is severe or persistent, your doctor may refer you to an interventional pain specialist. This specialist may administer image-guided injections into the lumbar (lower back) area. These injections, often including corticosteroids, can help reduce inflammation around the nerve roots, thereby relieving pain (2). These procedures are typically done under X-ray guidance to ensure accurate placement of the medication.
Remember, while these treatments can be effective for managing herniated disc symptoms, it’s also important to address the root cause of the herniation, such as poor posture or improper lifting techniques, to prevent further episodes. Regular exercise, maintaining a healthy weight, and proper ergonomics at work can also help maintain a healthy spine.
Warning Signs and Medical Emergencies
- Cauda equina syndrome is a serious neurological condition, potentially arising from severe lower back disc herniations.
- The condition occurs when the cauda equina, a bundle of spinal nerve roots extending from the lower end of the spinal cord, is compressed.
- This compression can cause significant or progressive loss of sensory and motor function, including control over bladder and bowel movements.
- Symptoms of cauda equina syndrome can include lower back pain, sciatica, saddle anesthesia (numbness in the area that would sit on a saddle), and bowel or bladder dysfunction such as incontinence or retention.
- The condition may also cause weakness or numbness in the legs.
- Cauda equina syndrome is a medical emergency that requires immediate attention to prevent permanent damage, including paralysis and incontinence (7).
Conclusion
Pain in the arm or leg, numbness or tingling, and weakness are the top three symptoms suggesting a slipped or bulging disc. If you’re experiencing any of these symptoms, consult your healthcare provider as soon as possible. Early recognition and treatment of a herniated disc can often lead to better outcomes and prevent long-term damage.
Remember, each individual’s experience with a herniated disc can vary, and these symptoms can also be associated with other conditions. Therefore, a comprehensive medical evaluation is essential for an accurate diagnosis.
FAQ’s
What are the top three symptoms suggesting a slipped or bulging disc?
The top three symptoms that may suggest a slipped or bulging disc include chronic back or neck pain that may be sharp, persistent, or radiating, numbness or tingling in the areas served by the affected nerve, and pain that worsens with certain movements, especially bending forward or twisting.
What does pain from a herniated disc feel like?
The pain from a herniated disc can be sharp and stabbing, persistent and aching, or radiating. It can also be exacerbated by certain movements or coughing. In some cases, you may feel pain in a different location from where the actual problem is, known as referred pain.
What is meant by ‘numbness or tingling’ in the context of a herniated disc?
Numbness or tingling is a common symptom of a herniated disc. It can feel like ‘pins and needles’ and typically occurs in the area that the affected nerve serves. For instance, if the herniated disc is in your lower back, you may feel numbness or tingling in your leg or foot. If it’s in your neck, you might feel these sensations in your arm or hand.
Why does a herniated disc cause pain when moving in certain ways?
Certain movements, especially those that involve bending forward or twisting, can put more pressure on the nerve root that’s being affected by the herniated disc. This can exacerbate the pain.
How can you differentiate between general back pain and pain from a herniated disc?
While general back pain often improves with rest and is usually confined to one area, pain from a herniated disc is often persistent or worsening over time, may radiate to other parts of the body, and can be accompanied by other neurological symptoms such as numbness, tingling, or weakness in the extremities. However, an accurate diagnosis requires medical evaluation.
If I have these symptoms, does it definitively mean I have a herniated disc?
Not necessarily. While these symptoms can suggest a herniated disc, they can also be caused by other conditions. If you’re experiencing these symptoms, it’s important to seek medical evaluation to obtain an accurate diagnosis.
What should I do if I’m experiencing these symptoms?
If you’re experiencing these symptoms and they are severe, persistent, or worsening over time, you should seek medical attention. Depending on the severity and duration of your symptoms, treatment options may vary from conservative measures like physical therapy and medication to more invasive methods like injections or surgery.
References
- Burke, J.G., Watson, R.W.G., McCormack, D.R.W.G., Dowling, F.E., Walsh, M.G. and Fitzpatrick, J.M., 2002. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. The Journal of bone and joint surgery. British volume, 84(2), pp.196-201.
https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.84B2.0840196 - Chou R, Hashimoto R, Friedly J, Fu R, Dana T, Sullivan S, Bougatsos C, Jarvik J. Pain Management Injection Therapies for Low Back Pain [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015. PMID: 25879124.
https://pubmed.ncbi.nlm.nih.gov/25879124/ - DePalma, M.J., Ketchum, J.M. and Saullo, T., 2011. What is the source of chronic low back pain and does age play a role?. Pain medicine, 12(2), pp.224-233.
https://academic.oup.com/painmedicine/article-abstract/12/2/224/1854925 - Hahne, A.J., Ford, J.J. and McMeeken, J.M., 2010. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine, 35(11), pp.E488-E504.
https://journals.lww.com/spinejournal/Fulltext/2010/05150/Acupuncture_for_Neck_Disorders.23.aspx - Jensen, M.C., Brant-Zawadzki, M.N., Obuchowski, N., Modic, M.T., Malkasian, D. and Ross, J.S., 1994. Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine, 331(2), pp.69-73.
https://www.nejm.org/doi/full/10.1056/nejm199407143310201 - Murphy, D.R., Hurwitz, E.L. and McGovern, E.E., 2009. A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: a prospective observational cohort study with follow-up. Journal of manipulative and physiological therapeutics, 32(9), pp.723-733.
https://www.sciencedirect.com/science/article/pii/S0161475409002711 - Ropper, A.H. and Zafonte, R.D., 2015. Sciatica. New England Journal of Medicine, 372(13), pp.1240-1248.
https://www.nejm.org/doi/full/10.1056/NEJMra1410151 - Stafford, M.A., Peng, P. and Hill, D.A., 2007. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. British journal of anaesthesia, 99(4), pp.461-473.
https://academic.oup.com/bja/article-abstract/99/4/461/305514
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd
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