Lumbar sprain vs herniated disk

Myelogram. This test uses dye injected into your spinal fluid, and an X-ray for to locate the pressure on the spinal cord.

CT scan. A CT (or CAT) scan takes several X-rays from different angles and combines them to create images of your spinal cord and the structures surrounding it.

MRI: An MRI uses radio waves, a magnetic field, and a computer to create detailed 3-D images of the spinal cord and surrounding areas. MRI images can locate the position of the herniated disk, look inside it, and also determine which nerves are affected.

Electromyogram and nerve conduction studies (EMG/NCS). Your doctor might use these tests to see if any nerves are damaged or compressed. The EMG test uses a device to detect the tiny amount of electricity muscle cells make when they’re stimulated by nerves connected to them. A needle electrode placed into a muscle records its electrical activity and looks for anything that isn’t as it should be.

The NCS test is often done at the same time as the EMG. In this test, the nerves are stimulated with tiny electrical impulses by an electrode at one point on the body while other electrodes detect the impulses at a different point. The time it takes for the electrical impulses to travel between electrodes lets your doctor know whether there is nerve damage.

Back Pain: How Do I Know if I Herniated a Disc?

Glad to be back posting for Everyday Health. If you have any specific topics that you would like to see addressed, please drop a comment!

Many patients with lower back pain want to know if they have herniated a disc, or if their pain is merely a lower back strain. Here are some tests that can help you differentiate between these two types of lower back injuries. As always, it is a good idea to seek out medical attention with any back pain that will not go away!

1. In general, disc herniations hurt both with bending forward AND with returning from bending up to an upright position. Back strains or sprains tend to hurt less with bending forward, and more with returning from a forward bend.

2. Herniated discs are often associated with shooting pain and numbness that travels down one of the legs. Lower back sprains and strains tend to have “centralized” pain (only in the lower back).

3. Herniated discs can cause weakness in a leg. Sometimes patients will experience repetitive “stubbing” of his or her toes while walking. This is a manifestation of certain muscles losing strength and not being able to adequately clear the foot from the floor while walking. Someone with a herniated disc will also often not be able to walk on his or her toes on one side.

4. Many people with a herniated disc will have a dulled patellar or heel-cord reflex on the involved side. Most people have had this test performed on them during a doctor visit. The patient is seated with the legs dangling off the side of the table. The doctor hits the patellar tendon with a rubber hammer just below the kneecap, and the lower leg momentarily jerks. If one leg has a muted response to this test, the cause may be a herniated disc.

5. In severe cases of disc herniation, bowel and bladder control is compromised. If this happens to you, immediately seek the attention of your doctor.

The good news here is that the vast majority of disc herniations do not require surgery. Medication, diagnostic imaging (such as an MRI), formal physical therapy, and rest are all part of the recovery equation. Do not try to manage this type of diagnosis on your own!

Back pain

In addition to doctors, many people find consulting with a physiotherapist or osteopath may help. Osteopaths and physiotherapists may help with diagnosis of some back problems, mobility, exercises, stretching and advice.

Osteopaths and physiotherapists don’t require you to have a referral from your GP. Their services are only rebated on Medicare as part of a specific chronic disease plan, but may be covered by private health insurance extras cover.

Causes of low back pain

Most backaches are due to problems with the muscles, ligaments and joints. More serious problems occur when the nerves or spinal cord are injured, usually by local pressure.

Back muscle strains

Low back pain can be due to a pulled or torn muscle in the lumbar region. There are many muscles involved in the lower back, which help support the spine and the upper body. These include extensor muscles (such as the erector spinae), the oblique muscles and the flexors (such as the psoas).

When any of these muscles are stretched or torn (strained), there are micro-tears in the muscle fibres and these tears give rise to inflammation and pain. Myofascial pain like this from the muscles around the spine usually resolves after a short period of active recovery. But, it can also be present alongside other causes of back pain.

Lumbar sprain

A lumbar sprain happens when the ligaments of the lower back are stretched or torn. Ligaments are the tough connective tissue that joins bones, joints and cartilage together and keeps them stable. If the ligaments are stretched too far they can tear.

The symptoms and treatment of a lumbar sprain are the same as for lumbar strain – which affects the muscles, rather than the ligaments.

Muscle spasms

You won’t usually know whether your low back pain is a result of a muscle problem or a ligament problem. Both can cause quite severe pain and cause inflammation in the surrounding area and sometimes spasm of the surrounding muscles. A back spasm is felt as a cramping or tightening of the muscles. Spasms are involuntary contractions of the muscle – that means you have no control over them.

Muscle spasms are usually caused by the back trying to protect itself from damage to the muscles themselves or may indicate that there is an underlying injury to the spine itself.

Degenerative disc disease

Degenerative disc disease refers to normal changes to the spinal discs caused by ageing. The intervertebral discs are cushion-like structures between the vertebrae – the bony joints of the spine. The discs have a tough outside casing and are filled with a gel-like centre. They act like shock absorbers.

As we age the discs become stiffer, drier and thinner. This makes them less flexible and supple and they may restrict movement and cause pain. Degenerative changes are more frequent in the lumbar (lower) spine and the cervical (neck) region of the spine.

Degenerative disc disease of the spine may cause chronic (ongoing) low back pain, interspersed with more painful flare-ups from time to time. The pain is often worse when sitting, as the back is carrying more load in that position, and the pain may be relieved by standing up, changing positions or lying down.

With ageing, bone spurs – tiny growths on the edges of the bones of the spine – may also occur. These bone spurs (osteophytes) are usually smooth and may not cause any pain.

Ruptured, prolapsed or herniated disc

Sometimes called a ‘slipped disc’, a herniated disc happens when the soft jelly-like centre of a spinal disc bulges out of a tear in the outer casing of the disc. The disc itself doesn’t move, but a split in its casing allows the soft middle (nucleus pulposus) to bulge out (herniate).

Herniated discs don’t always cause problems – up to a third of people who don’t have back pain are shown to have herniated discs on imaging. However, sometimes the bulging part can press on a nerve and cause pain, tingling and other problems, such as weakness. Inflammation from the site may also contribute to symptoms. Prolapsed discs like this can be the cause of sciatica. The discs in the lumbar spine are most likely to herniate – these are the discs between the 5 lumbar vertebrae – L1 to L5.

Over time, the herniated portion of the disc (that’s the part that’s bulging out) usually gets smaller (regresses) and the symptoms ease and may go away. Most people with symptoms will improve in 2 weeks.

