Herniated Disc: Symptoms, Causes, and Treatment Options

A herniated disc (slipped/ruptured disc) occurs when the nucleus pulposus protrudes through a tear in the annulus fibrosus, compressing nearby neural structures.

Common Symptoms

• Radicular pain: Sharp, shooting pain along nerve distribution (sciatica for L4-S1).
• Numbness/tingling: In dermatomal pattern.
• Muscle weakness: In myotomal distribution.
• Reflex changes: Diminished Achilles (S1) or patellar (L4) reflex.
• Cauda equina syndrome (emergency): Saddle anesthesia, bowel/bladder dysfunction, bilateral leg weakness.

Causes and Risk Factors

• Age-related degeneration (disc desiccation).
• Trauma or improper lifting.
• Repetitive flexion/rotation.
• Obesity, smoking, sedentary lifestyle, genetics.

Treatment

• Conservative (90% improve): Activity modification, NSAIDs, PT (McKenzie, core stabilization), epidural steroid injections.
• Surgical (if refractory >6–12 wks or neurologic deficit): Microdiscectomy, laminectomy, endoscopic discectomy.
• Emergent: Cauda equina → immediate decompression.

Prevention

• Core strengthening, proper lifting mechanics, weight control, smoking cessation, ergonomic workstations.

Most herniated discs resolve without surgery. Early PT and time are often the best medicine.