Tuesday, April 29, 2008


A herniated disc usually is caused by wear and tear of the disc (also called disc degeneration). As we age, our vertebral discs lose some of the fluid that helps them maintain flexibility. A herniated disc also may result from injuries to the spine, which may cause tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments.

Injury to the disc can occur from:

A sudden heavy strain or increased pressure to the lower back. Sometimes a sudden twisting movement or even a sneeze will force some of the nucleus (the material inside the disc) out through the disc's outer layer (annulus or capsule).
Activities that are done over and over again that may stress the lower back, including poor lifting habits, prolonged exposure to vibration, or sports-related injuries.

The goals of treatment for a herniated disc are to:

Relieve pain, weakness, or numbness in the leg and lower back caused by pressure on a spinal nerve root or the spinal cord. Promote a return to normal work, recreation, and other activities. Prevent reinjury to your back and reduce the risk of disability from back pain. Because inflammation usually fades over time, about 50% of people with a herniated disc in the low back recover within 1 month; after 6 months, most recover.1 Only 10% of people with herniated disc problems that cause noticeable symptoms have enough pain after 6 weeks to consider surgery.2 Often a herniated disc heals on its own as the jellylike material (nucleus) inside the disc is broken down and absorbed by the body, a process called resorption. For this reason, nonsurgical treatment is typically recommended before surgery is considered.

Nonsurgical treatment

Nonsurgical treatment is intended to help you return to your daily activities and usually includes:

Education. Learn how to take care of your back, which may include training in pain and symptom control. Your health professional may recommend physical therapy. A physical therapist can provide treatment with physical or mechanical means—such as through exercise or heat—and teach you exercises to do at home to strengthen the muscles that support your lower back.

Rest. Your health professional may recommend a short period of rest or reduced activity followed by a gradual increase in activity.

Pain relief. Some people can deal with pain without medicine if they know there is a good chance it will go away on its own. However, you can use medicine to control pain and inflammation. Pain medicines include:

Nonprescription and prescription pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

Muscle relaxants.
Oral or injected corticosteroids.
Drugs known as hypnotics, which are strong sleep aids.
Tricyclic antidepressants.

Keep active and use exercises, as recommended by your health professional or physical therapist, to help you return to your usual level of activity. Core stabilization exercises can help you strengthen the muscles of your trunk to protect your back.Core stabilization

SurgerySurgery is eventually considered for about 10% of people who have a herniated disc.1 Surgery can be a good choice for people who have nerve damage that is getting worse, or severe weakness or numbness, or if pain is not improved after 4 to 8 weeks of nonsurgical treatment.4 The most common and effective surgery for herniated disc is discectomy, in which disc material is removed through an incision. Discectomy is done mostly to relieve pain and other symptoms in the leg. It is not done if the herniated disc only causes back pain.

Should I have surgery for a herniated disc?

Many people are able to resume work and daily activities soon after surgery. In some cases, your health professional may recommend a rehabilitation program after surgery, which might include physical therapy and home exercises.

What To Think About
Pain management counseling can help you develop mental skills for coping with and reducing chronic pain.

Teens and young adults rarely develop herniated discs, but when they do, nonsurgical treatment based on rehabilitation and anti-inflammatory medicines usually helps to relieve symptoms



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