Facet joint problems

Facet joint problems are common causes of back pain and the resulting condition is commonly referred to as facet joint pain or facet joint syndrome.

The facet joints are small stabilising joints between and behind the vertebrae of the spine. There are 2 facet joints between each 2 vertebrae at every level of the spine (except the very top vertebrae in the neck). They allow some flexibility so that you can slightly twist and turn around, but they give you stability so that there isn’t excessive movement in your spine. The facet joints in the lumbar region allow only flexion and extension, so no twisting. Facet joints are synovial joints, so the joint surfaces have cartilage to allow them to glide smoothly together and they are enclosed in a lubricant-filled capsule.

Over time, facet joints can wear out, and with wear and tear the cartilage can become thin, leading to the bones rubbing on each other. This osteoarthritis leads to inflammation and pain, and bone spurs can form on the surface of the bone. As the intervertebral discs become thinner with age, more pressure still is put on the facet joints.

Facet joints can also slip (dislocate) and become locked in position. Locked facet joints happen suddenly, for example when a person bends down to tie a shoelace and then experiences that their back seizes up. Problems with facet joints can be unpredictable.

Symptoms of facet joint problems include tenderness over the affected facet joint, decreased movement and stiffness, pain when bending backwards and pain in the buttock or radiating down thigh (but not beyond knee).

Spinal stenosis

Spinal stenosis means narrowing of the spaces in the spine, either:

  • narrowing of the spinal canal (the hollow ‘tube’ that holds the spinal cord);
  • narrowing of the spaces where the nerve roots exit the side of each vertebrae; or
  • Narrowing and impingement of the nerve root after it has exited the vertebrae.

Spinal stenosis can be caused by degeneration of other structures in the back, such as the facet joints or discs, for example by bone spurs or herniated discs. Some people inherit a small spinal canal in the first place.

Symptoms of spinal stenosis often start slowly and worsen over time. They may include tingling, numbness or weakness in the feet or legs. If you have symptoms like these, you must visit a doctor.

Ankylosing spondylitis

Ankylosing spondylitis is a type of arthritis affecting the spine. The cause is not known, but there is a strong inherited component to the disease.

The symptoms of ankylosing spondylitis are lower back pain and stiffness (especially first thing in the morning), tiredness and pain over the buttocks and down the thigh. The pain tends to ease as the day goes on. Rest does not help back pain from ankylosing spondylitis.

Ankylosing spondylitis also causes pain and arthritis in other joints of the body, other than the spine.

Spondylolisthesis

Spondylolisthesis is when one of your vertebrae slips forwards or backwards out of its normal alignment, causing a step in the building blocks of the spine. It most commonly affects one of the lumbar vertebrae in the lower back.

It doesn’t always cause pain, but when it does the pain is usually worse during activity and relieved by lying down. If the slipped vertebra presses on a nerve, then you may have symptoms of sciatica – tingling down your leg and over your buttock. People with spondylolisthesis often have tight hamstrings.

Spondylolisthesis may be due to a fracture or a defect that is inherited. It may be caused by a traumatic injury, such as from high-impact sports (e.g. gymnastics) or a motor vehicle accident. If the spine has become worn and arthritic, then spondylolisthesis is more likely.

Sacro-iliac joint problems

Problems with the sacro-iliac joints – the 2 joints that join your sacrum (tailbone) to your pelvis – can give rise to low back pain. You have a sacroiliac joint on the left and one on the right of your sacrum (the triangular shaped bone at the base of your spine).

The sacro-iliac joints are designed to be fairly stiff, and don’t normally allow more than a few degrees of movement. They function as shock absorbers. If the joints are abnormally mobile (too much movement) or restricted in movement they can give rise to low back pain. The SI joints may also become inflamed (called sacroiliitis).

Symptoms of sacro-iliac joint pain include low back pain, leg pain (but rarely below the knee), pain in the sacro-iliac region itself or in the buttocks. There may be muscle spasms of surrounding muscles as they try to protect themselves or respond to underlying damage.

Cauda equina syndrome (CES)

Cauda equina syndrome is a medical emergency caused by compression of the spinal nerve roots. Below the waist near where the lumbar spine starts, your spinal cord separates into a bundle of nerves and nerve roots that resemble a horse’s tail; this is the cauda equina. These nerve roots supply messages to your legs, feet and pelvic organs. Anything that compromises the nerves can affect the function of your bladder, bowel, legs and feet and could result in paralysis or loss of continence.

Symptoms of cauda equina syndrome may come and go, developing slowly over time, or come on suddenly and include:

  • numbness of the buttocks in the pattern of where you would sit on a saddle;
  • severe low back pain;
  • tingling, weakness or pain in one or both legs;
  • changes to bowel or bladder function;
  • abnormal sensations in the bladder or rectum;
  • sudden loss of sexual function;
  • loss of some reflexes.

If you develop any of these symptoms, you should visit a doctor or the emergency department straightaway.

CES can be caused by a severe rupture of a lumbar disc, spinal stenosis, spine injury, inflammation or a birth defect.

Spinal fracture

Osteoporosis – a condition causing spongy bones – can cause sudden compression fractures (cracks) of the vertebrae. These osteoporotic compression fractures usually affect the vertebrae of the thoracic (upper) spine, but may also affect the lumbar (lower) vertebrae. They cause sudden back pain when they happen and can lead to ongoing pain, pain that is worse when standing or walking, and loss of height. Vertebral fractures such as this are common in postmenopausal women and older men.

Spinal fractures may also be due to trauma, falls, sports injuries, or motor vehicle accidents.

Spondylolysis

Spondylolysis is a type of fracture or stress fracture in the vertebrae. It often affects young athletes who do sports such as gymnastics or football. Whilst the fractures sometimes spontaneously heal, they may not heal correctly and can cause ongoing back pain.

Mostly there are no symptoms in young people with spondylolysis, but symptoms can include lower back pain which may extend into the buttocks or legs.

Spondylolysis is a common cause of spondylolisthesis (mentioned earlier) where one vertebra slips out of position over another. Conversely, in older people with spondylolisthesis, this can lead to uneven loading of the facet joint, causing a compression fracture.

Cancer

Cancer is a rare cause of back pain. Tumours affecting the spine are usually secondary cancers that have spread from the primary tumour somewhere else in the body. Symptoms of spinal tumours include back pain, unexplained weight loss, weakness or numbness in arms or legs, and pain that is worse at night and which doesn’t go away with rest.

