EMG tests measure the electrical activity of your muscles. Small needles are placed in your muscles, and the results are recorded on a special machine. NCS is similar, but it measures how well your nerves pass an electrical signal from one end of the nerve to another. These tests can detect nerve damage and muscle weakness. X-rays view the bony vertebrae in your spine and can tell your doctor if any of them are too close together or whether you have arthritic changes, bone spurs, or fractures.
It's not possible to diagnose a herniated disc with this test alone. Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, physical therapy, home exercises, hydrotherapy, epidural steroid injections ESI , chiropractic manipulation, and pain management. Self care : In most cases, the pain from a herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks.
Medication : Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications NSAIDs , muscle relaxants, and steroids. Steroid injections : The procedure is performed under x-ray fluoroscopy and involves an injection of corticosteroids and a numbing agent into the epidural space of the spine.
The medicine is delivered next to the painful area to reduce the swelling and inflammation of the nerves Fig. Repeat injections may be given to achieve the full effect. Duration of pain relief varies, lasting for weeks or years. Physical therapy: The goal of physical therapy is to help you return to full activity as soon as possible and prevent re-injury. Exercise and strengthening exercises are key elements to your treatment and should become part of your life-long fitness.
Surgery for a herniated lumbar disc, called a discectomy, may be an option if your symptoms do not significantly improve with conservative treatments. Surgery may also be recommended if you have signs of nerve damage, such as weakness or loss of feeling in your legs. Microsurgical discectomy : The surgeon makes a 1—2 inch incision in the middle of your back. To reach the damaged disc, the spinal muscles are dissected and moved aside to expose the vertebra.
A portion of the bone is removed to expose the nerve root and disc. The portion of the ruptured disc that touches your spinal nerve is carefully removed using special instruments.
Minimally invasive microendoscopic discectomy : The surgeon makes a tiny incision in the back. Small tubes called dilators are used with increasing diameter to enlarge a tunnel to the vertebra. The surgeon uses either an endoscope or a microscope to remove the ruptured disc. This technique causes less muscle injury than a traditional discectomy. Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective.
Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including their eligibility, protocol, and locations are found on the web. Back pain affects 8 of 10 people at some time in their lives, and usually resolves within 6 weeks. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If your regular job cannot be done initially, it is in the patient's best interest to return to some kind of modified light or restricted duty.
Your physician can give prescriptions for such activity for limited periods of time. Links Spine-health. Has two parts, a soft gel-like center called the nucleus and a tough fibrous outer wall called the annulus.
Usually caused by compression of the fifth lumbar spinal nerve. Your GP might ask you to raise your arms or do simple leg exercises to find out where the slipped disc is.
A GP might prescribe a stronger painkiller, a steroid injection or a muscle relaxant to use in the short term. They might also refer you to a physiotherapist. Physiotherapy from the NHS might not be available everywhere and waiting times can be long. You can also get it privately. Surgery is not usually needed, but a GP might refer to you a specialist to discuss surgery if your symptoms:. There's some evidence that manual therapies, like osteopathy, can help ease lower back pain.
Page last reviewed: 22 March Next review due: 22 March Slipped disc. Check if it's a slipped disc A slipped disc also called a prolapsed or herniated disc can cause: lower back pain numbness or tingling in your shoulders, back, arms, hands, legs or feet neck pain problems bending or straightening your back muscle weakness pain in the buttocks, hips or legs if the disc is pressing on the sciatic nerve sciatica Not all slipped discs cause symptoms.
Other causes of back pain Sometimes the pain may be a result of an injury such as a sprain or strain , but often there's no obvious reason. How you can ease the pain from a slipped disc yourself Keep active If the pain is very bad, you may need to rest at first. The initial treatment for a herniated disc is usually conservative and nonsurgical.
A doctor may advise the patient to maintain a low, painless activity level for a few days to several weeks. This helps the spinal nerve inflammation to decrease. Bedrest is not recommended. A herniated disc is frequently treated with nonsteroidal anti-inflammatory medication , if the pain is only mild to moderate. An epidural steroid injection may be performed utilizing a spinal needle under X-ray guidance to direct the medication to the exact level of the disc herniation.
The doctor may recommend physical therapy. The therapist will perform an in-depth evaluation, which, combined with the doctor's diagnosis, dictates a treatment specifically designed for patients with herniated discs. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises.
Pain medication and muscle relaxants may also be beneficial in conjunction with physical therapy. A doctor may recommend surgery if conservative treatment options, such as physical therapy and medications, do not reduce or end the pain altogether. Doctors discuss surgical options with patients to determine the proper procedure. As with any surgery, a patient's age, overall health and other issues are taken into consideration.
The benefits of surgery should be weighed carefully against its risks. Although a large percentage of patients with herniated discs report significant pain relief after surgery, there is no guarantee that surgery will help.
Lumbar laminotomy is a procedure often utilized to relieve leg pain and sciatica caused by a herniated disc. It is performed through a small incision down the center of the back over the area of the herniated disc. During this procedure, a portion of the lamina may be removed. Once the incision is made through the skin, the muscles are moved to the side so that the surgeon can see the back of the vertebrae. A small opening is made between the two vertebrae to gain access to the herniated disc.
After the disc is removed through a discectomy, the spine may need to be stabilized. Spinal fusion often is performed in conjunction with a laminotomy. In more involved cases, a laminectomy may be performed. In artificial disc surgery, an incision is made through the abdomen, and the affected disc is removed and replaced. Only a small percentage of patients are candidates for artificial disc surgery. The patient must have disc degeneration in only one disc, between L4 and L5, or L5 and S1 the first sacral vertebra.
The patient must have undergone at least six months of treatment, such as physical therapy, pain medication or wearing a back brace, without showing improvement.
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