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Is Your Back Pain from a Herniated Disk?
Could your back pain be from a herniated disk? The soft disks between your vertebrae cushion and keep your vertebrae in place. But as you age, they can break down and lose their ability to cushion the spine and can cause pain, weakness or numbness. Learn from spine expert Dr. Eugene Koh what a herniated disk is, what causes them, how to prevent them and much more.
Featured Speaker:
He completed an orthopedic surgery residency at Rhode Island Hospital, an affiliate of Brown University, and went on to complete two fellowships at Rhode Island Hospital and Emory University in orthopedic trauma and orthopedic spine.
Dr. Koh graduated summa cum laude and Phi Beta Kappa from Harvard. Dr. Koh has authored over two dozen journal articles and has been invited to speak at numerous conferences. He is an active member of the American Academy of Orthopaedic Surgeon and the Society for Minimally Invasive Spine Surgery.
Dr. Koh’s specific area of interest and clinical expertise, include disorders of the cervical and lumbar spine, minimally invasive spinal techniques, and reconstruction of the traumatically injured spine.
He is affiliated with UM Rehabilitation & Orthopaedic Institute, UM Upper Chesapeake Health, University of Maryland Medical Center,
University of Maryland Medical Center Midtown Campus, and is a
member of UM Faculty Physicians, Inc.
Eugene Koh, MD
Dr. Koh serves as the dedicated spine surgeon and the Chief of Orthopaedics for the Baltimore VA Medical Center. Under the Medical Scientist Training Program, he received a dual degree of MD-PhD from the Harvard School of Medicine and the Massachusetts Institute of Technology.He completed an orthopedic surgery residency at Rhode Island Hospital, an affiliate of Brown University, and went on to complete two fellowships at Rhode Island Hospital and Emory University in orthopedic trauma and orthopedic spine.
Dr. Koh graduated summa cum laude and Phi Beta Kappa from Harvard. Dr. Koh has authored over two dozen journal articles and has been invited to speak at numerous conferences. He is an active member of the American Academy of Orthopaedic Surgeon and the Society for Minimally Invasive Spine Surgery.
Dr. Koh’s specific area of interest and clinical expertise, include disorders of the cervical and lumbar spine, minimally invasive spinal techniques, and reconstruction of the traumatically injured spine.
He is affiliated with UM Rehabilitation & Orthopaedic Institute, UM Upper Chesapeake Health, University of Maryland Medical Center,
University of Maryland Medical Center Midtown Campus, and is a
member of UM Faculty Physicians, Inc.
Transcription:
Is Your Back Pain from a Herniated Disk?
Joey Wahler (Host): Well, a herniated disc is also known as a bulged or slipped disc and can be a source of back pain. But what exactly is it and how is it diagnosed, treated or prevented? We're discussing is your back pain from a herniated disc?
Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast sponsored by the University of Maryland Spine Network. I'm Joey Wahler.
Our guest, Dr. Eugene Koh, dedicated spine surgeon and the Chief of Orthopedic Spine for the Baltimore VA Medical Center. Dr. Koh, thanks so much for joining us.
Dr Eugene Koh: Thank you for having me.
Joey Wahler (Host): Well, first off, we sometimes hear the term, but for those unfamiliar, what exactly is a herniated disc?
Dr Eugene Koh: Herniated disc and kind of the best analogy that I like to tell patients is a disc is part of the anatomy of the spine that helps you give flexibility to your spine. And the analogy that I would like to tell patients is, think about it as a mini pillow and cushion. And over time, that mini pillow and cushion can flatten out and herniate. And essentially, what a herniation means is that the stuffing of the pillow can irritate some of the elements in your back, including the nerve elements.
Joey Wahler (Host): So, what are some of the main causes of a herniated disc?
Dr Eugene Koh: Usually, it's related to what we call degeneration of the disc. As we age, the stuffing of the pillow per se or, i.e., the insides of the disc lose water content and they kind of become stiffer in some aspects. And the outer layer of the disc actually ends up sometimes cracking or having a hole in it where the stuffing of the pillow could come out. What creates the stuffing of the pillow coming out or a disc bulge or flattening of the pillow, i.e., flattening of the lumbar disc usually is caused by the natural aging process of spine or some precipitated event where you're lifting something heavy in particular, it could be bending or twisting or repetitive motions of those activities of bending and twisting.