Risk factors

Risk factors for low back pain include:

  • Being overweight or obese – which puts more strain on the back.
  • Being middle aged or older – back pain is more common the older you get.
  • Lack of exercise – which can lead to weak back muscles that don’t support the spine.
  • Poor posture – this can lead to muscle imbalances.
  • Heavy physical work and lifting weights that are too heavy.
  • Incorrect lifting technique, e.g. using your back instead of your legs.
  • Overdoing it or doing unaccustomed exercise.
  • Being pregnant.
  • Stress – this can lead you to unconsciously tighten your back muscles.
  • Sitting for long periods of time.
  • Scoliosis – an abnormal curving of the spine sideways.

Treatment and self-help for low back pain

Most uncomplicated back pain resolves after a period of active recovery and people are generally back to normal within 4 weeks.

See your doctor if you are at all concerned about your back pain, and especially if any of the following occur:

  • Your back pain has not improved after a couple of weeks;
  • The pain is getting worse as time goes on.

Active recovery includes trying to do normal activities as much as possible and keeping active. Gentle walking, which improves blood flow and speeds up healing, can help. Doctors now know that inactivity and rest will lead to stiffness and more pain and is more likely to lead to ongoing back problems.

Careful stretching may help relax muscles, especially if you have muscle spasms.

You may find that sleeping with a pillow between your legs can make night-times more comfortable.

Over-the-counter painkillers such as paracetamol or anti-inflammatories, e.g. ibuprofen (Nurofen), may help ease pain and reduce inflammation. If they are suitable for you, anti-inflammatories may be more effective than paracetamol. The pain probably won’t be completely eliminated, but this should enable you to resume gentle activity. Make sure you take the recommended dose. These medicines are not suitable for everyone, so always check with your doctor or pharmacist.

Topical pain relievers are applied to the skin at the site of the pain. They are creams or ointments, usually. Some use the same ingredients that are in the tablet forms of over the counter pain relievers, such as ibuprofen or aspirin. Others have ingredients such as capsaicin, a compound from chilli peppers, or menthol.

Stronger painkillers. Depending on the circumstances of your back pain, your doctor may prescribe other painkillers, antidepressants or other medicines.There is no evidence to support using muscle relaxants to treat low back pain. Oxycodone (prescribed as Endone or Oxycontin) is a strong painkiller belonging to the opioid group of medicines and is sometimes prescribed for back pain. Oxycodone can lead to addiction if used for long periods and also carries the risk of overdose. Whilst it may be effective in the short term for sudden onset of back pain, oxycodone is not recommended long term and there is no evidence for it being effective in the long term. Codeine is another strong painkiller, sometimes used in the short term for back pain. Codeine is another opioid and can also lead to addiction.

Hot or cold packs may help with the pain as may sitting in a warm bath. Heat loosens tight muscles and increases blood flow, bringing more oxygen and nutrients to the area. Cold can help reduce pain and swelling. Cold is usually used in the beginning stages of an injury.

Exercise programs – A physiotherapist or osteopath should be able to help you with an exercise programme to improve mobility, reduce pain, prevent further injury and help with recovery from back pain.

Don’t worry too much or allow negative thoughts to run amok – the relationship between our thoughts and pain is complex. Worry and anxiety about back pain can make the pain worse.

Acupuncture – there is no evidence to show that acupuncture has any effect in improving low back pain, however, it is unlikely to be harmful.

TENS (transcutaneous electrical nerve stimulation) – this technique uses low voltage electrical current and is said to block pain signals. At the moment, there is no evidence to show TENS has any effect in helping low back pain.

Therapeutic massage – The evidence to support the effectiveness of massage to help lower back pain is not very strong, but some people have found it offers relief. Spinal manipulation is definitely not recommended, though, as it may not be safe in some situations.

Pilates – Studio training with experienced instructors can help with core stability and posture, and improve the health of your spine and muscle strength. Pilates training works on the deep support muscles of the spine and should help protect you from future episodes of back pain.

Yoga – Yoga can help with flexibility and posture, and along with the breathing and meditation aspects yoga may help to relieve lower back pain and improve function of the spine. Some yoga positions are not safe for people with certain back conditions, so you should always let a yoga instructor know if you have back problems.

Alexander technique – The Alexander technique helps you to recognise and correct poor postural habits which lead to tension and pain in the body. Teachers in the Alexander technique observe the way you move and then with gentle guidance help you to learn safer and more relaxed ways of moving your body. One-to-one lessons in the Alexander technique have been shown to have a beneficial effect on back pain and functioning in people with ongoing or recurrent low back pain, even 12 months after the lessons have finished.

Anti-inflammatory diet – Some foods have been shown to contribute to inflammation in the body, which in turn might aggravate back pain. Processed foods are generally acknowledged to be pro-inflammatory (causing inflammation). On the other hand, some foods are known to have an anti-inflammatory effect or can help with pain relief. Some foods known to reduce inflammation are omega-3 fatty acids (found in fish), and antioxidants from colourful fruit and vegetables.

Facet joint injections – Facet joint injections are corticosteroid injections. Australian guidelines now recommend that in most cases, facet joint injections are not helpful. They were done when a facet joint was suspected of causing the back pain. If the pain went away then this confirmed the diagnosis of facet joint disease or facet joint syndrome.

Back surgery – In ongoing, non-specific back pain, there is no evidence that surgery helps. Surgery is usually only relevant for a minority of people with back pain, who have specific anatomical causes of their back pain, such as problems that cause pinching of a nerve. Techniques for back surgery are becoming less and less invasive, many being carried out using keyhole surgery.

Types of spinal surgery include:

  • spinal fusion, which permanently connects 2 vertebrae together using a bone graft;
  • lumbar decompression, which removes structures that are pressing on a nerve root, by either microdiscectomy, where the protruding pieces of a herniated disc are removed under microscopic view; or laminectomy, a more open type of surgery, where the facet joints may be trimmed, as well as problems with discs resolved.
  • Kyphoplasty – insertion of a balloon to expand a compressed vertebra, followed by injection of bone cement into the vertebra. These compression fractures are usually from osteoporosis.
  • Vertebroplasty – injection of bone cement into a compressed vertebra.

Outlook

Most people who have an episode of non-specific low back pain improve quickly, and usually recover within 4 weeks. A positive outlook can help you recover more quickly. However, a minority of people will have ongoing problems – the risk of this happening increases with age. Older people are particularly at risk of having recurrent episodes of back pain.

