Disc Herniation: Causes, Symptoms, and Non-Surgical Treatments

Herniated disc

Hello, doctor.
Since last July, I have experienced a problem after a game of pool.
When I bent down to play and then stood up, I felt a sudden pain in my lower back on the right side.
At that time, I didn't think much of it, and after sleeping, the pain was gone the next day.
However, I noticed that whenever I frequently bent down, I would experience back pain that day, and the pain worsened with the number of times I bent down (especially if I lifted heavy objects).
The pain occurs at the moment I bend down and then stand up, but it is only in my lower back; I haven't felt pain in my buttocks or legs.
After resting, I feel better the next day.
This situation has persisted for about eight months, with no significant improvement or worsening.
Generally, if I avoid bending down or lifting heavy objects, and just sit or stand for a long time, I don't experience pain.
Therefore, I try to avoid bending down to pick things up (but I don't want to avoid bending for the rest of my life).
I squat first to pick things up to avoid the pain, but I feel that this doesn't address the root problem.
If I bend down multiple times, the pain returns (I feel that the bending position compresses a nerve, and after repeated compression, the pain starts to increase, but I feel fine after sleeping).
Since I don't feel pain when I avoid bending, I've been putting this off for eight months, but I really want to address the underlying cause.
I want to return to my previous condition, so I recently visited an orthopedic clinic.
The doctor took X-rays and said that my spine looks fine, but he mentioned that X-rays cannot show a herniated disc.
He prescribed pain medication for me, but I didn't seek medical attention because of constant pain; I generally feel better after sleeping.
However, I genuinely want to resolve the issue of experiencing pain after bending multiple times.
Thank you for patiently reading my concerns.
I would like to ask if you have encountered similar cases.
How should I proceed? Can I get an MRI at the hospital? If I have a herniated disc, can I recover to my previous state of being able to bend down and pick things up without surgery, relying solely on rehabilitation? Thank you, doctor.

Xiao Wu, 20~29 year old female. Ask Date: 2016/04/02

Dr. Shi Guozheng reply Orthopedics

If there is a lumbar disc herniation, it may compress the sciatic nerve, leading to symptoms that are not just lower back pain but pain in the buttocks that radiates down the back of the thigh and calf to the sole of the foot, accompanied by numbness.
Symptoms may worsen when coughing or sneezing.
When performing a straight leg raise, there may be an electric shock-like sensation extending from the buttocks to the sole of the foot.
Therefore, your symptoms do not quite resemble typical sciatica.
An MRI is necessary only if there are neurological symptoms, such as sciatica, foot weakness, inability to dorsiflex the big toe, or issues with bowel or bladder control (cauda equina syndrome).
Only then will a physician agree to arrange such an examination.
If it is simply lower back pain, you may consider consulting a rehabilitation specialist to see if some rehabilitative treatment is needed.

Reply Date: 2016/04/02

More Info

Understanding disc herniation is crucial for anyone experiencing back pain, especially if it affects daily activities. Based on your description, it seems you have been dealing with recurrent lower back pain for about eight months, particularly triggered by bending and lifting. This is a common scenario for individuals with disc issues, and it’s essential to differentiate between disc bulging and herniation, as well as to understand the underlying causes, symptoms, and non-surgical treatment options.

Causes of Disc Herniation
Disc herniation typically occurs when the soft inner gel of the disc protrudes through a tear in the tougher outer layer. This can happen due to several factors, including:
1. Age-related Degeneration: As we age, our discs lose hydration and elasticity, making them more susceptible to injury.

2. Repetitive Stress: Activities that involve frequent bending, lifting, or twisting can lead to disc herniation over time.

3. Trauma: Sudden injuries, such as lifting something heavy or a fall, can cause a disc to herniate.

4. Genetics: Some individuals may have a genetic predisposition to disc problems.

Symptoms of Disc Herniation
The symptoms can vary widely depending on the location and severity of the herniation. Common symptoms include:
- Localized Pain: Pain in the lower back that may worsen with certain movements, such as bending or lifting.

- Radiating Pain: If the herniated disc compresses nearby nerves, you may experience pain that radiates down the legs (sciatica).

- Numbness or Tingling: Nerve compression can lead to sensations of numbness or tingling in the legs or feet.

- Muscle Weakness: In severe cases, you may notice weakness in the legs.

In your case, the pain seems to be localized to the lower back and is triggered by specific movements, which suggests that you may have a disc issue that is not severely compressing the nerves at this point.

Non-Surgical Treatments
Fortunately, many cases of disc herniation can be managed without surgery. Here are some common non-surgical treatment options:
1. Physical Therapy: A physical therapist can design a rehabilitation program tailored to your needs, focusing on strengthening the core muscles that support the spine and improving flexibility. This can help alleviate pain and prevent future injuries.

2. Medications: Over-the-counter pain relievers, such as NSAIDs (ibuprofen or naproxen), can help reduce inflammation and relieve pain. In some cases, your doctor may prescribe stronger medications or muscle relaxants.

3. Activity Modification: Avoiding activities that exacerbate your pain, such as heavy lifting or prolonged bending, is crucial. Learning proper body mechanics, like bending at the knees instead of the waist, can also help.

4. Epidural Steroid Injections: If pain persists, corticosteroid injections can help reduce inflammation around the affected nerve roots.

5. Alternative Therapies: Some individuals find relief through acupuncture, chiropractic care, or massage therapy.

When to Consider MRI
Given that X-rays do not show soft tissue details, an MRI is the best imaging technique to evaluate the condition of your discs and confirm whether herniation is present. If your symptoms persist or worsen despite conservative treatment, discussing an MRI with your doctor would be a prudent step.

Conclusion
It’s essential to address your concerns about bending and lifting. While it’s understandable to want to avoid pain, completely avoiding these movements may not be a sustainable solution. Engaging in a structured rehabilitation program can help you regain strength and flexibility, potentially allowing you to return to your previous activities without pain. If conservative measures fail, further evaluation and possibly surgical options can be explored. Always consult with your healthcare provider to determine the best course of action tailored to your specific situation.

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