Joey Wahler (Host): So, what are some of the signs and symptoms that could indicate that someone should see a doctor if they think this may be an issue for them?
Dr Eugene Koh: The biggest kind of symptoms for these herniated discs can be debilitating low back pain. And sometimes when it hits the nerve elements, it can cause pain shooting down the legs. That's what we call radicular pain. We get very concerned about weakness in the leg that might be affected or can sometimes, if it's a big herniated disc, cause problems with bowel and bladder control. And so those are the big concerning things that probably necessitate going to an emergency room to get it evaluated.
Joey Wahler (Host): Interesting. So the symptoms might not necessarily be in the back itself. It may be elsewhere, as you just said. Now, if this does turn out to be an issue for someone, how about being able to manage it versus possibly needing surgery? What happens from there?
Dr Eugene Koh: For majority of people who have a herniated disc, that present with back pain that's often associated with leg pain, in about 90% of patients with an acute disc herniation, they'll end up getting better within six to eight weeks with minimal intervention and maybe some medication management, including some non-steroidal anti-inflammatory medication like Tylenol or ibuprofen, as well as other medications that can help with the pain.
For some people who would have severe amount of pain and is not managed well with medications, we can make recommendations of an epidural steroid injection, which is putting localized steroids nearby the herniated disc that can significantly relieve pain. And the final solution for this is to remove the herniated disc that's actually irritating the nerve roots. That can be through a surgery. And usually, it's a minimally invasive surgery called a microdiscectomy.
Joey Wahler (Host): So you're saying there that whether it's treatment, which you described or the need for surgery, a herniated disc is something that can be completely healed, right?
Dr Eugene Koh: It can. When people have resolution of their symptoms by six weeks, the thought is that the disc or per se the stuffing of the pillow that's irritating the nerve roots is getting reabsorbed, so it's no longer irritating the nerve elements. There's an unfortunate few that that herniated disc isn't being resorbed and is continuously irritating the nerve elements. And that may require an interventional process, an invasive process, like an epidural steroid injection or surgery, including a microdiscectomy.
Joey Wahler (Host): So if surgery is needed, is there a roughly typical scenario in terms of rehabilitation timetable, how long it takes to get back to being your old self?
Dr Eugene Koh: Usually, I tell patients that no matter what you do, whether it's surgery, no surgery, there's a possibility of reherneating that disc and about 5% to 10% chance of possibly reherniating that disc, even if there is surgery, no surgery. For patients who undergo surgery, there's usually a very small incision and that incision needs to heal up. So usually, we tell patients to take it easy and let the incision heal up for about two weeks. And then, we slowly increase their activity levels as everything gets better and improve. Usually, they're back to the swing of things by the four to six-week period of time.
Joey Wahler (Host): Now doctor, those of us that follow sports know that you hear the term herniated disc quite a bit in the sports world, where it's an athlete that has come up with this condition. If it's not degenerative, if it's not from regressing over time and it's something more acute, an injury or excess use, do those type causes typically happen more in people that are athletic that are working out, even if it's just weightlifting, weekend warrior, you know, your average Joe? Or do people often do it as well, let's say at work, by lifting things the wrong way, or maybe, I'm wondering also, could it take just one wrong move? Maybe you go to pick up the end of the couch and you're just not in the right position. I guess I'm wondering, if it's not degenerative and it's more acute, is there a typical person, a typical scenario that would cause this?
Dr Eugene Koh: To answer your first part of your question, definitely the high performance athletes put a lot of strain on their spine, and they're a little bit of a higher risk because of the performance they're putting on their bodies and then the strain that they put on their bodies. The second part of your question, I would say is that, yes, it is common for patients with repetitive motions of their back, like heavy lifting that end up particularly being set up for herniated disc or back problems. And the final part of your question is, yes, it can happen to a person with a single event of lifting something heavy or twisting in a funny position that causes that herniated disc to come out and aggravate some of the nerve elements.
