Herniated Disc

What is a herniated disc (HNP/herniated nucleus pulposus)?

Back pain? “Maybe you’ve got a herniated disc!” Yet only 5% of all back complaints can be traced back to a herniated disc. Most back complaints are non-specific, in other words there is no clear cause for the symptoms.

When we think of a herniated disc, we usually think of the lower back. But herniated discs also occur in the neck, although these are rarer.

Most herniated discs resolve on their own within 12 weeks. The Dutch word ‘hernia’ means ‘protrusion’. In a herniated disc there is a tear in an intervertebral disc in the spine, through which the elastic material that acts as a ‘shock absorber’ between the vertebrae comes out and presses, or may press, on a nerve. The disc is often inflamed as well. The resulting nerve pain can be very intense and is not comparable to ordinary back or neck pain. At the same time, many people have a (small) herniated disc without knowing it. As long as there is no pressure on the nerves, a herniated disc can go unnoticed and cause no symptoms.

Types of herniated disc

A herniated disc can occur anywhere in the spine, but usually develops in the lower back and, to a lesser extent, in the neck. We therefore distinguish between lumbar (back) and cervical (neck) herniated discs. Most lumbar herniated discs occur in the lowest vertebrae, L5-S1 and/or L4-L5 (lower back herniated disc).

How does a herniated disc develop and what are the symptoms? A herniated disc in the back or neck can be caused by:

• heavy or (prolonged) incorrect loading
• weak muscle function
• an awkward movement or a trauma (accident)
• lack of exercise
• hereditary factors (herniated discs are more common in some families than in others)
• Stress and smoking increase the risk of a herniated disc.

Symptoms of a herniated disc in the back

• A sharp pain in one buttock or leg (radiating pain). The pain can sometimes be felt down into the lower leg or the foot.
• The leg may feel burning, prickling or numb. You may have difficulty sensing heat or cold.
• Standing or walking makes the pain worse. Sometimes the muscles in the back can go into spasm.
• Pain in the lower back.
• The pain gets worse when coughing or sneezing.
• Weakness in a leg or the feeling of ‘walking on clouds’. In severe cases foot drop can develop. The pressure on the nerve is (or has been) so great that the motor function of the nerve (temporarily) fails.
• Reduced reflexes.

Symptoms of a herniated disc in the neck

Symptoms of a herniated disc in the neck include:

• pain in one arm. This is a sharp, cutting, burning or shooting pain, often reaching into the hand. The pain is almost constantly present.
• neck pain
• a numb or ‘dead’ feeling in the arm and/or hand
• weakness in the shoulder, arm or hand
• tingling or a prickling sensation in the arm and/or hand

Many people have neck complaints before they develop arm pain.

What can I do about a herniated disc?

Fortunately, most herniated discs resolve on their own without lasting complaints. Around 80% of people are free of symptoms after 12 weeks. By then the bulging disc has retracted, relieving the pressure on the nerve. Mild loss of nerve function usually recovers on its own too, although this can take longer.

Whereas patients with a herniated disc used to be operated on almost routinely or prescribed long periods of bed rest, this is no longer the case. Surgery is now only performed when symptoms persist for a long time, the pain cannot be controlled, or there is (serious) loss of nerve function.

A herniated disc can be diagnosed quickly by a GP, physiotherapist or osteopath using a few simple neurological tests. An X-ray is of no use (a herniated disc does not show up on it). Only in severe cases is an MRI sometimes carried out to determine the size and severity of the herniated disc.

If you have a herniated disc in your back or neck, it is best to do the following:

• alternate rest and movement. Do not stay in bed: your muscles will only get weaker and your fitness will decline.
• take paracetamol or ibuprofen for the pain. If the pain is very severe, your GP can prescribe stronger painkillers, such as tramadol or oxycodone (an opioid).
• do the exercises recommended by your practitioner

Do I need to see my GP first?

No, that is not necessary. With a herniated disc you can make an appointment with the osteopath straight away.

If you are in severe pain, and certainly if you have loss of nerve function, it is advisable to see your GP.

Do I need to see my GP first? No, that is not necessary. With a herniated disc you can make an appointment with the osteopath straight away. However, call your GP or the out-of-hours GP service immediately if you have one or more of these symptoms:

• if you suddenly have less strength in your leg (you can no longer stand on your toes or heels)
• if you have lost feeling around your penis, vagina or anus
• if you can no longer pass urine
• if you can no longer control your bladder or bowels
• This may indicate cauda equina syndrome, in which a large herniated disc presses on several nerves at once. This is a medical emergency requiring prompt surgery to free the nerves.

How can an osteopath help with a herniated disc?

Scientific research shows that osteopathy has a positive effect in the treatment of a herniated disc in the back or neck. Using gentle techniques, the osteopath removes blockages in the back, pelvis or abdomen, improving the blood supply to the damaged disc. The treatment also reduces the pressure between the vertebrae, which eases the pain.

With treatment, the osteopath supports the natural recovery of a herniated disc. The osteopath can also give you exercises and point out the importance of lifestyle changes (such as stopping smoking, reducing stress, etc.).

Osteopathy can help prevent a new herniated disc.