Prevention

If you’ve hurt your back already, then prevention is probably the last thing on your mind. However, some people have further episodes of back pain after the initial episode has resolved, so it’s worth finding out what you can do to protect your back from further attacks of back pain.

The back is at least risk of injury when it is in its neutral position. Anything that forces it to tilt can cause strains to the ligaments, and pain can result. Twisting when lifting is one common cause of low back pain.

The way we lift, sit at our desks, operate machinery and do hundreds of minor tasks can all affect our backs. Trying to keep the back in a neutral position at all times will reduce the risk of backache. This is particularly important with tasks such as gardening and housework, which involve a lot of bending. Whenever possible, bend the knees and keep the back straight when doing things at ground level.

Here are some things you can do to try to avoid back pain.

  • Maintain good posture. Try to sit and stand with a ‘neutral spine’ (a physiotherapist or pilates instructor will be able to show you this). Use your legs to walk up hills (not your back) by staying upright and not bending forwards. Slow down if you have to, to maintain good posture. Sit with your knees slightly higher than your hips.
  • Stay active. Low impact exercise, such as walking or swimming can strengthen the back muscles and the muscles of the core, which allows them to support the spine correctly. Regular exercise can help with strength and flexibility, ease pain and stiffness and protect bones.
  • Back strengthening exercises. Try to do these every week at least a couple of times. A physiotherapist or pilates instructor will be able to help you with the best exercises for your back.
  • Avoid heavy lifting. Avoid lifting weights that are too heavy for you. Learn correct lifting techniques – bend from the knees and use your legs to push up, and contract your abdominal muscles before you lift. Don’t twist when you lift, and don’t bend from the waist. Push, rather than pull, heavy objects.
  • Pay attention to your carrying technique. Try not to load down one side of your body with heavy bags or handbags – distribute the load as evenly as possible and keep your shoulders square. Swap sides often when carrying heavy bags.
  • Avoid stress. Being stressed or anxious leads to muscle tension by causing blood vessels to narrow, reducing blood flow and oxygen to the body’s tissues. This leads to a build-up of waste products, which cause the muscles to spasm or contract. Being under constant stress causes the muscles to tighten and shorten, causing pain – often in the neck and back.
  • Stretching. Stretching can help to reduce muscle tension. Tight hamstrings – the muscles down the back of your thigh – can be a cause of low back pain, so make sure your hamstrings are stretched out and not too tight.
  • Not smoking. Smoking is linked to the development of low back pain. Doctors think this is due to reduced blood flow (which reduces the nutrients reaching the back), jarring from coughing and the fact that the bones of smokers have a lower mineral content.
  • Eat a healthy diet. Some foods have been shown to have anti-inflammatory or pain-reducing properties. An anti-inflammatory diet, such as the Mediterranean diet, may help keep inflammation at bay and so lessen your chance of back pain.
  • Stay hydrated. As we age, the soft gel-like centre of our intervertebral discs dries out and the discs become less effective as shock absorbers. Staying hydrated may go some way to help keep the discs plumped up and slow down this process.
  • Maintain a healthy weight. Being overweight can make it harder to move about and puts more strain on your body. Being overweight also creates inflammation in the body.
  • Avoid high heels. High heels alter your body’s alignment and put a strain on your back. Unsupportive footwear, such as thongs or flipflops, do not support the arches of the feet and so can lead to poor posture and back pain.

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Last Reviewed: 02/10/2017

myDr

Fractures, Sprains and Strains

Lumbar Back Strain

Anatomy

The spinal column is made up of small bones (vertebrae) stacked on top of one another, creating the natural curves of the back. The spine contains three segments: cervical, thoracic and lumbar.

  • The cervical spine includes the neck and consists of seven small vertebrae, beginning at the base of the skull and ending at the upper chest.
  • The thoracic spine consists of 12 vertebrae and begins at the upper chest, extending to the middle back and connecting to the rib cage.
  • The lumbar spine consists of five vertebrae located in the lower back; lumbar vertebrae are larger because they carry more of the body’s weight.

Between the vertebrae are flat, round, rubbery pads (intervertebral disks) that act as shock absorbers and allow the back to flex or bend. Disks in the lumbar spine are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine, disks are similar but smaller in size.

Each vertebra has an opening (foramen) in the center and these line up to form the spinal canal. Protected by the vertebrae, the spinal cord and other nerve roots travel through the spinal canal. Nerves branch out from the spinal column through vertebral openings, carrying messages between the brain and muscles. Facet joints align at the back of the spinal column, linking the vertebrae together and allowing for rotation and movement. Like all joints, cartilage covers the surface where facet joints meet.

Muscles, tendons and ligaments are fibrous cords of tissue that connect the vertebrae and allow motion, while providing support and stability for the spine and upper body.

  • Three types of muscles support the spine: extensors (back and gluteal muscles), flexors (abdominal and iliopsoas muscles), and obliques or rotators (side muscles).
  • Tendons attach these muscles to bone. When a muscle contracts, the tendon pulls on the bone it is connected to, causing that body part to move.
  • Ligaments connect one bone to another and support the joints of the body. The elastic structure of ligaments allows them to stretch, within their limits, and then return to their normal positions.

Description

While a lumbar strain may not sound like a serious injury, it can be the source of surprisingly severe pain. Lumbar strains are among the most common causes of lower back pain, and the reason for many emergency room visits each year. A lumbar strain can occur at any age, but it is most common in those in their forties.

A lumbar strain is an injury to the tendons and/or muscles of the lower back, ranging from simple stretching injuries to partial or complete tears in the muscle/tendon combination. When the tissues are stretched too far, or torn, microscopic tears of varying degrees can occur. These tears cause inflammation in the surrounding area, resulting in painful back spasms and difficulty moving. A lumber strain that has been present for days or weeks is referred to as acute. If it has persisted for longer than 3 months, it is considered chronic.

Symptoms

Symptoms of a lumbar strain or sprain include mild to extreme discomfort or pain in the lower back area, particularly after an event or injury that mechanically stresses the lumbar tissues. Depending on the injury and severity, other symptoms that may be experienced include: weakness or noticeable loss of strength, instability, difficulty with movement, complete loss of muscle function; swelling, tenderness and bruising. Severity of symptoms typically corresponds with the severity of the injury.