Joey Wahler (Host): If it's let's say on the more minor side, will it ever heal on its own? And I'm not suggesting someone not see a doctor, of course. But do you ever say, "Hey, let's maybe just give it some time" or does it always require some sort of intervention by a physician?
Dr Eugene Koh: Yes. So about 90% of patients, when they have an acute episode of low back pain that we assume is a herniated disc, will get better within six to eight weeks with minimal medical management, including over-the-counter medications, including ibuprofen and Tylenol.
Patients need to be evaluated and see a doctor if the pain is persistent and you have some worrisome signs of neurological symptoms. And what I mean by neurological symptoms is if you're starting to have weakness in your legs, if you're having persistent numbness and tingling in your legs. You're having also loss of bowel and bladder control. Those are very concerning symptoms that need to be evaluated by a doctor. And usually, the doctor will then order MRI, magnetic resonance, imaging in order to look at your spine and that's detailed and looking at all the soft tissue and nerve elements that might be affected.
Joey Wahler (Host): How about prevention? Can a herniated disc be avoided? And if so, how?
Dr Eugene Koh: The best way to try to prevent the disc from aging and being the best health is actually a couple of things that we can do in our lifestyle. One of the biggest things that we can do is actually not take up smoking. Smoking actually causes the blood supply to the disc to actually be a lot less. And so the disc tends to age and degenerate a lot faster and put it at a higher risk of herniating. There's been some studies that suggest that smokers have a 10 times higher risk of herniating discs or having what we call degenerative discs and having low back problems throughout their life.
The second thing that can be very helpful is nutrition. Obesity or overweight can cause a lot of pressure onto the spine. And if you're in good enough health and in the right limit, you actually can decrease the amount of herniated disc that you have. Studies are out there that show that obesity and overweight is a risk for reherniating discs after surgery.
And final thing is what puts strain on the spine is using your back muscles, what we call the paraspinal muscles and puts a lot of strain on the nerve, the bony elements, as well as the disc to support your torso. So doing great dynamics for your back when you bend over, developing your core abdominal muscles helps reduce the strain on your lower back.
Joey Wahler (Host): And so in closing here, doctor, what's the main message would you say that you want people to take away from our discussion?
Dr Eugene Koh: The biggest take home message is that for most patients with acute episode of low back pain that may be caused by a herniated disc, most of the time, 90% of the time, will get much better with expected management with conservative treatment, including over-the-counter medications. And by six to eight weeks, we expect your back pain to be much better.
The worrisome signs that get us concerned and that you need to be evaluated by a physician sooner than that six to eight weeks is if you start having symptoms of weakness in your legs in addition to your back pain, as well as issues with control of your bowel and bladder, those are things that we need to address quite urgently in that aspect to make sure that we understand what's causing those symptoms and to make sure that we can treat it expeditiously.
Joey Wahler (Host): All right. Great. So folks, if you have back pain, again, it may be a herniated disc. And now, you know, some of the causes and treatments of that. Dr. Eugene Koh, thanks so much again.
Dr Eugene Koh: Thank you.
Joey Wahler (Host): And this episode is sponsored by the University of Maryland Spine Network connected by the renowned University of Maryland School of Medicine. The UM Spine Network is home to the state's leading spine experts with convenient locations throughout the state. UM Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve.
Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. I'm Joey Wahler.
Is Your Back Pain from a Herniated Disk?
Joey Wahler (Host): Well, a herniated disc is also known as a bulged or slipped disc and can be a source of back pain. But what exactly is it and how is it diagnosed, treated or prevented? We're discussing is your back pain from a herniated disc?
Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast sponsored by the University of Maryland Spine Network. I'm Joey Wahler.
Our guest, Dr. Eugene Koh, dedicated spine surgeon and the Chief of Orthopedic Spine for the Baltimore VA Medical Center. Dr. Koh, thanks so much for joining us.
Dr Eugene Koh: Thank you for having me.
Joey Wahler (Host): Well, first off, we sometimes hear the term, but for those unfamiliar, what exactly is a herniated disc?
