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A herniated disc is a bulge of the intervertebral disc. Between two vertebrae there is an intervertebral disc also known as a disc. The intervertebral disc has a cartilage-like ring on the outside with a soft core in the middle also called the nucleus. The function of this nucleus is to absorb daily shock loads. As we get older, the volume of this nucleus can decrease. The body is then less able to withstand this shock load. The cartilage-like ring then also deteriorates in quality. As a result, the core may come out and put pressure on a nerve. We call this a herniated disc. The nerve runs from the back to the leg. Hence, a herniated disc can cause symptoms in the leg.
Cause
A herniated nucleus pulposus (HNP) occurs due to damage to the annulus fibrosus, the fibrous outer ring of the intervertebral disc. This ring envelops the soft core, the nucleus pulposus, and provides stability and shock absorption to the spine. Wear and tear of the annulus can occur due to wear and tear, overuse or a combination of both. When the pressure on the intervertebral disc increases, for example due to lifting, twisting or prolonged incorrect posture, the nucleus pulposus can bulge out through these cracks. This bulging tissue can then exert pressure on nearby nerve roots or the spinal cord.
This nerve compression often causes pain, tingling, numbness or muscle weakness in the area controlled by the affected nerve. The more severe the damage or the larger the bulge, the more symptoms can occur. This process is a gradual accumulation of factors such as age-related degeneration, inadequate support from surrounding muscles, and poor circulation, which limit the recovery of the annulus. This makes the disc more susceptible to structural damage, which can lead to HNP and associated symptoms.
Common Hernia complaints
Risk factors hernia
- A herniated disc occurs most often between the ages of 35 and 44, when intervertebral discs still contain a lot of fluid and elasticity.
- After the age of 45, the risk of a herniated disc decreases as the discs become stiffer, making them less prone to damage.
- Although factors such as posture and strain are often mentioned, there is no strong scientific evidence that these directly cause hernias.
- Smoking does constitute a major risk factor, as it reduces blood flow and nutrition to the intervertebral discs, leading to faster degeneration.
- Heredity may play a role, but this influence is less obvious than in other conditions, such as osteoarthritis.
Acute hernia
A hernia can appear to occur suddenly, but in most cases it is a process that has been going on for some time.
When we talk about an acute hernia, it usually refers to the sudden onset of severe symptoms, often after a specific event such as lifting a heavy object, twisting the back or an uncontrolled movement.
In an acute episode, the pressure on the intervertebral disc can suddenly become too high, causing the weakened annulus fibrosus to rupture and the nucleus pulposus to bulge. This bulge can put direct pressure on a nerve root or the spinal cord, leading to sharp pain, radiating nerve pain (such as sciatica), muscle weakness or tingling in the leg or arm, depending on the location of the herniated disc.
Although symptoms may appear suddenly, it is important to understand that the hernia itself is often the result of a long-term process of decline.
This combination of gradual deterioration and a sudden trigger explains why a herniated disc can be experienced as both a chronic and acute problem.
Anatomy of the vertebral bodies and the intervertebral disc
The spine consists of 24 vertebrae, divided into the cervical (neck), thoracic (chest) and lumbar (lower back) spine. Each vertebra consists of:
- Vertebral body: The load-bearing part that supports weight and connects to other vertebrae via the intervertebral disc.
- Vertebral arch and spinal canal: Protect the spinal cord and nerve roots running through the spinal canal.
- Processus spinosi: Protrusions to which muscles and ligaments attach for stability and movement.
Between each two vertebral bodies lies an intervertebral disc, which serves as a shock absorber but also allows movement. The intervertebral disc consists of two main parts:
- Nucleus Pulposus: The soft, gel-like core in the centre of the disc. This core contains a lot of water and provides elasticity and cushioning.
- Annulus Fibrosus: The fibrous outer ring of the disc, composed of several layers of firm connective tissue. This part protects the nucleus and provides structural stability.
The intervertebral disc receives nutrients via diffusion from surrounding blood vessels, as it is barely perfused itself. This makes the disc prone to degeneration but also a reduced ability to recover after damage.
In a nucleus pulposi hernia, damage occurs to the annulus fibrosus, usually due to degeneration, prolonged strain or sudden trauma. This can cause the nucleus pulposus to bulge or even break through the fibrous ring. This bulging tissue can:
- Applying pressure to a nerve root: This usually occurs in the narrow space of the spinal canal or at the foramen (openings where nerves exit).
- Causing inflammation: The bulging material contains substances that can trigger inflammatory reactions, which amplifies pain and swelling.
Herniated discs are most common in the lumbar (lower back) and cervical (neck) regions, where the intervertebral discs are most stressed.
- Lumbar disc herniation (L4-L5, L5-S1): Often causes sciatica (radiating pain in the leg).
What symptoms are associated with a herniated disc?
Common symptoms include pain, tingling, numbness of the skin or even muscle failure. One of the most common symptoms is that leg pain is in the foreground. So you generally have more leg pain than back pain. Statistically, in general, men suffer from herniated discs more often than women. The average age is between 30 and 50 years.
