Herniated Discs: Symptoms, Diagnosis, and Treatment Options

Herniated disc

Hello Doctor: I have been experiencing intermittent pain for over a year now, with symptoms being more pronounced during the colder winter months.
The only external factor I can think of is that I have been doing weight training at the gym and abdominal exercises at home.
Symptoms: Initially, there was a sharp pain in the upper left buttock, followed by sudden electric-like shooting pain along the left side of my lower back near the spine.
After several episodes of shooting pain, I began to feel a dull ache and tingling sensation from my buttock down to my calf.
In January of this year, I had an X-ray, and the doctor said there were no significant issues with the bones, no scoliosis, or abnormal spinal gaps; he only mentioned that the nerves were inflamed and suspected it was mostly fascia inflammation, prescribing anti-inflammatory medication.
After three days of taking the medication, I felt some relief (though the buttock still had some soreness), so I stopped taking it and went to the gym once more.
A few days later, the symptoms returned.
Afterward, I felt the medication was not very effective, so I started acupuncture and chiropractic adjustments.
After a few days, the pain returned, and now I am seeing a rehabilitation specialist who diagnosed me with a herniated disc.
I was advised to get an MRI at a larger hospital to confirm this.
Currently, I am relying on medication and rehabilitation therapy; I have been in rehab for five days, and the shooting pain has not recurred, but I still experience intermittent dull aches and tingling sensations in my lower back, buttocks, and thighs, mostly feeling like a nagging pain.
I found out that an MRI is out-of-pocket and not inexpensive, and after consulting three or four different traditional and Western medicine practitioners, I feel there is no unified answer, which is quite frustrating.
I am unsure if I truly have a herniated disc or if there are other underlying causes.
Will a herniated disc heal on its own with rehabilitation? During this period, is it safe for me to perform splits and stretching exercises? Thank you for your response.

Neko, 30~39 year old female. Ask Date: 2016/03/29

Dr. Zhang Junwei reply Neurosurgery

It appears to be symptoms of lumbar disc herniation compressing the nerves.
An MRI can be performed, and it is covered by health insurance, so there is no out-of-pocket expense.
However, the physician will assess the severity of the condition based on clinical symptoms to determine whether an MRI is necessary.

Reply Date: 2016/03/29

More Info

Herniated discs, also known as intervertebral disc herniation, occur when the soft inner gel-like core of a spinal disc bulges out through a tear in the tougher exterior. This condition can lead to various symptoms, including pain, numbness, and weakness in the affected areas, depending on the location of the herniation and whether it compresses nearby nerves.

Symptoms of Herniated Discs
The symptoms of a herniated disc can vary widely. Common symptoms include:
1. Localized Pain: This is often felt in the lower back or neck, depending on the location of the herniation.

2. Radiating Pain: Pain may radiate down the leg (sciatica) or arm, following the path of the affected nerve.

3. Numbness or Tingling: Patients may experience numbness or tingling in the extremities, which can be indicative of nerve compression.

4. Muscle Weakness: Weakness in the muscles served by the affected nerves can occur, leading to difficulties in movement.

5. Changes in Reflexes: Reflexes may be diminished or absent in the affected areas.

Diagnosis
Diagnosis typically involves a combination of physical examinations and imaging studies. A healthcare provider will assess the patient's medical history, perform a physical examination, and may order imaging tests such as:
- X-rays: While X-rays can show bone alignment and rule out other issues, they do not show soft tissue such as discs.

- MRI (Magnetic Resonance Imaging): This is the most effective imaging technique for visualizing herniated discs and assessing the extent of nerve compression.

- CT Scans: These can also be used to visualize the spine and identify herniations.

Treatment Options
Treatment for herniated discs often begins conservatively and may include:
1. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. In some cases, corticosteroids may be prescribed.

2. Physical Therapy: A structured physical therapy program can help strengthen the muscles around the spine, improve flexibility, and reduce pain.

3. Activity Modification: Avoiding activities that exacerbate symptoms is crucial. Patients are often advised to limit heavy lifting and high-impact activities.

4. Epidural Steroid Injections: In some cases, injections can help reduce inflammation and provide temporary relief from pain.

5. Surgery: If conservative treatments fail to relieve symptoms after several months, surgical options such as discectomy (removal of the herniated portion of the disc) may be considered.

Recovery and Rehabilitation
Recovery from a herniated disc can vary. Many patients experience significant improvement with conservative treatment, and some may find that their symptoms resolve completely. However, others may continue to experience discomfort or recurrent symptoms. Rehabilitation exercises, including stretching and strengthening, are essential for recovery and can help prevent future issues.

Preventive Measures
To prevent herniated discs, consider the following:
- Maintain a Healthy Weight: Excess weight can put additional strain on the spine.

- Exercise Regularly: Strengthening the core muscles can provide better support for the spine.

- Practice Good Posture: Proper ergonomics while sitting, standing, and lifting can help reduce the risk of injury.

- Avoid Smoking: Smoking can decrease blood flow to the spine and contribute to disc degeneration.

Conclusion
In your case, it seems that you have been experiencing symptoms consistent with a herniated disc, particularly with the pain radiating from your lower back to your leg. The fact that your symptoms worsen with certain activities, such as weightlifting, suggests that you may need to modify your exercise routine. While physical therapy and medication can be effective, it is essential to follow up with your healthcare provider for further evaluation, especially if symptoms persist or worsen. An MRI may be warranted to confirm the diagnosis and guide treatment. Always consult with a healthcare professional before starting or modifying any exercise regimen, particularly if you have a history of back issues.

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