A Herniated disc in the lower back can range from being horrifically painful, a 10/10 or it can be completely pain-free. This completely depends on the person.
There are people who have herniated discs and don’t even know it (no they aren’t at a higher risk of developing pain), and then there are those that have a herniated disc and have terrible pain.
At this point in time we do not know why some people develop severe pain while others do not.
Where does it hurt when you have a herniated disc?
This is a loaded question as lumbar disc herniation can happen at multiple levels.
I’ll break this down into the different levels of the lumbar spine and where you might experience symptoms from that corresponding level.
L1/L2
The L1 nerve roots provide muscle function to the quadratus lumborum and iliopsoas muscle groups (partially).
They also contribute to the iliohypogastric nerve, the genitofemoral nerve, and the ilionguinal nerve.
If these nerve roots are compressed you could experience sensory or motor symptoms on your side (from the QL), difficulty with hip flexion due to the iliopsoas involvement, scrotum numbness in males and mons pubis numbness in females.
You may also experience upper thigh numbness on the anterior (front) portion.
L2/L3
Similar to the L1 nerve roots, the L2 nerve roots innervate the iliopsoas muscle and the QL (partly). The L2 nerve root also partially contributes to all of the quadricep muscles.
If the L2 nerve root is affected from a herniation you may experience numbness and tingling on front upper portion of your thigh and motor weakness in the muscle mentioned above.
Any progress weakness should be reported quickly to your doctor to determine the appropriate intervention.
L3/L4
With and L2, L3, or L4 nerve root compression you will likely experience numbness, pain, tingling, in the anterior (front) portion of the entire thigh.
You may also experience weakness in the quadricep musculature.
L4/L5
L4 is a major contributor to the quadricep musculature and most people will experience pain and weakness along the anterior surface of the front of the thigh and potentially musculature weakness.
L5/S1
L5 is the common culprit of sciatica-type pain. The L5 nerve root gives rise to sensation to the sciatic nerve and also provides innervation to the glute, hamstring, and other posterior musculature.
Pain, numbness, and weakness distribution is usually down the back of the leg in this case and you might find you’re having gluteal and hamstring weakness. The S1 and S2 nerve distribution is what affects calf muscle musculature, so if you’re having weakness there, you likely have some compression of those nerve roots.
If it is a centralized herniation of the spinal cord itself, everything below the level being compressed can be effected which is why an L5 herniation could still cause symptoms not exact to the distribution of the nerve roots.
Most herniations occur posterolaterally (back and to the side) which is why one side is affected most commonly.
How do you know if a herniated disc is serious?
Progressive weakness, numbness, tingling, and/or bowel and bladder changes should cause concern and this shows that you may need either an injection or a surgical procedure to prevent longer-term nerve damage.
When is surgery required for a herniated disc?
Surgery is most often done when patients present with progressive weakness, numbness, tingling, and/or bowel and bladder changes and then is confirmed by MRI to see where the herniation is located. If you have absent reflexes this is also a sign that you may need surgery.
The surgeon will carefully test your reflexes, strength, numbness and tingling and review your imaging.
Once these have all be reviewed the surgeon will determine whether you are an appropriate candidate or not.
What percentage of herniated discs require surgery?
According to this study, ~ 90.2% of people with disc herniations will not require surgery after one year.
“Results:
Five hundred patients met inclusion/exclusion criteria. Twenty-nine (5.8%) had L3-L4 herniations, 245 (49.0%) had L4-L5 herniations, and 226 (45.2%) had L5-S1 herniations. Overall, 451 (90.2%) patients did not undergo surgery within 1 year of diagnosis. Nonsurgical patients had an average herniation size occupying 31.2% of the canal, compared with 31.5% in patients who underwent surgery. While herniation size, age, sex, and race failed to demonstrate a statistical association with the likelihood for surgery, location of disc herniation demonstrated a strong association. L3-L4 and L4-L5 herniations had odds ratios of 0.19 and 0.45, respectively, relative to L5-S1 herniations (P = .0047). Patients were more than twice as likely to require a surgery on an L5-S1 herniation in comparison with an L4-L5 herniation (P < .05). L3-L4 herniations rarely required surgery.”
https://journals.sagepub.com/doi/10.1177/2192568220905849
Interestingly enough, this study showed that the size of the herniation didn’t really matter when it came to those who got surgery versus those who did not.
What does a neurosurgeon do for herniated discs?
A neurosurgeon has several different options of what they are able to do for a herniated disc.
Laminectomies are a common procedure and involve removing a portion of the bone to open up more space.
They will usually do a laminectomy with discectomy which involves removing the herniated portion.
To learn more about the actual procedure you can read this article or watch this video.
What should you not do with a herniated disc?
The only things you shouldn’t be doing with a herniated disc are things that make the pain significantly worse.
Contrary to popular belief, bending forward is not bad for a herniated disc. Some people actually feel better when they bend forward (speaking from experience with my clients).
What’s most important is to pick a movement that feels best and stick with that and allow for time to do it’s thing.
What is the fastest way to heal a herniated disc?
There isn’t any way to help the disc resorb more quickly and unfortunately, there isn’t really a way to make the symptoms go away faster either.
The best thing you can do is to try to stay moving as best as possible, find movements that feel good versus bad, and add in some ice, heat, and other modalities to help control the pain.
NSAID-type medication may also be helpful. Make sure to consult with your doctor before you take any medications.
For some more specific guidance, you’ll want to check out this article about my top exercises for herniated disc pain.
How Can I make my herniated disc stop hurting?
Give it time and don’t do activities that are constantly irritating it.
This is the thing people miss. They continuously are doing a bunch of things that keep hurting more and more and don’t realize that they may be keeping it around longer as opposed to if they just changed up their movement routine.
Again, i’m going to reiterate this, sometimes you just need to give it time. I’ve seen this take up to two years for people to really start to feel back to normal and to feel like their disc has healed.