disc extrusion

Herniated disc from A to Z: Better understand your diagnosis (symptoms and causes)

Article reviewed and approved by Dr. Ibtissama Boukas, a physician specializing in medicine in family

Boom! The diagnosis fell after having (finally) passed a lumbar MRI. Herniated disc. She may be on the level L4-L5, or even L5-S1. Worse still, it can be multi-layered, compress a nerve root or associated with a sciatica. What to do now ? Is it curable? Is that bad ?

Your first instinct (after listening to the doctor's explanations with a confused and annoyed air): consult your favorite specialist… Dr. Google! What is a herniated disc? Unfortunately, the sites viewed seem to create more confusion than anything else. As to Forums, they are inundated with testimonies referring to an infiltration or an operation.

What are the symptoms of a herniated disc?  Is a diagnosis of L4-L5 or L5-S1 disc herniation necessarily synonymous with serious impairment of the spine? what is the treatement? That's what we're going to look at today. By reading this popular article, you will have an overall understanding of your condition, from the anatomy of the spine to the potential causes that caused your low back pain. 

If it is the treatment of herniated disc that interests you, here is an article that offers 10 natural and surgical solutions when you suffer from herniated disc:

Herniated disc treatment: 10 solutions to consider

Herniated disc, what is it?

Impossible to explain the herniated disc to you without making a simplified anatomy lesson. As this diagnosis is related to intervertebral discs, let's start by identifying the main structures that are part of the spine:

anatomy of the spine and lumbar spine to understand herniated disc

The spine (or vertebral column) is made up of vertebrae superimposed. In the lumbar region (lower back), there are 5 vertebrae called L1, L2, L3, L4, and L5. Note that the spine ends with the sacrum, this triangular bone also composed of 5 welded vertebrae (S1, S2, S3, S4 and S5).

Between each vertebrate, there is a intervertebral disc. For example, the L4-L5 disc is the disc located between the L4 and L5 vertebrae. The L5-S1 disc, on the other hand, is located between the last lumbar vertebra (L5) and the first sacral vertebra (S1).

intervertebral disc anatomy including nucleus and annulus fibrosis to understand disc herniation

In summary, the intervertebral discs are structures located between 2 superimposed vertebrae. When we study the composition of these discs, we see that they look like pads. More specifically, they are composed of a gelatinous core (Nucleus pulposus) in the central region, and surrounded by a fibrous ring (annulus fibrosus).

But what are the intervertebral discs for? Here are their main roles:

Role of intervertebral discs:

  • The separation of the vertebrae from the spine
  • Shock absorption during movements involving impact (walking, running, jumping, etc.)
  • The distribution of pressures thanks to the gelatinous core
  • Mobility between the vertebrae

What happens in the presence of a herniated disc? Essentially, the discs become deformed and come out of their envelope. As the ligament behind the vertebrae (called the "posterior longitudinal ligament") is relatively strong, it is rare to see a purely posterior hernia. It is moreover in these cases that one can observe an attack of the spinal cord, or a cauda equina syndrome which constitutes a medical emergency.

posterior longitudinal ligament and herniated disc
The posterior longitudinal ligament (left) slows the migration of a herniated disc backward, resulting in migration to the sides (right or left) and irritation of the associated spinal nerves.

Thus, hernias are usually posterolateral, which means that they migrate backwards and to the side. Since there are several nerve roots around these discs, an inflammatory process and nerve irritation can ensue that can cause lower back pain. Moreover, as the nerves supply the sensation in the legs, it is not rare to see its pains radiate to the buttock, the knee and even the foot after a herniated disc.

anatomy of the spine to understand herniated disc

Looking at the picture I've painted so far, you probably think that a herniated disc is a serious spinal disease. This is sometimes the case. However, let me tell you something that may surprise you: Not all herniated discs are painful!

In other words, it is possible to have a herniated disc without experiencing lower back pain! I already see the skeptical gaze of people with a herniated disc diagnosed by MRI, and who have been suffering a lot for several months. Keep reading the article to understand the link between herniated discs and your pain.


