Herniated discs are the worst. Here’s what causes them.

Few injuries are as suddenly and thoroughly debilitating as a herniated disc. If you’ve experienced one, you know how quickly you can go from feeling completely normal to all at once having trouble walking or even standing up. Sleep becomes difficult as well, since tossing and turning can be frequently accompanied by lower back pain. Work can be affected, too, as getting in and out of a car or sitting at a desk for extended periods can be too difficult. 
Here’s what a herniated disc is, what causes it and what sort of treatment options are available and recommended if you experience one. 
A herniated disc, also known as a ruptured disc or a slipped disc, is characterized by one of the discs in the spine breaking open or moving out of place. 
“Your spinal column encases and protects the spinal cord and nerves running from your head to your tailbone,” says Dr. Charles Gatto, an orthopedic surgeon in the Atlantic Health System in New Jersey. He explains that this column contains of 23 segments, called intervertebral discs, which act as shock-absorbing cushions, and “each one allows for the exit of a pair of nerves that gives sensation and controls muscle function to specific parts of your body.”
Each disc is made up of an outer ring called the annulus, which Gatto says can be thought of like the outer part of a car tire. “It is a strong fibrous ring that surrounds the softer inner material of the disc, known as the nucleus pulposus.”
When that outer ring becomes damaged or weakened, he explains, “it may rupture or bulge – like a bleb on a tire, allowing the inner nucleus pulposus material to leak out.” This is what a herniated disc is, and the pain and impeded movement associated with one is caused by this rupture changing the shape or position of the disc, or by the leaked material pressing on the nerves in the spinal cord. 
While such damage can occur in any part of the spine, the lower back is usually where most herniated discs occur because it’s the area that carries the weight of the entire upper body.
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Numerous things cause this damage to occur, but getting older is a big one. “As we age, the disc material begins to lose its normal water content,” explains Dr. Andrew Gitkind, medical director of the spine center at Montefiore Medical Center in New York. “As the disc becomes drier, it becomes less flexible and therefore more likely to herniate.”
He says that being overweight also puts an excessive amount of force and pressure on the disc, which, over time, “may cause the disc to herniate beyond its normal location and position.” Smoking and genetics can also affect the strength and durability of intervertebral discs. 
As any such factors cause the disc to become more fragile, an injury or a sudden movement can be all that’s needed to cause the damage that leads to a herniated disc. 
Weight-bearing and high-impact sports like weightlifting, wrestling and football are all commonly associated with herniated discs. So are sports where one twists or bends often, such as skiing, golf, volleyball and tennis.
Beyond sports, “the most damaging activities involve bending forward at the waist to pick up a heavy item and twisting to one side as you lift it,” says Gatto. Think stocking shelves, lifting a baby out of their crib or car seat, or bending over to heave something large off the floor. “The motion of bending, lifting, and twisting to the side stresses all the different possible motions of the disc segment at the same time,” he explains. 
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Treatment and care are always required to remedy a herniated disc. It can be as simple as resting long enough for healing to occur, followed by the initiation of core muscle strengthening, says Gitkind. Such core strengthening is often overseen by a trained physical therapist. Some people with a herniated disc also find relief with the help of their chiropractor. 
Even without outside interventions, however, “many disc herniations will resolve on their own over time as the body can often partially or sometimes completely resorb the disc herniation,” says Gatto. “The chemical irritation often also dissipates.”
While the body heals and muscle strengthening begins, there are a number of ways to deal with the pain and swelling associated with a herniated disc. Ice packs and heating pads are often recommended, and, “depending on the level of pain, some individuals may also use over-the-counter pain medications such as non-steroidal anti-inflammatory medications or acetaminophen,” says Gitkind. “Nerve stabilizing medications such as gabapentin or pregabalin can also mitigate burning nerve-type symptoms radiating down the arm or leg,” adds Gatto. 
Gitkind says improvement time varies from person to person as “some people feel better fairly quickly while others require a longer period of time to begin to note improvement.” 
He says that patients who do not heal on their own may require further treatments after consultation with their physician. Such treatments, he explains, “may include stronger oral medications, epidural injections or potentially surgery in order to repair or remove the herniated disc.”
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