Seek immediate medical treatment if you experience sudden or severe pain, loss of mobility, complete muscle weakness, or if the potential for a fracture or other serious injury exists. Be sure to see your physician or other medical professional if you experience back pain that does not go away after a short period of rest, application of ice, and anti-inflammatory medication.

People with a pulled lower back muscle may experience one or more of the following:

  • Discomfort ranging from a mild ache to sudden debilitating pain.
  • Localized pain in the lower back (does not radiate into the leg, as in sciatica).
  • The lower back may be sore to the touch.
  • Sudden onset of pain; pain may be accompanied by muscle spasms.
  • Difficulty standing or walking, with some relief from pain when resting.
  • Severe pain may resolve quickly, with intermittent flare-ups or low-level pain persisting for a few weeks or months.

Cause

The injury causing a lumbar strain may be the result of overuse, improper use, or trauma that can occur during athletic participation as well as everyday activities.

Diagnosis

Your physician will perform a physical exam that may include placing pressure on or near the suspected injury to identify swelling, tenderness of pain. You may be asked to perform certain movements which will help determine your range of motion limitations and what increases or decreases your pain. You may also be asked to describe your symptoms and the activity or injury that caused them.

X-rays or magnetic resonance imaging (MRI) may be requested to rule out fractures, bone abnormalities or other potential sources of pain, or to determine if damage to spinal discs has occurred. If prescribed treatment does not provide relief from symptoms, additional diagnostic testing, such as electromyography (EMG) or nerve conduction studies, may be needed.

During your diagnosis, your physician may apply a grading scale to classify your injury as mild, moderate or severe.

  • Grade I (Mild)—Overstretching of the muscle or tendon; small tears may or may not occur; mild pain may occur, with or without swelling.
  • Grade II (Moderate)—Overstretching; more fibers are torn, but tearing is incomplete; considerable but moderate pain; swelling; bruising, tenderness; muscle spasm; joint instability, loss of strength and pain with movement may also occur.
  • Grade III (Severe)—Usually involves complete tearing of the tissues; and complete loss of muscle function; pain is severe and may be accompanied by swelling, tenderness, bruising, weakness, loss of muscle function, and joint instability.

Nonsurgical Treatment

Treatment for a lumbar strain typically involves: limiting the activity that caused the injury (heavy lifting, twisting, bending or other actions); applying ice for the first 48 hours, and applying heat, thereafter; anti-inflammatory medications (NSAIDS) and medications to relieve muscle spasms. Although an initial course of rest may be required, prolonged periods of inactivity or bedrest are not recommended and may actually slow recovery. Physical therapy and exercises to strengthen back muscles may also be prescribed. Surgical treatment is only indicated in rare circumstances when a complete tear of the ligaments or muscles has occurred.

Other nonsurgical treatment recommendations may include electrical stimulation, moist heat therapy and trigger point injections. For patients with no signs of nerve irritation, spinal manipulation for up to one month has been found helpful. Use back protection techniques and support devices as needed to avoid future injury.

  • Acetaminophen or aspirin—These drugs may be used to relieve mild pain, usually with few side effects.
  • Nonsteroidal anti-inflammatory medication (NSAIDs)—Drugs such as ibuprofen or naproxen may help relieve pain, inflammation and swelling. Most people are familiar with nonprescription NSAIDs such as aspirin and ibuprofen, however, whether using over-the-counter or prescription strength, they must be taken carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor. If you have serious contraindications to NSAIDs or your pain is not well-controlled, other types of pain medication can be considered, depending on your specific problem.
  • Narcotic pain medications—These drugs are rarely indicated for low back pain.
  • Massage—By stimulating blood flow in the lower back, massage can promote healing, as well as help loosen tight lower back muscles and release endorphins, which act as the body’s natural pain killers.
  • Chiropractic or manipulation therapy—Gentle manual manipulation takes a variety of forms and is generally a safe option to help loosen tight back muscles, provide relief from pain, and promote healing in the lower back. However, special care should be taken if a patient has osteoporosis or disk herniation, because in these cases, manipulation of the spine can worsen symptoms or even cause other injuries.
  • Ice and heat—Application of ice or some type of cold pack immediately following the injury can help reduce inflammation. After 48 hours, your physician may recommend the application of heat to the lower back as a longer-term therapy for stimulating blood flow and healing in the injured area. The proper way to ice an injury is to apply crushed ice directly to the injured area, but over a thin cloth. Ice should not be applied directly to the skin and should be applied for no more than 15 to 20 minutes at a time, waiting at least one hour between icing sessions. Chemical cold products (“blue” ice) should not be placed directly on the skin and are not as effective.

Recovery and Outcome

Back muscle strains typically heal with time, many within a few days, and most within 3 to 4 weeks. Most patients with mild or moderate lumbar strains make a full recovery and are free of symptoms within days, weeks, or possibly months. However, it is important to remember that resuming activity levels too quickly may cause re-injury, which can be more severe than the original injury and may result in recurring or chronic pain.

Although some low back muscles receive adequate exercise during daily activities, many do not. These tend to weaken with age unless specifically targeted. Generally, those who exercise regularly and stretch back muscles are less likely to suffer from low back pain due to strains, sprains, tears or spasms.

To prevent or lessen the impact of any problems, it is important to exercise regularly and combine walking, swimming or other activities with a spine conditioning program, low back exercises, or specific exercises to stretch and strengthen back and abdominal muscles. A complete exercise regimen for the low back may include: stretching for back pain relief, back strengthening exercises, and low-impact aerobic exercise. Regular stretching of the hamstring (the muscle running through the back of the thigh) will also help reduce and prevent back muscle tightness and injury. Tightness in the hamstring limits motion in the pelvis, which can strain the lower back. By gradually lengthening these muscles, regular hamstring stretching can reduce stress in the lower back.

Herniated Disk

Disks are your spine’s shock absorbers, flexible cushions that fit in between vertebrae. When you move your back, the disks absorb the pressure on your spine. They’re incredibly strong, but they’re subject to wear and tear. As you and your back age, the outer covering of these cushions can wear thin, especially if you strain your back. Eventually, the jelly-like center of one or more disks may start to ooze out. This is called a herniated or “slipped” disk. You don’t have to be old to have a herniated disk. They usually happen to people in their 30s and 40s.

What can contribute to a herniated disk?

Sudden pressure, smoking, repetitive strenuous activities, improper lifting (such as twisting and turning while picking up something heavy) and carrying extra body weight that puts stress on the discs in the lower back can all help weaken disks in the lower back.

