Lower Back and Leg Pain From a Herniated Disc

Many patients with lower back pain, sciatica, pain down the back of the legs, or weakness of the lower-extremity muscles are diagnosed with a herniated (a.k.a. compressed or ruptured) spinal disc. Nerves surrounding the spine are very sensitive to irritation and pressure that stems from a shift in disc position or physical damage to the disc itself, resulting in discomfort that can range from mild to severe.

Treatment to resolve related back and/or leg pain depends on the type of spinal disc herniation and the severity, but getting a medical evaluation early-on helps ensure better outcomes.

Your Spine and Your Nerves

Spinal discs act as shock absorbers between vertebrae. They consist of a tough outer layer (the annulus fibrosis) covering a soft, jelly-like core (the nucleus pulposus).

When a disc is damaged, it can bulge beyond its normal boundaries and irritate nearby spinal nerves. In more severe cases, the annulus fibrosis can weaken or tear, allowing the nucleus material to leak out.

This can cause the spinal cord or spinal nerves become compressed. They may not work properly and, as a result, abnormal signals may be sent to and from the brain.

The most common lower back herniations occur in the lumbar region, five vertebrae near the base of the spine. (Healthcare providers classify them top to bottom as L1 through L5.) One reason pain resulting from an injury to this part of the spine can be so debilitating is that it may involve irritation of the sciatic nerve, which runs from the lower spine down to the legs. It's the largest nerve in the peripheral nervous system, which connects the brain and spinal cord to the rest of the body.

One or more causes generally play a part in herniated discs, including age-related degeneration, overweight/obesity, trauma, a lack of conditioning (sedentary lifestyle), and overloading of the spine.

Pain and Related Symptoms

Lower back pain is the most common herniation symptom due to nerve irritation, possible muscle spasm, and inflammation.

Radiculopathy, related to abnormal signaling of the nerves, is also common. Symptoms include:

• Electric shock pain: Nerve pressure can cause abnormal sensations, commonly experienced as electric shock pains. For lumbar herniations, the shocks go down one or both legs.
• Tingling and/or numbness: Patients often have abnormal sensations such as tingling, numbness, or pins and needles down one or both legs.
• Muscle weakness: Nerve signals from the brain may be interrupted, causing lower-body muscle weakness.
• Bowel or bladder problems: These symptoms are important because they may signal cauda equina syndrome, a rare condition resulting from a herniated disc between the L5 vertebrae and the first vertebrae of the sacrum.

Diagnosis

Most often, a healthcare provider can diagnose a herniated disc as the cause of your back and/or leg pain by testing sensation, muscle strength, and reflexes. Magnetic resonance imaging (MRI) is commonly used to aid in this process as well.

MRIs bring their own challenges to the problem, however, because they often show herniated discs or other abnormalities, particularly in older patients. Meanwhile, it's possible that those abnormalities have nothing to do with lower back pain symptoms.

Treatment Herniated Disc-Related Pain

Most herniated disc symptoms resolve themselves in four to six weeks. However, people routinely seek medical care for severe lower back pain, particularly when it doesn't improve after several days.

Lower back pain is generally treated conservatively with the following:

• NSAIDs (ibuprofen) to reduce inflammation
• Topical pain relievers for muscle spasms
• Exercise and stretching: Total rest is never recommended for back pain, even if movement is challenging, to avoid muscle degeneration. A regimen could include physical therapy.
• Relaxation techniques and other natural back pain remedies
• Pain-blocking injections (anesthetics or corticosteroids) at the source

Surgery is generally recommended only when conservative treatments are ineffective after six weeks or more, if you have significant muscle weakness from nerve damage, or when motor functions are compromised.

Summary

Lower back pain can be frustrating and debilitating, but understand that medical treatment for a lumbar herniated disc will depend on your specific symptoms, the duration of symptoms, and the prognosis of the condition. Simple treatments are often effective, but some situations may require more aggressive treatment, particularly if the pain is ongoing. If so, it's important to be evaluated by your healthcare provider.