A common cause of low back and leg pain is a ruptured or herniated disc. Symptoms may include dull or sharp pain, muscle spasm or cramping, sciatica, and leg weakness or loss of leg function. Sneezing, coughing, or bending usually intensifies the pain. Rarely bowel or bladder control is lost, and if this occurs, seek medical attention at once.
Sciatica is a symptom frequently associated with a lumbar herniated disc. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling, and numbness that extends from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected.
Anatomy - Normal Lumbar Disc
In between each of the five lumbar vertebrae (bones) is a disc, a tough fibrous shock-absorbing pad. Endplates line the ends of each vertebra and help hold individual discs in place. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus).
Nerve roots exit the spinal canal through small passageways between the vertebrae and discs. Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots.
How a herniated disc causes pain
As a disc degenerates, it can herniate (the inner core extrudes) back into the spinal canal, which is known as a disc herniation (or a herniated disc). The weak spot in a disc is directly under the nerve root, and a herniated disc in this area puts direct pressure on the nerve, which in turn can cause pain to radiate all the way down the patient’s leg to the foot
Approximately 90% of disc herniations will occur at L4- L5 (lumbar segments 4 and 5) or L5- S1 (lumbar segment 5 and sacral segment1), which causes pain in the L5 nerve or S1 nerve, respectively.
- L5 nerve impingement from a herniated disc can cause weakness in extension of the big toe and potentially in the ankle (foot drop). Numbness and pain can be felt on top of the foot, and the pain may also radiate into the rear.
- S1 nerve impingement from a herniated disc may cause loss of the ankle reflex and/or weakness in ankle push off (e.g. patients cannot do toe rises). Numbness and pain can radiate down to the sole or outside of the foot (
Progression of disc herniation
- Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
- Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
- Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
- Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).
Conservative treatment for a lumbar herniated disc
Conservative treatment options for a lumbar herniated disc
There are a number of non-surgical treatment options that can help alleviate the pain and hel heal a lumbar herniated disk:
Spine surgery for a lumbar herniated disc
- Chiropractic manipulation. Gentle manipulation can help reduce the joint dysfunction and disc pressure. In the initial treatment period your chiropractor may also use modalities, such as heat/ice or ultrasound, to help reduce muscle spasm and lessen referred leg pain.
- Massage. Massage can treat active trigger points and associated muscle tightness and spasm related to the nerve compression.
- Spinal Decompression or Lumbar Traction. Traction/ decompression of the lumbar spine can help reduce pressure over the nerve root. It does not work for everyone but for those that get relief it can be an effective way to treat lumbar disc herniations.
- Physical therapy / exercise rehab. Mckenzie exercises can be used to help reduce the pain in the leg. As the disc and nerve heal, more intense exercises can be added to stabilize the disc and joint complex.
- Activity modification. Some types of activities may tend to exacerbate the herniated disc pain and it is reasonable to avoid these activities to keep from irritating the nerve root. Such activities may include heavy lifting, activities that can cause increased vibration and compression to the lumbar spine (boating, snowmobile riding, running, etc.).
- Bracing. In some instances a lumbar brace/support belt may be recommended to help provide some rest for the lumbar spine.
- Medications. In addition to the anti-inflammatory medication, narcotic agents (pain killers) might be used on a temporary basis to help reduce the pain and discomfort from a lumbar herniated disc. Also, muscle relaxants or certain anti-depressants may help reduce the nerve-type pain (neuropathic pain) and help restore normal sleep patterns. For patients with severe pain from a herniated disc, oral steroids (such as Predisone or a Medrol Dose Pak) may give even better pain relief. However, these medications can only be used for a short period of time (one week).
- Injections. Epidural steroid injections or selective nerve root blocks can be helpful to reduce inflammation in cases of severe pain from a lumbar herniated disc, and can be very effective if accompanied by a comprehensive rehabilitation program that may involve a number of the above conservative treatments.
Most episodes of leg pain due to a lumbar herniated disc will resolve over a period of weeks to months. However, if the pain and disability is not improving or is worsening spine surgery may be a reasonable option.
Summary of lumbar herniated disc treatment options
Lumbar herniated disc typically respond well to conservative treatments. For the few cases that don’t respond well surgery may be your only option
At Holmes Spine & Sport Chiropractic we provide a number of conservative treatments under one roof to treat your lumbar disc herniation. We also work with your family physician or orthopedic surgeon to assist in getting you any medications or consultations you may need.