Dr Eugene Koh: Herniated disc and kind of the best analogy that I like to tell patients is a disc is part of the anatomy of the spine that helps you give flexibility to your spine. And the analogy that I would like to tell patients is, think about it as a mini pillow and cushion. And over time, that mini pillow and cushion can flatten out and herniate. And essentially, what a herniation means is that the stuffing of the pillow can irritate some of the elements in your back, including the nerve elements.
Joey Wahler (Host): So, what are some of the main causes of a herniated disc?
Dr Eugene Koh: Usually, it's related to what we call degeneration of the disc. As we age, the stuffing of the pillow per se or, i.e., the insides of the disc lose water content and they kind of become stiffer in some aspects. And the outer layer of the disc actually ends up sometimes cracking or having a hole in it where the stuffing of the pillow could come out. What creates the stuffing of the pillow coming out or a disc bulge or flattening of the pillow, i.e., flattening of the lumbar disc usually is caused by the natural aging process of spine or some precipitated event where you're lifting something heavy in particular, it could be bending or twisting or repetitive motions of those activities of bending and twisting.
Joey Wahler (Host): So, what are some of the signs and symptoms that could indicate that someone should see a doctor if they think this may be an issue for them?
Dr Eugene Koh: The biggest kind of symptoms for these herniated discs can be debilitating low back pain. And sometimes when it hits the nerve elements, it can cause pain shooting down the legs. That's what we call radicular pain. We get very concerned about weakness in the leg that might be affected or can sometimes, if it's a big herniated disc, cause problems with bowel and bladder control. And so those are the big concerning things that probably necessitate going to an emergency room to get it evaluated.
Joey Wahler (Host): Interesting. So the symptoms might not necessarily be in the back itself. It may be elsewhere, as you just said. Now, if this does turn out to be an issue for someone, how about being able to manage it versus possibly needing surgery? What happens from there?
Dr Eugene Koh: For majority of people who have a herniated disc, that present with back pain that's often associated with leg pain, in about 90% of patients with an acute disc herniation, they'll end up getting better within six to eight weeks with minimal intervention and maybe some medication management, including some non-steroidal anti-inflammatory medication like Tylenol or ibuprofen, as well as other medications that can help with the pain.
For some people who would have severe amount of pain and is not managed well with medications, we can make recommendations of an epidural steroid injection, which is putting localized steroids nearby the herniated disc that can significantly relieve pain. And the final solution for this is to remove the herniated disc that's actually irritating the nerve roots. That can be through a surgery. And usually, it's a minimally invasive surgery called a microdiscectomy.
Joey Wahler (Host): So you're saying there that whether it's treatment, which you described or the need for surgery, a herniated disc is something that can be completely healed, right?
Dr Eugene Koh: It can. When people have resolution of their symptoms by six weeks, the thought is that the disc or per se the stuffing of the pillow that's irritating the nerve roots is getting reabsorbed, so it's no longer irritating the nerve elements. There's an unfortunate few that that herniated disc isn't being resorbed and is continuously irritating the nerve elements. And that may require an interventional process, an invasive process, like an epidural steroid injection or surgery, including a microdiscectomy.
Joey Wahler (Host): So if surgery is needed, is there a roughly typical scenario in terms of rehabilitation timetable, how long it takes to get back to being your old self?
Dr Eugene Koh: Usually, I tell patients that no matter what you do, whether it's surgery, no surgery, there's a possibility of reherneating that disc and about 5% to 10% chance of possibly reherniating that disc, even if there is surgery, no surgery. For patients who undergo surgery, there's usually a very small incision and that incision needs to heal up. So usually, we tell patients to take it easy and let the incision heal up for about two weeks. And then, we slowly increase their activity levels as everything gets better and improve. Usually, they're back to the swing of things by the four to six-week period of time.
Joey Wahler (Host): Now doctor, those of us that follow sports know that you hear the term herniated disc quite a bit in the sports world, where it's an athlete that has come up with this condition. If it's not degenerative, if it's not from regressing over time and it's something more acute, an injury or excess use, do those type causes typically happen more in people that are athletic that are working out, even if it's just weightlifting, weekend warrior, you know, your average Joe? Or do people often do it as well, let's say at work, by lifting things the wrong way, or maybe, I'm wondering also, could it take just one wrong move? Maybe you go to pick up the end of the couch and you're just not in the right position. I guess I'm wondering, if it's not degenerative and it's more acute, is there a typical person, a typical scenario that would cause this?
