A herniated disc is part of the normal aging process. In many people, it is painless, but in some individuals, it can result in severe debilitating pain. The disc begins to break down in the third decade of life. It is most common in individuals aged 30 to 50 years.
A herniated disc can be exacerbated with repetitive strain, mechanical overloading or trauma which can result in a progressive deterioration of the adjacent bone, muscles, joints and ligaments. Luckily, large disc herniations are more likely to shrink compared with smaller disc herniations. The pain associated with a disc herniation is related to the compression of an adjacent nerve as well as the release of inflammatory chemicals which further irritates the nerve.
Symptoms can vary widely and can include:
• Pain radiating down the arm or leg
• Pain with leg extension
• Arm or leg weakness
• Arm or leg numbness
Other diseases that can mimic a disc herniation include:
• Shoulder osteoarthritis
• Hip osteoarthritis
• Sacroiliac joint dysfunction
• Spinal stenosis
Treatment will depend on the source of pain which may range from simple medications and physical therapy to complex targeted interventions. For less severe pain a course of non-steroidal anti-inflammatory medicines (NSAIDs) and physical therapy may be helpful. For more severe pain, trigger point injections for symptoms of myofascial pain or epidural steroid injections may be more helpful. Long term studies have shown that treatment should be geared to returning you back to your normal functional status as 2 years later there is no difference in the surgery and non-surgical groups.
Panagos A. Rehabilitation Medicine Quick Reference-Spine (ed. Buschbacher R.M.) New York: Demos Publishing; 2010. p. 130-131.
Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007 May;25(2):387-405.