Lumbar disc herniation (vs cervical disc herniation)

You've probably already been diagnosed with a herniated disc after having a magnetic resonance imaging (MRI). Moreover, as X-rays mainly show the bones and joints, they are therefore insufficient to detect a disc problem.

medical imaging showing a herniated disc

The MRI will determine the level of the herniated disc. Note that a herniated disc located between L1 and L5 is qualified as lumbar disc herniation, while we call cervical disc herniation a herniated disc located between C2 and C7 (at the cervical level). This is another condition that affects neck pain, and can be accompanied by pain in the arm.

Now, is MRI enough to accurately explain your condition and symptoms? Again, the answer to this question will probably confuse you.

Remember when I mentioned that disc pathologies were not always symptomatic. So, if you have back pain and your MRI detected a herniated L4-L5 or L5-S1 disc, it remains to be determined whether it is really the herniation that is responsible for your low back pain. Besides, two people with the same imaging results may still have completely different symptoms.

This is why it is important to consult a health professional to have a more global and precise picture of your low back pain. There are different clinical tests that can be performed by an expert. Generally, any assessment begins with a complete medical history.

physiotherapist assessment of a herniated disc

Following the subjective assessment of your symptoms, the clinician will perform a complete physical examination. These more objective tests can clarify the diagnosis and thus guide treatment. Here are some things your doctor or therapist will want to look at:

  • posture
  • Ranges of motion
  • Muscular force
  • Sensitivity
  • Reflexes
  • nerve conduction
  • Tensioning your nerves (like the sciatic nerve)
  • Link with the dorsal region and the hips
  • Respiratory pattern
  • Just to name a few

Herniated Disc Symptoms

Here are some symptoms that can be found in someone with a symptomatic herniated disc:

woman with sciatic type leg pain from herniated disc

Note: In some rare cases, a herniated disc can be a medical (and possibly surgical) emergency. If you ever experience one of the following symptoms, you should consult your doctor without delay.

back pain red flags

Cause of herniated disc: But how does it appear in the first place?

Before talking about the potential causes of herniated discs, let me recap some key concepts. It was mentioned that a hernia could exist without the presence of pain. Yet, there are other situations where the problematic disc is the main culprit for your symptoms.

How to differentiate between the two situations?

Generally, it is accepted that if the herniated disc is associated with an inflammatory process, the lumbar region will be painful. Also, an irritated nerve root is usually responsible for radiation of pain in the leg, as well as numbness and tingling.

back pain from a herniated disc

Let us now discuss the possible causes of your herniated disc. At the risk of surprising you once again (it has become a habit!), it is very difficult to identify the exact cause of disc pathologies.

Why ? Because each time we try to relate certain factors possibly responsible for your low back pain, we are surprisingly disappointed by the inconsistency of the results. Here are some biomechanical and environmental causes believed to be related to herniated discs:

  • Bad postures (At the risk of surprising you: Lack of evidence!)
  • Stress (Yes, there is a link!)
  • Overweight (Conclusions vary by study!)
  • Genetics (YES-it's unfortunate, I know!)
  • Previous injury (Very possible)
  • Repeated efforts (Highly probable)
  • Abdominal weakness (Possible, but studies vary!)
  • Sedentary work (It depends on what you do outside of work!)
  • Bad shoes (Lack of evidence!)
  • Displaced pelvis and vertebral subluxation (No scientific basis!)
  • Leg length difference (No scientific basis!)

I will not go into details in this article, but know that many of these causes have not been scientifically proven. Worse still, some have no scientific basis or validity.

Can a herniated disc heal?

I have good news for you. Yes ! The herniated disc can heal.

On the one hand, a large proportion of herniated discs heal spontaneously (the scientific studies speak of 62 to 83% of cases of herniated discs.). Strangely, it seems that large herniated discs take LESS time to heal than hernias that are smaller in size (11 months for large herniated discs vs 7 months for small ones).

healing of a herniated disc
Intervertebral discs have healing potential.