Do herniated disks always cause pain?

A herniated disk can be painful, especially if it presses against a nerve. But usually the condition is silent. Plenty of people who have herniated disks never know it — it simply doesn’t cause any pain. In fact, studies have found that roughly 22 to 40 percent of people without back pain have herniated disks.

Many people who suffer from back pain also have herniated disks, but the two problems aren’t necessarily related. Many cases of back pain arise from sprained or strained muscles in the lower back, not leaking disks. According to a report in the New England Journal of Medicine, herniated disks account for only about 4 percent of cases of lower back pain.

What are the symptoms of a herniated disk?

You may feel pain that is especially severe after any sort of strain, including coughing or prolonged periods of sitting or standing. If the filling of a ruptured disk presses against a nerve, you may feel a sharp, shooting pain that runs from your lower back through your buttocks and down one of your legs. This type of pain is called sciatica.

Seek immediately medical attention if you notice signs of nerve damage such as numbness, tingling, and weakness in your legs, feet, or buttocks. Rarely, the disk may pinch the nerves that control bowel and bladder function, causing incontinence.

If pain, numbness and weakness have spread to one or both of your legs; you have a loss of bladder or bowel control or are unable to urinate; and/or you feel a loss of sensation in your inner thighs, back of the legs and areas around the rectum, go to the emergency room: you may have a compression of the spinal nerve roots, a problem that can require emergency surgery to relieve the pressure.

How are herniated disks diagnosed?

Your symptoms alone might be enough to make your doctor suspect a herniated disk, but it’s all guesswork unless he or she takes a picture with an MRI (magnetic resonance image) or a CT (computed tomography). These tests can give your physician a clear view of your spine, leaky disks included.

An MRI is probably the best test, because it gives a clear view of the bones, the disks, and the nerve roots that may be damaged. Since herniated disks account for only a small percent of low back pain, however, doctors generally don’t do an MRI unless a patient has both back pain and warning signs of a serious injury or disease.

In addition, these imaging tests have a major drawback: They can’t prove that herniated disks (or any other common abnormalities) are actually causing your pain. Indeed, the pictures may just confuse the issue. If a patient suffers from a simple back sprain, a picture of a herniated disk could cause unnecessary anxiety or worse, unnecessary treatment.

Many experts now believe that high-tech images are overused for back pain. The New England Journal of Medicine report suggests that doctors should hold off on such tests for at least a month, unless they suspect an infection, cancer, or nerve damage. The pain often gets better on its own, without treatment, and disk abnormalities that the doctor sees on the MRI may not be the cause of the pain.

What can I do to ease the pain?

Not only are disks durable, they’re also very resilient. If you rest and take good care of your back, there’s a good chance your disk will get better without medical treatment. According to a report from the Mayo Clinic, most herniated disks will take four to six weeks to significantly improve, and many manage to return to normal within a couple of months.

Taking the strain off your back is the first step in the healing process. You may need to start by taking it easy for a couple of days. Don’t lift heavy objects, bend repeatedly, sit for long periods, or do anything else that might aggravate your back. But you don’t want to become a couch potato, either. Regular activity will help strengthen your back and promote healing. Your doctor or physical therapist can recommend specific exercises to speed the healing process and prevent future injuries.

While you’re waiting for your back to heal, you can take over-the-counter pain relievers such as aspirin or ibuprofen. For extra relief, try putting a cold compress on the aching spot for 15 minutes at a time, four times a day. If you’re still in pain, your doctor may prescribe stronger painkillers. Injections of corticosteroids — medications that calm inflammation — are another option for pain control in selected cases. In especially severe cases, your doctor may also try a nerve block (regional anesthesia).

Some people who suffer from back pain have tried transcutaneous electrical nerve stimulation (TENS). In TENS, a physical therapist uses a battery to send very modest electrical current into the muscle, thought to stimulate the body to release endorphins, the body’s natural painkillers. Controlled studies have shown conflicting data as to the benefit of this practice.

Some find relief from acupuncture. Studies have shown conflicting results, but a systematic review by the Cochrane Collaboration, which evaluates evidence for medical and complementary treatments, found that acupuncture was a useful added treatment for chronic low back pain. Ask your doctor if acupuncture is a good option for you.

When is surgery necessary?

Most people with herniated disks never need to seek an operation. For a small minority, however, surgery is the only option for relief. If signs of nerve damage — numbness, tingling, and weakness — grow steadily worse, you may need an operation right away. Likewise, a herniated disk that interferes with the bowel and bladder is a medical emergency and requires immediate treatment.

For other patients, doctors take a wait-and-see approach. If your sciatica (pain shooting from your lower back down to your leg) lingers for six weeks or more despite your self-care efforts, you and your doctor may want to start thinking about getting an MRI and evaluating the need for surgery.

How does a surgeon treat a herniated disk?

The traditional surgical treatment for herniated disk is a diskectomy. In this procedure, a surgeon will cut away the portion of the disk over the spinal canal that is pressing against the nerve. At the same time, a surgeon may trim some of the bone from the backside of the vertebrae to relieve pressure on the nerves, a procedure called a laminectomy.

In recent years, surgeons have developed a new twist on this approach. The troublesome part of the disk can be removed through a tiny incision with the use of a special microscope, a procedure called a microdiskectomy. This technique seems to be just as effective as a standard diskectomy, but patients tend to recover more quickly. According to the Mayo Clinic, success rates for both diskectomy and microdiskectomy — measured by pain relief and patient satisfaction — reach about 80 to 90 percent.

Having a herniated disk sounds serious — but it’s only rarely a true emergency. With care and time, the pain will usually disappear entirely.

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. The Cochrane Database of Systematic Reviews Issue 11.

American Academy of Orthopaedic Surgeons. Herniated disk.

Herniated Disks. Mayo Clinic.

Brinkhaus B., et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Archives of Internal Medicine. 166(4):450-7.

Asch, HL et al. Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm? Journal of Neurosurgery 96 (1 suppl.) 34-44

Deyo RA and JN Weinstein. Primary care: Low back pain. New England Journal of Medicine 344 (5) 363-370.

Approximately 85% of Americans will experience some form of lower back pain. While it may seem like such a high prevalence of back pain must mean most people are dealing with the same problems, the reality is that a variety of underlying conditions can cause lower back pain. This article will explore two of the most common causes, back sprains and herniated discs, and give you the information you need to take the next steps in relieving pain.

