Lumbar Herniated Disc

Know Everything From Causes, Symptoms, To Treatment

Jump to

Symptoms
Causes
Treatment
Our Providers

A lumbar herniated disc occurs when the soft inner core of a spinal disc in the lower back pushes through its tougher outer layer, irritating or compressing nearby spinal nerves. This condition can be caused by age-related degeneration, sudden movements or twists, and injury from lifting heavy objects. Common symptoms include sharp, shooting pain in the lower back, numbness or tingling in the legs, and discomfort that worsens with certain activities like sitting or prolonged standing.

At Compass Pain and Wellness, we understand that each patient’s experience with a lumbar herniated disc is unique. For older adults, it may stem from wear and tear and limit daily activities, while athletes experiencing a low back injury may lose training and playing time^[1].

That is why we strive to offer evidence-based, comprehensive care plans that address all aspects of pain and are fully tailored to your specific needs and wants. Discover how our therapies can help you take control of your spinal health, reduce pain, and improve your quality of life.

What Is A Lumbar Herniated Disc?

The spine is a complex structure composed of bones, known as vertebrae. These bones create a passageway, called the spinal canal. This acts as a protective channel for the spinal cord, a “highway” for nerves connecting the brain to the rest of the body.

The spine is segmented into regions.

The lower section, known as the lumbar region, consists of five vertebrae (L1-L5). The lumbar spine plays a key role in mobility and stability:

Supports much of the body’s weight, providing stability for movements like standing and sitting.
Allows for a range of movements, including bending, twisting, and rotating.
Protects the lower part of the spinal cord and nerves that extend to the lower body.
Helps absorb and distribute stress through activities like walking or lifting.
Contributes to maintaining an upright posture, which is crucial for balance and spinal alignment.

Between each pair of vertebrae is a disc of cartilage, known as an intervertebral disc. These discs act as cushions to absorb shocks, prevent friction between bones, and maintain the spine’s smooth movement.

Each intervertebral disc has two distinct zones:

Annulus fibrosus: This is the outer layer of the disc. It is a ring-like structure made of tough, fibrous tissue. Its role is to provide strength and flexibility, enabling the spine to withstand pressure and movement.
Nucleus pulposus: This is the softer inner core of the disc. It is composed of a gel-like substance that helps the disc absorb pressure and distribute load evenly.

A lumbar herniated disc occurs when the softer core pushes out through a tear in the tougher exterior. The protruding gel-like substance can potentially compress nearby nerves, causing symptoms like lower back pain, leg pain, and numbness.

Types Of Disc Herniations

Lumbar disc herniations can vary significantly in nature and severity. Understanding these differences is crucial for accurate diagnosis and treatment.

Protrusion (bulging disc): In this type of herniation, the softer core of the disc pushes outwards beyond its normal boundaries, but doesn’t break through the tough outer ring. It can occur when the annulus is weakened by age-related degeneration or repeated stress on the lower back. While the nucleus remains contained, its protrusion may compress nearby nerves, causing discomfort and pain.
Extrusion: This occurs when the disc’s core breaks through the annulus fibrosus and extends into the spinal canal. Although still attached to the disc, the protrusion can put pressure on surrounding nerves. This often results in more intense pain and neurological symptoms, like numbness and pins-and-needles sensations, compared to a bulging disc.
Sequestration (free fragment): In sequestration, the herniated fragment of the disc breaks away entirely from the disc structure. Once detached, the fragment can move up or down the spinal canal. The location of the fragment will determine where you’ll experience symptoms. For example, if the detached fragment pressures nerves in the neck area, you may feel numbness or pain in your arms. If lodged in the lower back, symptoms will be felt in the hip or leg.
Contained herniation: In a contained herniation, the outer ring of the disc remains intact but begins to stretch. This protrusion can irritate nearby nerves, causing localized pain and discomfort.

Herniation can affect any disc in the spine. However, studies^[2] estimate that 95% of lumbar disc herniations affect the L4-L5 or L5-S1 segments of the spine.

Symptoms Associated With Lumbar Herniated Disc

Lumbar disc herniation is often associated with pain, numbness, pins-and-needles sensations, and inflammation. These symptoms occur because the protruding substance can irritate the nerves in the spinal cord, inhibiting the ability of nerves to transmit motor and sensory signals correctly between the brain and the rest of the body.