Dr Eugene Koh: To answer your first part of your question, definitely the high performance athletes put a lot of strain on their spine, and they're a little bit of a higher risk because of the performance they're putting on their bodies and then the strain that they put on their bodies. The second part of your question, I would say is that, yes, it is common for patients with repetitive motions of their back, like heavy lifting that end up particularly being set up for herniated disc or back problems. And the final part of your question is, yes, it can happen to a person with a single event of lifting something heavy or twisting in a funny position that causes that herniated disc to come out and aggravate some of the nerve elements.
Joey Wahler (Host): If it's let's say on the more minor side, will it ever heal on its own? And I'm not suggesting someone not see a doctor, of course. But do you ever say, "Hey, let's maybe just give it some time" or does it always require some sort of intervention by a physician?
Dr Eugene Koh: Yes. So about 90% of patients, when they have an acute episode of low back pain that we assume is a herniated disc, will get better within six to eight weeks with minimal medical management, including over-the-counter medications, including ibuprofen and Tylenol.
Patients need to be evaluated and see a doctor if the pain is persistent and you have some worrisome signs of neurological symptoms. And what I mean by neurological symptoms is if you're starting to have weakness in your legs, if you're having persistent numbness and tingling in your legs. You're having also loss of bowel and bladder control. Those are very concerning symptoms that need to be evaluated by a doctor. And usually, the doctor will then order MRI, magnetic resonance, imaging in order to look at your spine and that's detailed and looking at all the soft tissue and nerve elements that might be affected.
Joey Wahler (Host): How about prevention? Can a herniated disc be avoided? And if so, how?
Dr Eugene Koh: The best way to try to prevent the disc from aging and being the best health is actually a couple of things that we can do in our lifestyle. One of the biggest things that we can do is actually not take up smoking. Smoking actually causes the blood supply to the disc to actually be a lot less. And so the disc tends to age and degenerate a lot faster and put it at a higher risk of herniating. There's been some studies that suggest that smokers have a 10 times higher risk of herniating discs or having what we call degenerative discs and having low back problems throughout their life.
The second thing that can be very helpful is nutrition. Obesity or overweight can cause a lot of pressure onto the spine. And if you're in good enough health and in the right limit, you actually can decrease the amount of herniated disc that you have. Studies are out there that show that obesity and overweight is a risk for reherniating discs after surgery.
And final thing is what puts strain on the spine is using your back muscles, what we call the paraspinal muscles and puts a lot of strain on the nerve, the bony elements, as well as the disc to support your torso. So doing great dynamics for your back when you bend over, developing your core abdominal muscles helps reduce the strain on your lower back.
Joey Wahler (Host): And so in closing here, doctor, what's the main message would you say that you want people to take away from our discussion?
Dr Eugene Koh: The biggest take home message is that for most patients with acute episode of low back pain that may be caused by a herniated disc, most of the time, 90% of the time, will get much better with expected management with conservative treatment, including over-the-counter medications. And by six to eight weeks, we expect your back pain to be much better.
The worrisome signs that get us concerned and that you need to be evaluated by a physician sooner than that six to eight weeks is if you start having symptoms of weakness in your legs in addition to your back pain, as well as issues with control of your bowel and bladder, those are things that we need to address quite urgently in that aspect to make sure that we understand what's causing those symptoms and to make sure that we can treat it expeditiously.
Joey Wahler (Host): All right. Great. So folks, if you have back pain, again, it may be a herniated disc. And now, you know, some of the causes and treatments of that. Dr. Eugene Koh, thanks so much again.
Dr Eugene Koh: Thank you.
Joey Wahler (Host): And this episode is sponsored by the University of Maryland Spine Network connected by the renowned University of Maryland School of Medicine. The UM Spine Network is home to the state's leading spine experts with convenient locations throughout the state. UM Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve.
Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. I'm Joey Wahler.