How to relieve herniated disc pain in lower back at home

In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. For information:  Questions and Answers for Patients Regarding Elective Surgery and COVID-19. For patients whose procedures have not yet been rescheduled:  What to Do If Your Orthopaedic Surgery Is Postponed.

A herniated disk is a condition that can occur anywhere along the spine, but most often occurs in the lower back. It is sometimes called a bulging, protruding, or ruptured disk. It is one of the most common causes of lower back pain, as well as leg pain, or sciatica.

Between 60 and 80% of people will experience low back pain at some point their lives. Some of these people will have low back pain and leg pain caused by a herniated disk.

Although a herniated disk can be very painful, the majority of people feel much better with just a few weeks or months of nonsurgical treatment. 

Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord.

Five vertebrae make up the lower back. This area is called your lumbar spine.

Other parts of your spine include:

Spinal cord and nerves. These electrical cables travel through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae called foramen.

Intervertebral disks. In between your vertebrae are flexible intervertebral disks. These disks are flat and round, and about a half inch thick.

Intervertebral disks act as shock absorbers when you walk or run. They are made up of two components:

• Annulus fibrosus. This is the tough, flexible outer ring of the disk.
• Nucleus pulposus. This is the soft, jelly-like center of the disk.

A disk begins to herniate when its jelly-like nucleus pushes against its outer ring due to wear and tear or a sudden injury. This pressure against the outer ring may cause lower back pain. 

If the pressure continues, the jelly-like nucleus may push all the way through disk’s outer ring or cause the ring to bulge. This puts pressure on the spinal cord and nearby nerve roots. Not only is this a mechanical compression of the nerves, but the disk material also releases chemical irritants that contribute to nerve inflammation. When a nerve root is irritated, there may be pain, numbness, and weakness in one or both of your legs, a condition called sciatica.

Watch: Herniated Disk in the Lower Back Animation

A herniated disk is most often the result of natural, age-related wear and tear on the spine. This process is called disk degeneration. In children and young adults, disks have high water content. As people age, the water content in the disks decreases and the disks become less flexible. The disks begin to shrink and the spaces between the vertebrae get narrower. This normal aging process makes the disks more prone to herniation.

A traumatic event, such as a fall, can also cause a herniated disk.

In most cases, low back pain is the first symptom of a herniated disk. This pain may last for a few days, then improve. Other symptoms may include:

• Sciatica. This is a sharp, often shooting pain that extends from the buttock down the back of one leg. It is caused by pressure on the spinal nerve.
• Numbness or a tingling sensation in the leg and/or foot
• Weakness in the leg and/or foot
• Loss of bladder or bowel control. This is extremely rare and may indicate a more serious problem called cauda equina syndrome. This condition is caused by the spinal nerve roots being compressed. It  requires immediate medical attention.

Medical History and Physical Examination

After discussing your symptoms and medical history, your doctor will perform a physical examination. The exam may include the following tests:

• Neurological examination. A neurological examination will help your doctor determine if you have any muscle weakness or loss of sensation. During the exam, the doctor will:
  • Check muscle strength in your lower leg by assessing how you walk on both your heels and toes. Muscle strength in other parts of your body may also be tested.
  • Detect loss of sensation by checking whether you can feel a light touch on your leg and foot.
  • Test your reflexes at the knee and ankle. These may sometimes be absent if there is a compressed nerve root in your spine.
• Straight leg raise (SLR) test. This is a specialized test to predict if a disk herniation in present, especially in younger patients. During the test, you lie on your back and your doctor carefully lifts your affected leg. Your knee stays straight. If you feel pain down your leg and below the knee, it is a strong indication that you have a herniated disk.

For the majority of patients, a herniated lumbar disk will slowly improve over a period of several days to weeks. Typically, most patients are free of symptoms by 3 to 4 months. However, some patients do experience episodes of pain during their recovery.

Overall, the results of microdiskectomy surgery are generally very good. Patients tend to see more improvement of leg pain than back pain. Most patients are able to resume their normal activities after a period of recovery following surgery. Typically, the first symptom to improve is pain, followed by overall strength of the leg, and then sensation.

In recent years, there has been extensive research on the treatment of disk herniation. Your doctor will be able to talk with you about the advantages and disadvantages of both surgical and nonsurgical treatment.

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