Diagnosis

During the physical exam, your doctor will check your back for tenderness. He or she may ask you 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:

  • Reflexes
  • 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 to make 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.

Imaging tests

  • X-rays. Plain X-rays don't detect herniated disks, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
  • Computerized tomography (CT scan). A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.
  • Magnetic resonance imaging (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, and then X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.

Nerve tests

Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.

Treatment

Conservative treatment — mainly avoiding painful positions and following a planned exercise and pain-medication regimen — relieves symptoms in most people within a few days or weeks.

Medications

  • Over-the-counter pain medications. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others).
  • Narcotics. If your pain doesn't improve with over-the-counter medications, your doctor might prescribe narcotics, such as codeine or an oxycodone-acetaminophen combination (Percocet, OxyContin, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs.
  • Anticonvulsants. Drugs originally designed to control seizures also may be helpful in the treatment of the radiating nerve pain often associated with a herniated disk.
  • Muscle relaxers. Muscle relaxants may be prescribed if you have muscle spasms. Sedation and dizziness are common side effects of these medications.
  • Cortisone injections. Inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves. Spinal imaging can help guide the needle more safely. Occasionally a course of oral steroids may be tried to reduce swelling and inflammation.

Therapy

If your pain has not resolved within a few weeks, your doctor may suggest physical therapy. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk.

Surgery

A very small number of people with herniated disks eventually need surgery. Your doctor may suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to experience:

  • Numbness or weakness
  • Difficulty standing or walking
  • Loss of bladder or bowel control

In many cases, surgeons can remove just the protruding portion of the disk. Rarely, however, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability. Rarely, your surgeon may suggest the implantation of an artificial disk.

Alternative medicine

Some alternative and complementary medicine treatments may 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 only modest, acupuncture appears to ease chronic back and neck pain fairly well.
  • Massage. This hands-on therapy can provide short-term relief to people dealing with chronic low-back pain.
  • Yoga. A combination of physical activity, breathing exercises and meditation, yoga can improve function and relieve chronic back pain in some people.

Lifestyle and home remedies

  • Take pain relievers. Over-the-counter medications — such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others) — may help reduce the pain associated with a herniated disk.
  • Use heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you may switch to gentle heat to give relief and comfort.
  • Avoid too much bed rest. Too much bed rest 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 during the healing process.

Preparing for your appointment

You're likely to initially bring your symptoms to the attention of your family doctor. He or she may refer you to a doctor specializing in physical medicine and rehabilitation, orthopedic surgery, neurology, or neurosurgery.

What you can do

Before your appointment, write a list that answers the following questions:

  • When did you first begin experiencing symptoms?
  • 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 you wanted to do?
  • 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 some of the following questions:

  • Do you have any pain that travels into your arms or legs?
  • Do you feel any weakness or numbness in your arms or legs?
  • Have you noticed any changes in your bowel or bladder habits?
  • Does coughing or sneezing worsen your leg pain?
  • Is the pain interfering with sleep or work?

Herniated disk care at Mayo Clinic

Nov. 23, 2016
References
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