What is a Back Sprain?

Back sprains occur when one of the ligaments that hold the bones of the lower back together over stretches. In severe cases, this stretching can result in a tear of the ligament. While there is overlap in the way you can manage pain caused from both, a back sprain differs from back strains in that a strain involves either the muscles or tendons of the lower back, not the ligaments.

Lumbar muscle strains are likely to occur during physical activity. They happen as a result of the muscles in the lower back pulling in a strange position. Strains may come about slowly as a result of overuse. By contrast, sprains are typically caused by sudden trauma like accidents, heavy impacts, falls, and intense twisting of the lower back. These events may cause your ligaments to stretch beyond their natural capacity, resulting in a sprain. You will likely feel a popping sensation if a sprain occurs. Symptoms of a lower back sprain include:

  • Pain that gets worse with movement
  • Muscle tightness and cramps
  • Limited range of motion in the affected joint

In many cases, the pain associated with sprains will subside as the ligament heals, though this may be a lengthy process.

What is a Herniated Disc?

There are discs between the vertebrae, so when one starts to come out from between those bones, it is called a herniated disc. Because of the location of these discs, the protrusion may also impact some nerves. The pain associated with this kind of injury is typically not from the disc, but from the nerves being compressed by the ruptured disc. Herniation of the lumbar discs can occur from both physical activity and trauma, as both can cause excessive pressure on the disc. Symptoms of a herniated disc include:

  • Numbness in the limbs
  • Muscle weakness
  • Pain that radiates into the limbs
  • Constant pain
  • Pain with spinal movement

While surgery is often necessary to heal this type of injury, there are alternative ways to treat a herniated disc.

Differences in Treatment

While both back sprains and herniated discs can result in lower back pain, we treat them differently. If you have the former, treatment will likely involve resting the affected area, using heat and cold on the lower back, as well as massage and gentle stretching to increase mobility.

Also, over-the-counter medications sometimes relieve pain and reduce inflammation, though you should use them sparingly. You likely will not need surgery, but you should still contact a doctor to get a proper diagnosis and treatment plan for your sprain.

Herniated discs tend to require more intensive treatment, as it is uncommon for discs to heal themselves. In both cases, you should be proactive and seek treatment as soon as possible following the injury. Expedient treatment will allow you to recover quickly and get you back to a healthy, pain-free life.

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Herniated lumbar disc

Overview

A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall, similar to the filling being squeezed out of a jelly doughnut. Back or leg pain, numbness or tingling may result when the disc material touches or compresses a spinal nerve. Treatment with rest, pain medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be recommended.

Anatomy of the discs

Your spine is made of 24 moveable bones called vertebrae. The lumbar (lower back) section of the spine bears most of the weight of the body. There are 5 lumbar vertebrae numbered L1 to L5. The vertebrae are separated by cushiony discs, which act as shock absorbers preventing the vertebrae from rubbing together. The outer ring of the disc is called the annulus. It has fibrous bands that attach between the bodies of each vertebra. Each disc has a gel-filled center called the nucleus. At each disc level, a pair of spinal nerves exit from the spinal cord and branch out to your body. Your spinal cord and the spinal nerves act as a “telephone,” allowing messages, or impulses, to travel back and forth between your brain and body to relay sensation and control movement (see Anatomy of the Spine).

What is a herniated lumbar disc?

A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall (annulus) (Fig. 1).The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if low back and/or leg pain is going to resolve it will do so in about 6 weeks.

Figure 1. Normal and herniated disc. The gel-filled nucleus material escapes through a tear in the disc annulus and compresses the spinal nerve.

Different terms may be used to describe a herniated disc. A bulging disc (protrusion) occurs when the disc annulus remains intact, but forms an outpouching that can press against the nerves. A true herniated disc (also called a ruptured or slipped disc) occurs when the disc annulus cracks or ruptures, allowing the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal.

Most herniated discs occur in the lumbar spine, where spinal nerves exit between the lumbar vertebrae, and then join together again to form the sciatic nerve, which runs down your leg.

What are the symptoms?

Symptoms of a herniated disc vary greatly depending on the location of the herniation and your own response to pain. If you have a herniated lumbar disc, you may feel pain that radiates from your low back area, down one or both legs, and sometimes into your feet (called sciatica). You may feel a pain like an electric shock that is severe whether you stand, walk, or sit. Activity such as bending, lifting, twisting, and sitting may increase the pain. Lying flat on your back with knees bent may be the most comfortable because it relieves the downward pressure on the disc.

Sometimes the pain is accompanied by numbness and tingling in your leg or foot. You may experience cramping or muscle spasms in your back or leg.

In addition to pain, you may have leg muscle weakness, or knee or ankle reflex loss. In severe cases, you may experience foot drop (your foot flops when you walk) or loss of bowel or bladder control. If you experience extreme leg weakness or difficulty controlling bladder or bowel function, you should seek medical help immediately.

What are the causes?

Discs can bulge or herniate because of injury and improper lifting or can occur spontaneously. Aging plays an important role. As you get older, your discs dry out and become harder. The tough fibrous outer wall of the disc may weaken. The gel-like nucleus may bulge or rupture through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking, and a number of occupational and recreational activities may lead to early disc degeneration.

Who is affected?

Herniated discs are most common in people in their 30s and 40s, although middle aged and older people are slightly more at risk if they’re involved in strenuous physical activity.

Lumbar disc herniation is one of the most common causes of lower back pain associated with leg pain, and occurs 15 times more often than cervical (neck) disc herniation. Disc herniation occurs 8% of the time in the cervical (neck) region and only 1 to 2% of the time in the upper-to-mid-back (thoracic) region.

How is a diagnosis made?

When you first experience pain, consult your family doctor. Your doctor will take a complete medical history to understand your symptoms, any prior injuries or conditions, and determine if any lifestyle habits are causing the pain. Next a physical exam is performed to determine the source of the pain and test for any muscle weakness or numbness.

Your doctor may order one or more of the following imaging studies: X-ray, MRI scan, myelogram, CT scan, or EMG. Based on the results, you may be referred to a neurologist, orthopedist, or neurosurgeon for treatment.

Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine. Unlike an X-ray, nerves and discs are clearly visible (Fig. 2). It may or may not be performed with a dye (contrast agent) injected into your bloodstream. An MRI can detect which disc is damaged and if there is any nerve compression. It can also detect bony overgrowth, spinal cord tumors, or abscesses.

