• What are the symptoms of a herniated disc?
• How did I herniate my disc?
• What is the difference between a herniated disc and a bulging disc?

• What is the treatment for herniated discs?
• Is it true that a bulging disc can be normal?
• Does whiplash cause herniated discs?

What are the symptoms of a herniated disc?

Typically, a herniated disc will give rise to specific nerve root compression that will result in radiating pain, numbness, tingling, or weakness in a very specific pattern correlating with the particular nerve that is compressed.  For instance, a right L4-L5 disc herniation would be expected to give rise to compression of the right L5 nerve root.  This, in turn, would result in decreased or altered sensation in the right lateral calf and the top of the right foot as well as weakness of the right great toe.  The specific pattern of nerve symptoms will often allow an accurate diagnosis of the level of disc herniation, even without the use of MRI scanning. 

How did I herniate my disc?

Sometimes we never know the answer to this question. Other times there may have been a minor injury, such as a twist, or a major injury, such as a car accident, which could have contributed to the disc herniation.

What is the treatment for herniated discs?

The vast majority of disc herniations tend to resolve with conservative care consisting of rest, anti-inflammatory medications, and an exercise program focusing on core strengthening.  Studies have shown that even in the presence of an MRI confirmed disc herniation giving rise to specific radiating numbness, paresthesia, and weakness in a specific nerve distribution, the vast majority of symptoms resolve spontaneously within six to 12 weeks.  Ultimately, if symptoms persist, treatment with oral or epidural steroid injections directed at the specific disc herniation may be effective.  As a last resort, a minimally-invasive lumbar discectomy procedure could be performed to remove the compressing disc material.  Typically, patients leave the hospital within 24 hours after this type of surgical intervention. 

What is the difference between a herniated disc and a bulging disc?

The human intervertebral disc consists of two separate components:  the inner gelatinous “nucleus pulposus” (mostly type 2 collagen) and the outer “anulus fibrosis” (type 1 collagen).  These cartilaginous components of our discs are composed primarily of water and proteoglycan.  With increasing age, the water content of the disc decreases, resulting in loss of height of the disc space.  This is often accompanied by peripheral bulging of the disc.  Studies involving MRI scans of the lumbar spine in asymptomatic individuals have demonstrated that the vast majority of patients over the age of 30 without any associated back pain do, in fact, have varying degrees of disc degeneration and disc bulging.  As such, it is important to recognize that disc bulging does not necessarily reflect pathology and is not always associated with pain.  A true "herniated disc", on the other hand, implies that there was a discrete moment in time when the inner gelatinous portion of disc nucleus actually protruded through the outer annular fibers.  This extrusion of disc material may create a mass effect on an adjacent nerve and give rise to acute and specific radiating arm or leg pain.  Oftentimes, a herniated disc does reflect more acute injury rather than a bulging disc, which may reflect a more natural degenerative process experienced by everyone. 

Is it true that a bulging disc can be normal?

It has long been established that the existence of a bulging disc is commonly seen in asymptomatic individuals.  Studies have been performed in which MRI scans were obtained on asymptomatic young individuals.  These studies have shown that the majority of patients over the age of 30 do, in fact, have loss of water content of the disc with resulting loss of disc height and associated disc bulging.  Typically, the degree of disc bulging will not correlate with an individual's low back pain.

Does whiplash cause herniated discs?

Whiplash is a term used to describe a mechanism of injury whereby an individual's head is thrown backward into extension, followed by a reactive forced forward flexion.  Typically, this results in either acute or chronic muscular strain and, oftentimes, irritation of the joints in the back of the spine called facet joints.  It is unusual for a whiplash to result in an acute herniated disc.