Moreover, if the herniated disc developed gradually, it is possible that the body had time to adapt. Thus, if the hernia does not cause an inflammatory response and/or nerve irritation, it can be expected that it will not cause pain or impaired function.

Finally, there are ways to train the intervertebral discs to allow their regeneration (especially if they are the site of degeneration or osteoarthritis). Among the means proposed, theadapted physical activity appears to be effective in promoting disc healing.

How long does a herniated disc last?

When the doctor reveals to us that we have a herniated disc, there are often two things that come to mind.

First, we want to know how serious our condition is (for that, refer to the article explaining the serious damage related to low back pain).

Then we would like to know how long does it take to heal, a herniated disc.

doctor's explanation of herniated disc

The answer to this last question is related to several factors. Here are a few:

  • Type of herniated disc
  • Duration of symptoms
  • Radiation of pain
  • Psychosocial factors
  • Physical activity level

To know everything about the healing time of a herniated disc, see the following article.

Can you work with a herniated disc?

The question of professional activity in the presence of herniated disc is quite legitimate. On the other hand, it should not be imagined that a herniated disc automatically implies a sick leave or a handicap. This is because the presence of herniated disc may be asymptomatic in some individuals.

In the case of symptomatic herniated discs, that is to say responsible for pain and functional limitations, here are the difficulties often encountered (and related to work):

  • Inability to lift heavy loads
  • Inability to perform repetitive movements
  • Difficulty maintaining a seated position in the car for a long time
  • Difficulty supporting prolonged static postures (sitting or standing)
herniated disc at work

With this in mind, the doctor may suggest a sick leave. When you return, you may need to make some changes to prevent your condition from getting worse. For example, a ergonomic seat can be considered. Likewise, functional limitations could be imposed by your doctor (for example, not the right to lift loads of more than 5 kg, or even any gesture requiring mechanical vibrations).

It will also be necessary to determine if your herniated disc is the result of your professional activity. Indeed, herniated disc is one of the most common occupational diseases. If you are affected by a herniated disc, you can have it recognized as an occupational disease. For more information, I invite you to consult theAssociation of Injured Workers and Victims of Occupational Diseases.

Herniated disc and sport

For athletes and the active population, it is not uncommon for a herniated disc to be a hindrance to the resumption of sport. We want to resume our activities and hobbies at all costs, but we are also afraid of hurting ourselves or of aggravating our condition.

Can you resume sport after a herniated disc? Which sports should be encouraged and which should be avoided? How to rehabilitate our back so that we can resume sport without complications.

To learn more about resuming sport in the presence of a herniated disc, see the following article:

Herniated disc and sport: do they go together?

Treatment: How to treat a herniated disc?

Now that you have a better understanding of your condition, the next logical step is to identify strategies to treat yourself. When talking about the treatment of herniated discs, there are only two possibilities.

Either we use a so-called “conservative” treatment, or we use more “invasive” techniques (such as the operation).

The following article offers you 10 solutions to treat your herniated disc:

Herniated disc treatment: 10 solutions to consider



So much for the herniated disc! Well, I can understand that this article may have raised some questions. Indeed, I have demystified several false beliefs, and revealed some surprising facts!

Who knew your herniated disc could be present long before you experienced back or leg pain? And who would have thought that two people each diagnosed with a herniated disc could have completely different symptoms?!

If you ever want to go into more detail, I strongly urge you to get this complete guide which will cover all elements related to herniated discs. For others, know that this diagnosis is not as decisive and revealing as one might think.

It's not like a fracture where a simple x-ray will dictate the exact location of the problem. For herniated disc, several factors will have to be taken into consideration to get an overall idea of ​​the clinical picture. These factors include your reviews ofmedical imaging, your symptoms, risk factors, potential causes, and psychosocial factors.

And your best ally in this process is undoubtedly the health professional.

stress breathing exercises

Let's end on a note of hope. Even with a herniated disc, there is ALWAYS something to do to get better. The pain, even if it is intense today, can be modulated.

Your condition, even if it seems very complex, can be treated. Continue to adopt a proactive approach, set goals, and I assure you that your back will thank you!

Good recovery!

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