Figure 2. MRI image and illustration show a disc herniation between the L5 vertebra and the sacrum. On MRI healthy discs appear white and plump, while degenerative, dried out discs appear grayish and flattened.

Myelogram is a specialized X-ray where dye is injected into the spinal canal through a spinal tap. An X-ray fluoroscope then records the images formed by the dye. The dye used in a myelogram shows up white on the X-ray, allowing the doctor to view the spinal cord and canal in detail. Myelograms can show a nerve being pinched by a herniated disc, bony overgrowth, spinal cord tumors, and abscesses. A CT scan may follow this test.

Computed Tomography (CT) scan is a noninvasive test that uses an X-ray beam and a computer to make 2-dimensional images of your spine. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. This test is especially useful for confirming which disc is damaged.

Electromyography (EMG) & Nerve Conduction Studies (NCS). EMG tests measure the electrical activity of your muscles. Small needles are placed in your muscles, and the results are recorded on a special machine. NCS is similar, but it measures how well your nerves pass an electrical signal from one end of the nerve to another. These tests can detect nerve damage and muscle weakness.

X-rays view the bony vertebrae in your spine and can tell your doctor if any of them are too close together or whether you have arthritic changes, bone spurs, or fractures. It’s not possible to diagnose a herniated disc with this test alone.

What treatments are available?

Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, physical therapy, home exercises, hydrotherapy, epidural steroid injections (ESI), chiropractic manipulation, and pain management. With a team approach to treatment, 80% of people with back pain improve in about 6 weeks and return to normal activity. If you don’t respond to conservative treatment, your doctor may recommend surgery.

Nonsurgical treatments

Self care: In most cases, the pain from a herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks. Restricting your activity, ice/heat therapy, and taking over the counter medications will help your recovery.

Medication: Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications (NSAIDs), muscle relaxants, and steroids.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) (NSAIDs), such as aspirin, naproxen (Alleve, Naprosyn), ibuprofen (Motrin, Nuprin, Advil), and celecoxib (Celebrex), are used to reduce inflammation and relieve pain.
  • Analgesics, such as acetaminophen (Tylenol), can relieve pain but don’t have the anti-inflammatory effects of NSAIDs. Long-term use of analgesics and NSAIDs may cause stomach ulcers as well as kidney and liver problems.
  • Muscle relaxants, such as methocarbamol (Robaxin), carisoprodol (Soma) and cyclobenzaprine (Flexeril), may be prescribed to control muscle spasms.
  • Steroids may be prescribed to reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) in a tapering dosage over a five-day period. It has the advantage of providing almost immediate pain relief within a 24-hour period.

Steroid injections: The procedure is performed under x-ray fluoroscopy and involves an injection of corticosteroids and a numbing agent into the epidural space of the spine. The medicine is delivered next to the painful area to reduce the swelling and inflammation of the nerves (Fig. 3). About 50% of patients will notice relief after an epidural injection, although the results tend to be temporary. Repeat injections may be given to achieve the full effect. Duration of pain relief varies, lasting for weeks or years. Injections are done in conjunction with a physical therapy and/or home exercise program.

Figure 3. During an ESI injection, the needle is inserted from the back on the affected side to reach the epidural space to deliver steroid medication (green) to the inflamed nerve root.

Physical therapy: The goal of physical therapy is to help you return to full activity as soon as possible and prevent re-injury. Physical therapists can instruct you on proper posture, lifting, and walking techniques, and they’ll work with you to strengthen your lower back, leg, and stomach muscles. They’ll also encourage you to stretch and increase the flexibility of your spine and legs. Exercise and strengthening exercises are key elements to your treatment and should become part of your life-long fitness.

Holistic therapies: Some patients find acupuncture, acupressure, nutrition / diet changes, meditation, and biofeedback helpful in managing pain as well as improving overall health.

Surgical treatments

Surgery for a herniated lumbar disc, called a discectomy, may be an option if your symptoms do not significantly improve with conservative treatments. Surgery may also be recommended if you have signs of nerve damage, such as weakness or loss of feeling in your legs.

Microsurgical discectomy: The surgeon makes a 1–2 inch incision in the middle of your back. To reach the damaged disc, the spinal muscles are dissected and moved aside to expose the vertebra. A portion of the bone is removed to expose the nerve root and disc. The portion of the ruptured disc that touches your spinal nerve is carefully removed using special instruments. About 80–85% of patients successfully recover from a discectomy and are able to return to their normal job in approximately 6 weeks.

Minimally invasive microendoscopic discectomy: The surgeon makes a tiny incision in the back. Small tubes called dilators are used with increasing diameter to enlarge a tunnel to the vertebra. A portion of the bone is removed to expose the nerve root and disc. The surgeon uses either an endoscope or a microscope to remove the ruptured disc. This technique causes less muscle injury than a traditional discectomy.

Clinical trials

Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including their eligibility, protocol, and locations are found on the web. Studies can be sponsored by The National Institutes of Health (NIH), clinicaltrials.gov, as well as private industry and pharmaceutical companies, www.centerwatch.com.

Recovery & prevention

Back pain affects 8 of 10 people at some time in their lives, and usually resolves within 6 weeks. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If your regular job cannot be done initially, it is in the patient’s best interest to return to some kind of modified (light or restricted) duty. Your physician can give prescriptions for such activity for limited periods of time.

The key to avoiding recurrence is prevention:

  • Proper lifting techniques (see Self Care for Neck & Back Pain)
  • Good posture during sitting, standing, moving, and sleeping
  • Appropriate exercise program to strengthen weak abdominal muscles and prevent re-injury
  • An ergonomic work area
  • Healthy weight and lean body mass
  • A positive attitude and stress management
  • No smoking

Sources & links

If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Links

Glossary

annulus (annulus fibrosis): tough fibrous outer wall of an intervertebral disc.

disc (intervertebral disc): a fibrocartilagenous cushion that separates spinal vertebrae. Has two parts, a soft gel-like center called the nucleus and a tough fibrous outer wall called the annulus.

foramen (intervertebral foramen): the opening or window between the vertebrae through which the nerve roots leave the spinal canal.

nucleus (nucleus pulposus): soft gel-like center of an intervertebral disc.

sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the fifth lumbar spinal nerve.

vertebra: (plural vertebrae): one of 33 bones that form the spinal column, they are divided into 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. Only the top 24 bones are moveable.

updated > 9.2018
reviewed by > Robert Bohinski, MD, PhD, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.

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