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Wed, Feb. 26

Symptoms and treatments for herniated disk

For four days, Shannon worked her company's trade show booth. She spent hours standing during the day. Evenings, she attended social gatherings that also meant standing for hours. The dull ache that started in her lower back suddenly became a sharp pain in her right buttock and ran down the back of her leg. When the pain didn't subside even after she rested, a visit to the doctor confirmed her suspicion: a herniated disk.

What is a herniated disk?

The spinal column consists of vertebrae separated by softer, cushiony disks. When that softer material slips outside the vertebral column, it can press against nerves and cause pain. Disk pain is often the result of a gradual, aging-related wear and tear called disk degeneration. In Shannon's case, the lumbar or lower back was involved. But disks in the neck can also slip or herniate. The thoracic or mid-back disks are rarely affected.

Symptoms include:

• Arm or leg pain, depending on the location of the affected disk, can radiate from the buttock to the foot or through the shoulder and arm.

• Numbness or tingling can occur in the limb that is served by the nerve the disk is pressing against.

• Weakness can occur in the muscles served by the affected nerve, causing you to stumble or have difficulty lifting or holding items.

Treatment varies based on your overall health, age, activity level and severity of the symptoms. Initially a short period of rest and pain medications, such as anti-inflammatory drugs or painkillers, may be followed by physical therapy. Taking into consideration your condition, physical therapists may combine exercise with:

• Heat or ice

• Traction

• Ultrasound

• Electrical stimulation

• Short-term bracing for neck or back

As the pain improves, they will teach you core-strengthening exercises to help avoid a recurrence. Generally, most people's symptoms improve within a month of conservative treatment.

If physical therapy doesn't relieve the pain, steroid injections may help control the pain. These injections, done in the doctor's office, reduce swelling around the disk to relieve symptoms. Your doctor may use X-ray or fluoroscopy to locate where the injection is needed.

For the few patients whose symptoms do not subside with other treatments, surgery may be necessary. Your doctor may recommend surgery if:

• Your symptoms haven't improved after six weeks of conservative therapy.

• A disk fragment lodges in your spinal canal and presses on a nerve, causing progressive weakness.

• You have difficulty performing basic activities such as standing or walking.

In most cases, the surgeon removes the protruding section of the disk. Rarely, the entire disk must be removed and the vertebrae fused with metal hardware to stabilize the spine. Your surgeon could also suggest implanting an artificial disk.

Watch for emergency warning signs.

Sometimes low back pain can be a sign of something more serious. Seek medical attention right away if you experience:

• Back pain that does not go away.

• Numbness, loss of movement or weakness.

• Changes in bladder or bowel function.

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