A disc bulge is different from a disc herniation. This must be made clear, because many confuse the two. A disc bulge is less serious and most likely is not causing compression of the spinal cord or spinal nerves. A disc herniation; however, is more serious and can indeed cause compression or irritation of the surrounding nerves. Most Americans over 50 have disc bulges. Those who experienced more trauma to the spine or participated in more manually intensive labor throughout life are more likely to have more bulging discs.
According to the American Academy of Orthopaedic Surgeons, 90 percent of disc herniations occur between the fourth and fifth (L4/L5) lumbar (lower back) vertebrae. An L4/L5 disc herniation can cause significant symptoms in the back, leg and foot. The spinal column is a complex structure composed of vertebrae (bones) and discs (cartilage). The main functions of the vertebrae are to protect the spinal cord from injury and to provide support for the vital organs of the abdomen and thorax. The discs are located between each vertebrae and allow the spinal column to be flexible. Sometimes the discs can herniate, or move, into the spinal canal and compress the nerves coming off the spinal cord. According to the Mayo Clinic, the compression of nerves by discs can cause significant symptoms. Most cases of disc herniations heal on their own within a few months to one year.
Shooting Pain and Sensations
The most common symptoms experienced with a specific L4/L5 disc herniation include numbness, tingling, burning or electric-shock like sensations that move from the back, down the back of the leg and often into the foot. An L4/L5 disc herniation may compress the L4 nerve as it exits the spine. These symptoms can be constant or intermittent. Conservative treatments, including medications that target nerve pain, such as gabapentin and physical therapy can help treat the symptoms of nerve compression or help the disc heal. In some cases, a corticosteroid injection may be needed to calm down inflammation secondary to a herniated disc. I caution you to hold off on getting surgery for a disc herniation if these are the only symptoms you are experiencing. Exercise may also help. Learn how to run with these symptoms.
Once you begin to have leg weakness, you should begin to be concerned. An L4/L5 disc herniation can cause weakness with lifting your foot towards the ceiling, or dorsiflexion. Therefore, if you start tripping over your foot or are noticing other signs of leg weakness, then it may be time for you to see your neurosurgeon. In the mean time, you can ask your doctor for an AFO, or ankle-foot orthosis, which is a shoe insert that will prevent you from tripping over your foot.
If you lose control of your bowels or bladder or have numbness in your groin area, go to the emergency room immediately. These are symptoms of Cauda Equina Syndrome, which can cause serious disability if ignored. This syndrome is rare, but must be taken seriously when it occurs. Surgery is almost always eminent, and most patients do well after the procedure.
Keep your back strong with the most important exercises for back health to do what you can to live a pain free life.