Back Pain Archive

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Ask the doctors

Q. I have a herniated disc in my back. What does this mean, and will this heal on its own?

A. A herniated disc, also called a slipped or ruptured disc, is a common problem that can happen at any age, but becomes more common in middle age and beyond. It occurs when the jelly-like filling in a spinal disc — one of the pads between your vertebrae, or spinal bones — breaks through the disc's outer shell, called the annulus, and bulges through the tear. When this happens, the material may press on nearby nerves, which can cause a host of symptoms including inflammation, pain, and numbness. Where in your body you experience these symptoms depends on the location of the herniated disc. For example, if the disc is in your neck, you may feel pain down your shoulder and into your arm. If the disc is lower in your back, it may irritate your sciatic nerve, which can cause pain that radiates through your buttock and down your leg. The good news is that in most cases — 90% of the time — pain caused by a herniated disc will go away on its own within six months. Initially, your doctor will likely recommend that you take an over-the-counter pain reliever and limit activities that cause pain or discomfort. But in some cases, if you've been using these strategies and haven't noticed an improvement, your doctor may recommend further evaluation and possibly an additional treatment strategy, such as physical therapy. Surgery is typically not recommended unless the problem does not respond to therapy, if you are having an increasingly hard time moving, or if your doctor believes the spinal cord is being compressed.

Mind-body therapies can help you reframe awareness of pain, whether recent or chronic, and rethink your response to it. There are several different techniques, some of which involve guidance or working with a therapist; others require nothing but focus and a small amount of time.

Try conservative measures first to control pain, and know the limits and risks of cortisone  shots if you choose to try it.

Most people who suffer with back pain already know the drill: time heals this wound. Over weeks to months, the pain will calm down, and you will slowly return to your normal life. In the meantime, try to stay as active as possible and rely as much as possible on over-the-counter pain relievers to help avoid needing cortisone shots. Doctors call these shots corticosteroid injections.

But for some, these conservative measures may not relieve the agony soon enough—especially if the problem is back pain caused by irritated spinal nerves. After a few weeks, just getting to the bathroom may start to feel like Napoleon's winter march in Russia. At that point, you may be offered a cortisone injection to calm the war zone in your lower back.

Spinal instability can contribute to low back pain, but the "big three" exercises can help.

A strong core can stabilize your spine to help keep your lower back healthy and pain-free. The muscles and ligaments surrounding your spine can weaken with age or from an injury, which can make movements like twisting, stretching, lifting, and bending difficult.

"The lower back often has to compensate for this lack of mobility, which places greater stress and burden on its muscles," says Eric L'Italien, a physical therapist with Harvard-affiliated Spaulding Rehabilitation Center.

Stretching becomes crucial as you age. Here is a quick routine that addresses the major tight spots.

Stretching is much like flossing. You know it's good for your health, but for whatever reason, you may not always make time for it.

"Most people know they need to stretch more, but find it burdensome or are not sure what to do," says Urvashi Chogle, a physical therapist at Harvard-affiliated Spaulding Rehabilitation Network.

Sciatica's (pronounced sigh-AT-eh-ka) hallmarks are pain and numbness that radiates down the leg, often below the knee. In nine out of 10 cases, sciatica is caused by a displaced disk in the lower spine.

The best medicine is often patience — with some stoicism mixed in — because the pain often goes away, even if the problem disk does not. Researchers have found that the pain usually improves within a month.

Building the strength of the central muscles in your torso can help improve your balance and mobility.

You probably don't give a lot of thought to your core muscles, but they play a starring role in your daily life.

"The core is critical for stability and functional motion day to day," says Dr. Beth Frates, clinical assistant professor of physical medicine and rehabilitation at Harvard Medical School. "For example, standing, bending, twisting, and sitting all require the core muscles. With a strong core, people can reach for glasses on high shelves and stay balanced while walking with heavy grocery bags."