Back Pain Causes

Symptoms of a herniated disc usually include pain that travels into one or both arms or legs, numbness or tingling in areas of extremities, muscle weakness, and loss of the reflexes in extremities. The symptoms of a herniated disc may not include a wide array of pain. The symptoms come from increased pressure and irritation of the nerves. Many people may not have neck or back pain with a herniated disc. Where these symptoms occur depends on where the herniation is located. The location of the symptoms helps determine the diagnosis as nerves usually travel in specific patterns.

Back Pain due to a herniated disc may be diagnosed by orthopedic surgeon after a complete history and comprehensive physical exam by spine specialist & spine doctors.  In addition, several diagnostic tests can be used. Imaging studies at the Virginia Spine Institute are usually a first step in understanding spine pathology. These include standing and bending X-rays to evaluate spinal alignment, stability and disc space height. Your Spine doctor will determine whether additional tests are needed. An MRI is the standard imaging to assess disc and nerve pathology. An EMG may be used to determine which specific nerves are involved and the extent of possible nerve damage.

Anatomy of a Disc

An intervertebral disc is a strong ligament that connects one vertebral bone to the next. The discs are the shock-absorbing cushions between each vertebra of the spine. Each disc has a strong outer ring of fibers, called the annulus fibrosus, and a soft, jelly-like center, called the nucleus pulposus. The annulus is the strongest area of the disc and the ligament that connects each vertebra together. The nucleus, or center of the disc, is hydrated and serves as the main shock absorber.

Disc Injury

The annulus can tear or rupture anywhere around the disc & give rise to back pain. If it tears and no disc material is ruptured, this is called an annular tear and can be extremely painful as the outer fibers carry pain signals. This tear will heal with scar tissue over time but is more prone to future tears and injury. If the annulus tears and the center nucleus can squeeze out, a piece of the disc from the center or outside portion can break off and extend outward. A disc herniation, by definition, is a displacement of disc material beyond the normal confines of the disc space. The terms disc protrusion, disc bulge, disc herniation, ruptured disc, and slipped disc all mean the same thing and imply that disc material has left the normal disc space this leads to severe back pain, it can be diagnosed by orthopedic surgeon or spine specialist by few simple back pain tests.

Treatment Options

Treatment of a herniated disc depends on the severity of symptoms and apparent nerve damage. Most disc herniations improve in six weeks to three months from the initial injury. In many cases, medication management and quality physical therapy may be enough to allow your body to heal.

Medications:
One of the commonly used to control pain, inflammation, muscle spasm, and sleep disturbance. These may involve steroids, non-steroidal anti-inflammatory drugs (NSAIDs), pain medications, and muscle relaxers to help control symptoms and reduce inflammation.

Physical Therapy:
The often prescribed with the goal of assisting in calming pain and inflammation, improving mobility and strength, and helping achieve daily activities with greater ease and ability. Exercises focus on improving core strength, spinal strength, coordination and mobility of the spine.

Epidural Steroid Injections (ESI):
Its usually reserved when other conservative measures do not work, or in an effort to postpone surgery. An ESI places a small amount of ‘cortisone’ into the spinal canal. Cortisone is a strong anti-inflammatory medicine that may decrease nerve inflammation and ease pain caused by irritated nerve roots. This treatment is not always successful but may provide short-term help.

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