However, if you have a herniated disc, the location and severity of your symptoms will depend on the type and extent of the herniation. For example, if the outer ring of the disc is ruptured and the gel-like substance leaks into the spinal cord, you are more likely to experience severe pain and numbness, usually affecting the lower extremities. In sequestration, the free fragment from the disc can become lodged in other areas of the spine. When this happens, nerves far from where the herniation occurred—like in the neck or thoracic areas—become affected, leading to symptoms perceived in other parts of the body.

Additionally, minor herniation cases are sometimes asymptomatic (have no symptoms). Research^[3] shows that bulging discs affect around a third of individuals in their 20s and 84% of those aged 80 and above. However, in most cases, these bulging discs don’t cause pain or numbness.

Common signs associated with lumbar herniated discs include:

Lower Back Pain

Lower back pain may arise from strain, disc issues, or nerve compression, often limiting movement.

Muscle Weakness

Muscle weakness may stem from nerve, muscle, or joint issues, making movement and activity more difficult.

Tingling And Numbness

Restricted range of motion may result from stiffness, inflammation, or damage, making movement difficult.

Muscle Spasms

Muscle spasms are sudden contractions from nerve issues, dehydration, or fatigue, causing pain and stiffness.

Difficulty Standing Or Walking

Difficulty standing or walking may result from muscle, joint, or nerve issues, affecting daily mobility.

Common Causes Of Disc Herniation

Lumbar disc herniation is estimated to affect up to 3% of the population^[4], with peak prevalence in people aged between 40 and 50. However, this condition often arises from a combination of causes and risk factors, and it can affect anyone, at any stage of life.

Factors that can increase the likelihood of disc herniation through various mechanisms include:

Age-related degeneration: As we age, the intervertebral discs naturally lose hydration and elasticity. Research^[5] estimates that around 90% of individuals aged 60 and over show some degree of disc degeneration. Over time, wear-and-tear leads to decreased disc height and increased susceptibility to tears in the annulus fibrosus, which increase the risk of herniation.

Genetics: Genetic predisposition can play a role in disc herniation. Individuals with a family history of spinal conditions may be at risk of early disc degeneration, which increases the likelihood of herniation. A 2011 study^[6] found that individuals with lumbar disc herniation often have both close and more distant relatives with this condition. This supports the idea that genetics contribute to the likelihood of developing lumbar disc issues.
Physical strain: Activities that involve heavy lifting, sudden twisting, or excessive force can stress the lumbar discs. This strain leads to increased pressure within the disc, potentially causing the nucleus to break through the annulus.
Repetitive movements: Jobs or sports that require repetitive bending, twisting, or lifting increase the risk of developing disc herniation. Over time, these movements can wear down the annulus fibrosus, making it more prone to rupture.
Degenerative disc disease: This condition accelerates the natural aging process of the spine. Discs become increasingly brittle and lose their ability to absorb shock. The weakened discs are more prone to bulging and herniation, particularly in the lumbar region.

How Medical Professionals Diagnose Herniated Discs

Diagnosing a lumbar herniated disc requires a comprehensive approach to accurately identify the cause of symptoms and develop an effective treatment plan. Physicians may utilize several diagnostic tools, including:

Physical exams: Physical examinations help evaluate range of motion, muscle strength, and reflexes. A physician may also palpate the lower back to determine what areas feel painful.
Imaging techniques: Imaging tests are used to obtain a view of the inner aspect of the spine. Common tests include:
- MRI (magnetic resonance imaging) provides images of soft tissues, like discs and nerves.
- CT scans (computed tomography) provide cross-sectional images of the spine. They can be useful to identify bone-related issues and changes in the structure of the disc.
Medical history review: A physician will review factors like your symptoms, occupation, sports involvement, previous spinal conditions or injuries, and your family history. This helps determine genetic traits or lifestyle factors that may be contributing to the herniation.

Physicians will also check for other conditions, like arthritis or osteoporosis, which can compromise spine health and increase the risk of disc herniation.

Complications If Lumbar Herniated Disc Is Left Untreated

Untreated lumbar herniated discs can lead to complications, including the following:

Development of chronic back pain: Untreated disc herniation can lead to recurrent herniation. This condition affects up to 14% of patients^[7] and is often associated with months of severe pain and increased healthcare costs. Additionally, prolonged nerve irritation and inflammation caused by a herniated disc can become harder to treat over time, increasing the risk of chronic low back pain.

