During the physical exam, your doctor will check your back for tenderness. You might be asked to lie flat and move your legs into various positions to help determine the cause of your pain.
Your doctor may also perform a neurological exam to check your:
- Muscle strength
- Walking ability
- Ability to feel light touches, pinpricks or vibration
In most cases of herniated disk, a physical exam and a medical history are all that's needed for a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.
- X-rays. Plain X-rays don't detect herniated disks, but they can rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
- CT scan. A CT scanner takes a series of X-rays from different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.
- MRI. Radio waves and a strong magnetic field are used to create images of your body's internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.
- Myelogram. A dye is injected into the spinal fluid before X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of nerve damage.
- Nerve conduction study. This test measures electrical nerve impulses and functioning in your muscles and nerves through electrodes placed on your skin. The study measures the electrical impulses in your nerve signals when a small current passes through the nerve.
- Electromyography (EMG). During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they're at rest.
Conservative treatment — mainly modifying activities to avoid movement that causes pain and taking pain medication — relieves symptoms in most people within a few days or weeks.
- Over-the-counter pain medications. If your pain is mild to moderate, your doctor might recommend over-the-counter pain medication, such as acetaminophen (Tylenol, others) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
- Cortisone injections. If your pain doesn't improve with oral medications, your doctor might recommend a corticosteroid that can be injected into the area around the spinal nerves. Spinal imaging can help guide the needle.
- Muscle relaxers. You might be prescribed these if you have muscle spasms. Sedation and dizziness are common side effects.
- Opioids. Because of the side effects of opioids and the potential for addiction, many doctors hesitate to prescribe them for disk herniation. If other medication doesn't relieve your pain, your doctor might consider short-term use of opioids, such as codeine or an oxycodone-acetaminophen combination (Percocet, Roxicet). Sedation, nausea, confusion and constipation are possible side effects from these drugs.
Your doctor might suggest physical therapy to help with your pain. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk.
Diskectomy is the surgical removal of the damaged portion of a herniated disk in your spine. A herniated disk occurs when some of the softer material inside the disk pushes out through a crack in the tougher exterior. This can irritate or compress nearby nerves and cause pain, numbness or weakness.
Few people with herniated disks eventually need surgery. Your doctor might suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to have:
- Poorly controlled pain
- Numbness or weakness
- Difficulty standing or walking
- Loss of bladder or bowel control
In nearly all cases, surgeons can remove just the protruding portion of the disk. Rarely, the entire disk must be removed. In these cases, the vertebrae may need to be fused with a bone graft.
To allow the process of bone fusion, which takes months, metal hardware is placed in the spine to provide spinal stability. Rarely, your surgeon might suggest the implantation of an artificial disk.
Lifestyle and home remedies
Besides taking the pain medications your doctor recommends, try:
- Applying heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you might switch to gentle heat to give relief and comfort.
- Avoiding too much bed rest. Staying in bed can lead to stiff joints and weak muscles — which can complicate your recovery. Instead, rest in a position of comfort for 30 minutes, and then go for a short walk or do some work. Try to avoid activities that worsen your pain.
- Resuming activity slowly. Let your pain guide you in resuming your activities. Make sure your movements are slow and controlled, especially bending forward and lifting.
Some alternative and complementary medicine treatments might help ease chronic back pain. Examples include:
- Chiropractic. Spinal manipulation has been found to be moderately effective for low back pain that has lasted for at least a month. Rarely, chiropractic treatment of the neck can cause certain types of strokes.
- Acupuncture. Although results are usually modest, acupuncture appears to ease chronic back and neck pain.
- Massage. This hands-on therapy can provide short-term relief to people dealing with chronic low back pain.
Preparing for your appointment
You're likely to start by seeing your family doctor. You might be referred to a doctor specializing in physical medicine and rehabilitation, orthopedic surgery, neurology, or neurosurgery.
What you can do
Before your appointment, be prepared to answer the following questions:
- When did your symptoms start?
- Were you lifting, pushing or pulling anything at the time you first felt symptoms? Were you twisting your back?
- Has the pain kept you from participating in activities?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- What medications or supplements do you take?
What to expect from your doctor
Your doctor might ask other questions, including:
- Does your pain travel into your arms or legs?
- Do you feel weakness or numbness in your arms or legs?
- Have you noticed changes in your bowel or bladder habits?
- Does coughing or sneezing worsen your leg pain?
- Is the pain interfering with sleep or work?
- Does your work involve heavy lifting?
- Do you smoke or otherwise use tobacco products?
- How has your weight changed recently?
Sept. 26, 2019