The symptoms can arise in different ways. It may be that the pain kicks in during when you have to pick something up off the ground. It can also gradually get worse over a few days. The most common complaint is lower back pain with radiation to the leg. With a herniated disc, there is often more leg pain than low back pain. Where the core bulges out determines where it radiates. So this is down to the level of the bulge. Each nerve has its own muscle and radiating area. When the nerve becomes pinched by the bulge, it can interfere with the care of an area. Besides pain, there may be tingling or numbness of the skin. In some cases, muscles can no longer be properly controlled here we speak of motor failure. The symptoms usually increase when coughing, sneezing or squeezing. When this happens, there is an increase in pressure in the abdomen, which in turn increases the pressure on the bulge. Standing or sitting for long periods is often uncomfortable and the advice is therefore to change positions regularly.
How long does recovery take?
The prognosis of a herniated disc is generally favourable. The bulging part of the intervertebral disc responsible for the symptoms is largely reabsorbed by the body. As a result, the symptoms gradually diminish. The prognosis for leg pain is generally more favourable. Back pain often disappears at a later stage. A herniated disc lasts several months on average, but actively working on your recovery can speed up this process. It is important to keep moving during this period, as this promotes healing and reduces the likelihood of long-term symptoms.
What can we do for you?
Most importantly, you need to know how best to deal with these symptoms. A good start is half the battle. Information on the internet is often outdated and causes unnecessary panic. Together, with targeted advice, we look at how you can keep moving responsibly again. When the back is less mobile, manual therapy can offer a solution to restore mobility in the back. Exercise has a pain-relieving effect and keeps the muscles in shape during recovery from a herniated disc. The right exercises are important to recover naturally and avoid surgery. More than 80% recover naturally an operation is then not necessary. In case of severe complaints with matching symptoms, it is still possible to intervene surgically. Physiotherapy also plays an important role in recovery after surgery.
Fables with a herniated disc
Bed rest is necessary for back pain
This is one of the biggest misconceptions. While bed rest for extreme pain can certainly provide temporary relief, lying still too much is actually not desirable in the long run. Keeping calm in motion such as walking or other light exercises often helps to dampen the pain. Bed rest for too long can lead to a decrease in load capacity and delayed recovery.
Anyone with back pain should have an X-ray or MRI
It is not necessary to have an X-ray or an MRI for every form of back pain. In cases, back pain has a non-specific cause. For example, overuse of muscles. Imaging is only considered when there are signs of specific conditions. An example is failure or significant loss of strength. Taking an image or MRI without a concrete indication may actually lead to unnecessary concerns. This is because abnormalities can always be seen from a certain age and need not be the reason for the symptoms.
With a hernia, surgery is always necessary
A herniated disc, in which an intervertebral disc protrudes and presses on a nerve, can cause severe pain and sometimes failure symptoms. Yet surgery is not necessary in most cases. In about 90% of people, symptoms improve within a few weeks to months with conservative treatment, such as physiotherapy and pain relief. Only in severe failure symptoms, such as loss of bladder or bowel control, or persistent severe symptoms that limit daily life, surgery is necessary.
After a herniated disc, my back will always remain a weak spot
A herniated disc is very annoying and can be very limiting for all kinds of daily activities, but this does not mean that your back will remain vulnerable forever. With the right rehabilitation, people fully recover after a herniated disc and can resume their daily activities and even sports. It is important to maintain a healthy movement pattern and work on back stability and strength to limit future symptoms.
What can you do yourself?
Because a herniated disc can cause serious pain, often the automatic reaction is to do little and, above all, take rest. Now this is certainly important in the first 10 to 14 days. After this phase, it is important not to sit or lie still. Above all, make sure you change your posture regularly. Do not sit, stand or lie down for too long. Start by walking small distances and build up slowly. If necessary, choose a route where you can sit down in between. When you get home, it is a good idea to lie down as well. Lying down puts strain on other parts of the intervertebral disc than sitting or standing. But certainly not for too long or too often. Try not to bend forward too often and be careful with lifting. Ask your physiotherapist for appropriate exercises and gradually build up to the pain. If necessary, consult your GP about appropriate painkillers or anti-inflammatories.
Advice for a herniated disc
- Ensure sufficient variety of lying, standing, sitting and walking
- Know that the vast majority of people with herniated discs recover naturally. Don't panic unnecessarily and trust your body's ability to recover
- Pain relief can help tremendously to get moving again(consult your GP)
- Together with your physiotherapist, look for exercises that suit the recovery phase you are in
- The bigger the hernia the faster the recovery!
- The leg pain often resulting from your herniated disc often subsides faster than the back pain itself
To gain a more thorough understanding of hernia symptoms and specific treatment options, visit our detailed page on Hernia Nuclei Pulposi. This section provides essential information for anyone wishing to delve deeper into the symptoms, causes, and treatment methods for hernia, a crucial resource for effective pain relief and recovery. Ideally, place this reference under a relevant section such as 'More About Hernia Pain' or at the end of the general information so that readers who want to know more can easily access it.
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