Nerve damage: Continuous pressure on spinal nerves can lead to irreversible nerve damage. Damaged nerves are unable to properly transmit signals relating to movement and sensation, causing numbness, pins and needles, and burning pain.
Cauda equina syndrome: This condition arises when nerve roots at the base of the spine become compressed. This leads to serious neurological symptoms, including severe lower back pain, loss of sensation in the legs, and bowel or bladder dysfunction. 45% of cases^[8] of cauda equina syndrome stem from a lumbar herniated disc, making this a leading cause. This condition is considered a medical emergency requiring immediate surgical intervention.
Atrophy: Ongoing pain can limit mobility and make activity undesirable. Over time, disuse causes muscles in the back and limbs to weaken or shrink. This affects strength and posture and increases the risk of ongoing back issues.
Loss of mobility: Persistent discomfort and pain compromise movement and flexibility, often leading to reduced physical activity and quality of life.
Muscle weakness: Compressed or damaged motor nerves in the low back can become unable to control muscles in the lower extremities. This can lead to numbness, muscle weakness, and spasms, affecting coordination and balance. Herniation of the L4-L5 intervertebral disc is also considered a leading cause of foot drop^[9], a condition where a person cannot lift the front part of the foot.
Sleep disruption: Pain and discomfort can hinder sleep quality, leading to fatigue and worsening of other health conditions, including chronic pain. A 2019 study^[10] confirmed that sleep quality is directly affected in patients with low back pain.

Mental health effects: Chronic pain and reduced mobility can increase the risk of depression, anxiety, and other mental health challenges due to lifestyle changes and frustration. A 2023 study^[11] shows that there is a direct correlation between back pain and the risk of depressive symptoms. Similarly, 2019 research^[12] highlights that lumbar disc herniation can lead to or worsen chronic pain, which is associated with depressive behavior.
Sciatica: The sciatic nerve is the body’s longest and largest nerve, running from the lower back through the legs. It is responsible for controlling leg movement and sensation. A herniated disc can press on this nerve, causing sciatica, a condition that causes sharp pain, numbness, or weakness in the leg. If untreated, it can lead to chronic pain or mobility issues.
Bladder or bowel dysfunction: Severe nerve compression can disrupt bladder and bowel function. For example, involuntary contractions of the bladder nerves can lead to incontinence or loss of control.
Permanent disability: Over time, untreated herniated discs can severely restrict daily activities and lead to long-term disability if nerve damage and other complications progress. Today, low back pain is considered a leading cause of long-term disability^[13], and it’s most commonly caused by lumbar disc herniation.

We provide evidence-based treatments for lumbar herniated disc.

Experiencing a herniated lumbar disc can affect all aspects of your life—from your ability to participate in sports to mental health, physical function, and professional performance.

At Compass Pain and Wellness, we understand the debilitating effects of a lumbar herniated disc and the importance of addressing this condition. Our team of specialized physicians knows that each patient’s situation is different. That is why, at our clinic, we offer a comprehensive, evidence-based approach tailored to your unique needs and wants. Our aim is to alleviate symptoms while also taking a step further, addressing the root cause of pain and supporting long-term spinal health. We are here to support you every step of the way on your journey to recovery and well-being.

Massage

Massage therapy eases muscle tension and improves circulation to support pain relief and overall well-being.

Physical Therapy

Physical therapy improves strength, flexibility, and mobility while addressing pain from injury or chronic conditions.

Nerve Block

Nerve blocks interrupt pain signals from specific nerves to reduce chronic or procedure-related discomfort.

Epidural Steroid Injection

Epidural steroid injections reduce spinal inflammation to ease pain radiating from nerve compression or irritation.

Trigger Point Injections

Trigger point injections treat muscle knots by relaxing tense tissue and relieving localized pain or stiffness.

Spinal Cord Stimulation

Spinal cord stimulation delivers electrical pulses to block nerve pain and reduce discomfort in the back or limbs.

Back Injury: Whether from a fall, heavy lifting, or an accident, back injuries can weaken your spine, making it more vulnerable to weaknesses, herniated discs, and painful symptoms.
Spinal Cord Injury: Severe injuries to your spinal cord can lead to significant pain and mobility challenges, especially if herniated discs are involved.
Muscle Strain: Overusing or overstretching your muscles can put extra pressure on your spine, making herniated disc pain worse and everyday movements more difficult.

Our Providers

Meet our experienced and compassionate team of doctors who specialize in helping you manage your condition. With a patient-centered approach, our doctors work to understand your unique needs and provide compassionate, personalized care. Trust our providers to guide you on your journey to better health and improved well-being.

Dr. Kristi Reed, MD

Dr. Randolph Cribbs, MD

Dr. Carl Balog, MD

References

Discover personalized treatment options designed to manage your lumbar herniated disc effectively.

Contact Compass Pain today to schedule your consultation.

Get Started