The spinal discs are shock-absorbing cushions between the vertebrae. Vertebrae are the large bones of the spinal column. If the spinal column tears open and the discs protrude outward, they can press on, or “pinch,” nearby spinal nerves. This is known as a ruptured, herniated, or slipped disc.
A ruptured disc causes severe low back pain and, sometimes, shooting pain down the back of the legs, which is known as sciatica. Usually the symptoms of a disc rupture heal on their own after a few weeks to a month. If the problem persists for months and becomes chronic, you may choose to eventually consider surgery.
Severe low back pain on its own may be a symptom of a ruptured disc, but it can also be caused by strains or sprains of muscles, tendons, and ligaments. However, low back pain combined with shooting pain down the back of one or both legs (sciatica) usually points to a herniated or ruptured disc.
The telltale signs of sciatica include:
- sharp pain down the back of the buttocks and leg (usually one leg)
- tingling in part of the leg or in the foot
- weakness in the leg
If you have a ruptured disc, sciatica may get worse when you bend over with your legs straight or when you sit. That’s because those movements tug on the sciatic nerve. You may also feel a sharp pain when you sneeze, cough, or sit on the toilet.
Normally, the rubbery discs allow the spine to flex and absorb forces on the spine when you twist, bend, or lift. With aging, the discs start to wear out. They may flatten a bit or bulge outward, like an underinflated tire. The gelatinous material inside the disc begins to dry out and grow stiffer, and the layers of the fibrous wall of the disc start to separate and fray.
If a damaged disc presses on nearby spinal nerves, they become inflamed. Disc ruptures in the low back typically affect the sciatic nerve roots that exit the spine on either side of the discs. The sciatic nerves pass through the buttock, down the leg, and into the foot. That’s why you feel pain, tingling, and numbness in those locations.
Weakened discs may be more prone to rupture as a result of everyday activities and work, or from sports, car accidents, or falls. It’s often difficult to connect the disc rupture to any particular event since it may occur as part of the aging process of the disc.
Doctors can often diagnose a ruptured disc based on symptoms, particularly sciatica. That’s because pinched nerves near the discs affect different areas of the buttocks, legs, and feet.
You may assume your doctor should order a CT scan or MRI to look for the affected disc. However, in many cases, a thorough exam and answering detailed questions about the symptoms and history of the problem is enough for a reliable diagnosis. By middle age, discs often look abnormal on MRIs but don’t cause pain or any other problems.
Disc-related back pain and sciatica often gets better on its own in a few weeks, though in some cases it can last longer. For new disc pain or a flare-up of an existing condition, current treatment guidelines recommend you first use self-care steps to relieve the symptoms and wait for your back to heal. The standard “conservative” care includes:
Heat and cold
Applying cold packs to the painful area when you first start to feel pain can help to numb the nerves and reduce your discomfort. Heating pads and hot baths later can reduce tightness and spasms in the muscles of the lower back so you can move more freely. Learn more about treating pain with cold and heat.
Over-the-counter (OTC) pain relievers can help to reduce pain and inflammation. These may include:
- nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Advil, Motrin)
- naproxen (Aleve)
- acetaminophen (Tylenol)
Take the recommended dosage. Excessive or prolonged use, especially of NSAIDs, can cause damage to the stomach and bleeding.
If OTC pain relievers and other home remedies don’t help, your doctor may recommend prescription muscle relaxers.
Extended bed rest is not recommended for back pain, though taking it easy for a few hours at a time is fine. Otherwise, try to walk around a bit throughout the day and stick to normal daily activities as much as possible, even if it hurts a little.
When your pain starts to subside, gentle exercise and stretches can help you return to normal activities, including work. But make sure to get instructions from your doctor or see a physical therapist to show you safe exercises and stretches for back pain.
Spinal manipulation (chiropractic), massage, and acupuncture may help relieve pain and discomfort while your back is healing. Make sure the person who provides these services is a licensed professional. Tell them about your ruptured disc so that they can properly treat your condition.
When to consider surgery
If pain and sciatica persist for three months or more, it’s considered chronic and may need a higher level of care. Many people at this stage start thinking about surgery.
Injections of anti-inflammatory steroids into the area near the inflamed nerve and ruptured disc may help to delay surgery, but they aren’t a long term solution. Injections can provide relief for up to a few months, but the relief will wear off. There are limits on how many injections you can safely have in a given year.
Deciding to move forward with surgery is an individual decision. Your doctor should explain all the pros and cons so that you can make an informed decision that fits your lifestyle.
The most common surgery is called diskectomy. Surgical techniques vary, but diskectomy removes part of the ruptured disc so it doesn’t press on the spinal nerve roots anymore. In many cases, it can be done as an outpatient procedure.
Disc surgery is not guaranteed to work, and the pain might get worse. The disc may rupture again later, or a different disc may fail.
Most disc pain substantially improves within a month. Expect gradual improvement after the early, acute stage right after the flare-up.
Going forward, exercise can help to prevent future flare-ups of disc pain. Traditional exercises as well as yoga and tai chi can help to tone and strengthen the core muscles, which support your spine. Be mindful that you don’t overdo it with any kind of exercise since that could trigger new back pain.
Disc wear and tear tends to worsen over time, so you should be prepared for occasional flare-ups. Your best bet is to maintain your back health. You can do that by:
- exercising regularly
- maintaining a healthy weight
- avoiding activities that trigger back pain
Ruptured discs become increasingly common with aging and the breakdown of the spinal discs. It may not be possible to prevent a ruptured disc, but regular back-strengthening exercise can lower your risk.