Lower back pain caused by a herniated lumbar disc is a very common problem and a major reason for lost productivity and time off the job in the United States.
First a bit about what a "disk" is. Our vertebrae (spinal bones) are cushioned by pads of tissue called disks. The disks are made up of a outer capsule or ring called the annulus which is made up of a tough fiber amterail. It surrounds a nucleus, which is a spongy center of "jelly" material. When disks are healthy and working like they should, they serve as shock absorbers to the spine and keep us flexible. When the disks are damaged somehow by an injury or age or disease, they begin to bulge abnormally and can even rupture (the jelly-like material breaks through the tough outer layer. This is called a herniated disk. Herniated disks can occur anywhere in the spine, but most of them take place in the lumbar (low back) region. The disk material can place pressure on the adjacent spinal cord or the nerve roots exiting the spine. This can cause pressure on the spinal cord or nerve roots can result in pain or numbness or tingling in the lower back, in the buttocks, hip region and down the legs to the feet.
There are many risk factors contributing to a herniated lumbar disc. As we age, there is an ongoing loss of both water and proteins from the disc which causes it to become thinner and less able to function as an adequate cushion between the vertebrae. There are genetic (inherited) predispositions to having herniated discs. Obesity puts undue pressure on the spine and lack of exercise results in a loss of muscle strength and diminished spinal support. Smoking deprives blood flow and nutrients needed to the spine and disks. Work activities consisting of heavy lifting, poor body mechanics, and repetitive motions, can also play a part in increasing one's chances of having problems with herniated disks.
You should consult your physician if you have symptoms such as prolonged severe back pain, problems with urination or a sudden change in bowel habits or control, and prolonged numbness, tingling, and perhaps weakness in your legs and feet.
The diagnosis of a herniated disk is based on a history and physical examination by your doctor and perhaps imaging studies such as xrays or an MRI scan. Most back injuries resolve in a matter of weeks and one shouldn't expect to have an MRI scan ordered by your doctor initially unless he feels it is necessary.
Most back problems, even due to a herniated disk, can be managed conservatively with some rest, anti-inflammatory medications, physical therapy and exercises. For patients who have ongoing severe back pain or weakness or functional problems with walking and performing their everyday functions, then surgery or epidural corticosteroid injections maybe considered. There is a significant misconception among the public that surgery is the only solution. One should reserve the surgical option when all conservative measures have been tried and failed.
Copyright (c) 2006 Ted Crawford
