Herniated disc: causes and treatment

Intervertebral discs act as shock absorbers between the vertebrae in your spinal column, enabling movement and stability. A herniated (or slipped) disc occurs when the soft core of an intervertebral disc breaks through the outer fibrous ring because the disc can no longer cushion loads on the spine. This may place pressure on nearby nerves or the spinal cord, causing severe pain.

Any disc in the spine can become herniated, including the neck, but it most commonly occurs in the lower back This is caused by ageing and wear and tear of the spine, which begins as early as the age of 20. As the outer fibrous ring of the intervertebral disc wears away, pieces of tissue can escape into the spinal canal and compress the nerves and spinal cord.

Frequency and age

Herniated discs are one of the most common causes of back ache in Switzerland, with around 10,000 people experiencing a slipped disc every year. “One to three percent of all people between the ages of 30 and 50 are affected,” says Andreas Raabe, director and chief physician of the Department of Neurosurgery at the Inselspital university hospital in Bern. However, the condition is not one that occurs more frequently in old age.

And it is also down to a person’s genes. “Some people suffer from several herniated discs over the course of their life,” says Raabe. Most people experience back pain prior to the slipped disc, but it hits others out of the blue. Wear and tear is exacerbated by weak back muscles, genetic factors, stress and increased bodyweight.

Symptoms

The symptoms of a herniated disc can be diverse and vary depending on the site and severity of the herniation. Typical symptoms include back pain that radiates into the buttocks and down the leg or pain in the neck that radiates down the arm. “The pain is usually easy to feel,” says Raabe. But the intensity can vary considerably, taking in everything from a pulling sensation to an inability to move.

Sensory disturbances, such as tingling, numbness or even signs of paralysis can also occur. “In extremely rare cases, patients may also experience bladder or bowel dysfunction, which indicates an urgent need for action to prevent possible nerve damage,” says Raabe.

But in the vast majority of cases, herniated discs can be treated by a visit to the family doctor. Surgery is only necessary in rare cases. If you think you may have a herniated disc, it is a good idea to seek medical advice.

Treatment

The treatment for a herniated disc varies case by case and depends on the severity of the symptoms. Generally speaking, conservative therapy is tried first before deciding on more invasive measures.

Conservative treatment as a first step

Conservative treatment often includes a combination of rest, painkillers, anti-inflammatory medication, chiropractic care, physiotherapy and targeted exercises to strengthen the back muscles, with the aim of relieving pain, reducing inflammation and restoring the spine’s mobility. “In most cases, patients recover within a few weeks or months without the need for surgery,” says Raabe. It is important to manage the pain based on your doctor’s advice and allow your body time to recover. However, wear and tear of herniated discs is a lifelong process that cannot be reversed.

Minimally invasive therapy as a second step

In cases where conservative measures aren’t sufficient, surgery may be a solution, especially if the herniated disc is pressing on surrounding nerves and causing severe pain or neurological deficits. Minimally invasive endoscopic microdiscectomy is often used in this case. It requires only a small incision and uses a high-resolution surgical microscope or endoscope, which causes less trauma to muscles and soft tissue than traditional open surgery. However, most herniated discs can be treated without surgery. 

Sport during and after a herniated disc

You have to be very careful doing sport when you have a herniated disc, and you should only exercise after talking to a doctor. It is important to protect your back and avoid activities that could exacerbate the symptoms, particularly those that cause strong vibrations or strain on the spine, such as strength training with heavy weights, jumping or abrupt movements. However, doing moderate exercise and targeted activities will help strengthen the back muscles and improve flexibility, which in turn will ease the symptoms. Pilates or cycling, for example, are good options.

After suffering from a herniated disc, you need to be patient when getting back to sport, starting with gentle stretches and low-impact aerobic exercises. These stimulate the blood circulation and improve flexibility without putting too much strain on the back. It is particularly important to strengthen your back muscles. “It’s important not to trigger the pain, so it’s a good idea to take it easy during the recovery period,” says Raabe. However, this doesn’t mean that you should always lie down or stay in the same position. Raabe recommends switching between lying, standing, sitting and walking. This helps the body to regenerate without putting it under excessive strain.

How to prevent a herniated disc

There are several things you can do to prevent a slipped disc. The most important thing is to keep your back strong and healthy. Regular exercise, such as swimming, cycling or hiking, is the biggest help. Sport strengthens your back muscles and improves the spine’s flexibility. “You don’t have to take extreme measures,” says Raabe. It’s enough to plan in a few sessions of yoga, Pilates or Kieser training in addition to your daily exercise. Raabe stresses the importance of doing these exercises regularly. “There’s little point in completing a six-week course and then doing nothing for the rest of the year.

Good posture also reduces strain on the spine. Make sure that you adopt an ergonomic posture when sitting, standing and moving. Avoid sitting too often and for too long. An ergonomic chair, height-adjustable desk and taking regular breaks to ease the spine can all help reduce symptoms and minimise the risk of back injuries. “Think about your daily activities, too. For example, it’s important to keep your back straight when lifting beer crates or vacuuming,” says Raabe. However, herniated discs cannot be completely avoided: “Exercise is part and parcel of daily life, and you can’t control everything.” In most cases, herniated discs heal without complications.