A herniated disk is a common cause of back pain. It happens when the soft center of a spinal disk slips out of its casing. This can affect nearby nerves, leading to pain, numbness, or weakness in the limbs.

Some people experience no pain from a herniated disk, particularly if the disk does not press on any nerves. People also refer to the condition as a slipped disk or disk prolapse.

Although it can sometimes be extremely painful, a herniated disk has many promising treatment options. Symptoms normally reduce or resolve after a number of weeks, but a person may need surgery if these persist or get worse.

This article will examine the causes, diagnosis, and treatment of a herniated disk. It will also discuss the risk factors for disk herniation and strategies that may help to prevent the condition.

An anatomical diagram showing a cross section of the spine with a disk herniationShare on Pinterest
The soft center of a spinal disk pushes through a crack in the disk’s fibrous lining. This herniated material can put pressure on a spinal nerve or nerve root. Image by: Yaja’ Mulcare

A herniated or slipped disk occurs when some of the soft internal section of a spinal disk (the nucleus) slips out through a crack in the disk’s fibrous lining. This most commonly occurs in the lower back but can also happen in the spinal column of the neck and middle back.

The cause of a herniated disk is usually gradual wear and overuse as a result of repeated movement over time. In older people, spinal disks become drier and weaker, making a herniated disk more likely.

Some medical conditions can increase the risk of disk herniation, including spinal stenosis and connective tissue disorders.

The escape of the disk’s inner section releases chemicals that can irritate nerves in the surrounding area and cause inflammation and pain. The herniated disk can also put pressure on nerves and cause pain through compression.

In some cases, a person will have no symptoms. However, common symptoms can include:

  • Numbness or tingling: This can happen when a herniated disk presses on the spinal cord or the nerves that exit the spinal cord. The unusual sensations may travel outwards along the nerve, into the arms or legs.
  • Muscle weakness: When a herniated disk presses on a nerve, the muscles connected to the nerve may become weaker. This can cause stumbling when walking.
  • Pain: This usually occurs in the back and may radiate out to the arms or legs. People sometimes describe the sensation as burning or sharp.

Symptoms of a herniated disk can also differ according to the location of the problem.

A severely herniated disk in any region of the back can potentially cause problems with bowel or bladder control. If a person has back pain and sudden changes to their bladder or bowel control, this is usually a sign that emergency medical help is needed.

Lower back (lumbar region)

If the herniated disk is in the lower back, the pain often affects the buttocks, thighs, and calves. Pain that travels along the path of the sciatic nerve, from the buttocks and down the legs, is known as sciatica.

Neck (cervical region)

If the problem occurs in the neck, pain is more likely in the shoulders and arms. A serious herniation in the neck region can also cause stiffness, weakness, and numbness in the legs.

Middle back (thoracic region)

A herniated disk in the middle back is likely to cause pain around the location of the herniation. Pain may travel around the rib cage to the front of the body. This is the least common area for disk herniation.

More than 85% of people with herniated disk symptoms will recover on their own, though this can take up to 12 weeks.

Most of the time, people can resolve symptoms by avoiding movements that trigger pain and following the exercise and pain management regimens that a doctor recommends.

Treatment options include medication, physical therapy, injections, and surgery.

Medication

  • Over-the-counter (OTC) medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help reduce pain.
  • Opioids: If pain is severe and OTC medications do not relieve discomfort, a doctor may prescribe opioid medications. It is important to discuss the potential risks and side effects of opioid medications with a doctor if they recommend this treatment option.
  • Muscle relaxants: These medications can help to relax painful areas, but they can also cause fatigue and other serious side effects.
  • Nerve pain medications: If symptoms persist over time, a doctor may prescribe anticonvulsant medications that people use for nerve pain, such as gabapentin. However, these medications can also cause side effects such as drowsiness.

Physical therapy

A physical therapist can recommend positions and exercises that minimize herniated disk pain.

Because disk herniation symptoms often resolve on their own, physical therapy is not usually recommended during the first 3 weeks after symptoms begin. A doctor can make more specific recommendations in an individual case.

It is important to always consult a doctor when starting a new exercise or physical therapy program.

Injections

A doctor can use injection medications to help relieve the symptoms of a herniated disk. The procedure is also known as a nerve block.

Injection procedures that doctors use to treat a herniated disk include epidural injections and spinal nerve injections.

Learn more about epidural procedures here.

Surgery

Most of the time, disk herniation will improve with nonsurgical treatment. However, the treating doctor may recommend surgery if a person has symptoms such as:

  • muscle weakness
  • pain that persists over time
  • mobility issues
  • problems with bladder or bowel control

Surgical treatments for disk herniation include the following:

  • Discectomy: This is where a surgeon removes all or part of a disk.
  • Nucleotomy: This removes the soft center (nucleus) of the disk via suction or laser excision.
  • Laminectomy: A surgeon may remove part of the vertebrae to make room for nerves.
  • Spinal fusion: In this procedure, a surgeon may join two or more vertebrae together.
  • Disk replacement: This procedure replaces herniated disks with artificial implants.

Learn more about herniated disk surgeries here.

A doctor can often diagnose a herniated disk with a physical exam. They may check:

  • reflexes
  • the location of any painful regions in the back
  • muscle strength
  • range of motion
  • walking ability
  • sensitivity to touch

A doctor will also ask when symptoms began and whether a person has had similar symptoms in the past.

Imaging tests

In some cases, a doctor will request imaging tests. This is more likely if the results of the physical exam indicate that there may be neurological symptoms requiring treatment.

Imaging tests include:

Below the waistline, the spinal cord separates into a group of individual nerves, collectively called the cauda equina, or “horse’s tail.”

In rare instances, a herniated disk can compress this entire set of nerves. This is called cauda equina syndrome (CES).

CES can cause permanent weakness, paralysis, loss of bowel and bladder control, and sexual dysfunction. Emergency surgery is necessary to treat CES.

A herniated disk can happen to anyone, but the condition is most common among males and people aged from 30–50 years.

Factors that increase the likelihood include:

Tips for preventing a herniated disk include:

  • learning the correct techniques for lifting and handling heavy items
  • avoiding painful movements and seeking a doctor’s advice if symptoms occur
  • managing weight, if being overweight or obesity is a concern
  • speaking with a doctor about strategies to quit smoking for individuals who smoke

A herniated disk occurs when the jelly-like center of a spinal disk protrudes through the disk’s outer casing. This can result in pain, numbness, and weakness if the slipped disk causes pressure or irritation to nearby nerves.

People can’t always prevent disk herniation. Aging, genetics, and frequent driving are some of the factors that make a herniation more likely. But experts suggest that using safer lifting techniques, quitting smoking, and managing weight can help to reduce the risk.

In many cases, a doctor can use a physical exam to diagnose a herniated disk. They may order imaging tests such as an X-ray or CT scan if they need more information about the condition of the spine and disks.

Herniated disks can cause severe pain, but the right treatment can relieve symptoms. Available treatments include pain medication and physical therapy. Most people will recover with minimal intervention. In more severe cases, a person may require surgery.