Herniated Disc Diagnosis

If you think you may have a herniated disc, the first step is to call and schedule an appointment with your regular doctor. While herniated discs are not uncommon, there are a wide variety of conditions and injuries that can cause symptoms to those experienced by individuals with herniated discs.  Spinal stenosis, pulled or torn muscles and ligaments, fractures, issues with the sacroiliac joint – to name only a few – are all conditions that can cause neck and/or back pain and in cases where nerves are significantly affected, numbness and weakness.

How Do I Know If I Have a Herniated Disc?

There is no way to know what is causing your symptoms until you have been definitively diagnosed. Therefore, before moving forward with any type of treatment plan, it is imperative that your physician conduct a comprehensive diagnostic interview and examination. Without a full and clear understanding of the nature and cause of the symptoms that have brought you in to seek treatment, your physician cannot properly assist you in determining the best course of treatment.

Preparing for Your Initial Appointment

When you are in pain, it can be difficult to do much of anything – preparing for and going to a doctor’s appointment is no exception. Unfortunately, many herniated disc cases (as well as many other spinal injuries) do not resolve without treatment. There’s no getting around going to the doctor if you want to get well, but there are ways that you can prepare for and help your appointment to go as smoothly and quickly as possible. The key to an accurate diagnosis is plentiful and accurate information about the condition. Your doctor will play their role in collecting the best possible information through their examination, clinical interview, and any imaging or other diagnostic tests that they run.  As a patient, you can help in this process by collecting and writing down relevant details about your condition before your appointment, so that you have the information clearly and concisely available while going through the diagnostic interview with your physician.

Questions you will likely be asked include:

• What symptoms are you currently experiencing?
• If you are experiencing pain, how would you rate its severity?
• Have you experienced any loss of sensation or weakness in your arms, legs, fingers, or toes?
• Have you had any difficulty going to the bathroom?
• When did you first notice your symptoms?
• Does taking over-the-counter medication help with your pain?
• Do any particular movements or positions help to ease your discomfort?
• Are there any particular movements or positions that make your symptoms worse?
• How would you describe your pain (e.g., dull, sharp, aching, shooting, pinching)?
• Does you regularly engage in rigorous physical exercise and/or is your job routinely physically demanding?
• Do you spend long hours sitting at a desk without regular breaks?
• Do you have any existing medical conditions?
• Do you have a family history of disc herniation?

Having clear, concise, and honest answers to these questions prepared before your appointment can help to facilitate you receiving an accurate diagnosis more quickly. Additionally, prepare a list of any and all questions that you may have for your doctor so that they will be able to inform you in the most effective way possible.

What to Expect During Your Appointment

In most situations, your doctor will begin your appointment with a thorough discussion of the nature and extent of your symptoms. You will also discuss any medicines or at-home treatment methods you may have used thus far in your efforts to alleviate your symptoms. This is usually a good time to let your doctor know if you have prepared information for the appointment, and to bring up any questions that may have come up during your appointment preparation.

During this diagnostic interview, your physician will also perform a physical exam. In addition to visually examining the affected area, they may ask you to attempt different positions to evaluate your spinal mobility. The leg raise test is often used in a herniated disc diagnosis when symptoms are felt in the lower back or legs. This test involves the doctor lifting your each of your legs while you lie on your back until it begins to hurt. If you experience pain while your leg is at a 30-70 degree angle, it may indicate a herniated disc and your doctor will likely proceed with other diagnostic tests. They will also gently touch the affected area and the areas surrounding it to investigate the severity, type, and location of your presenting symptoms. In addition to pain, your doctor will be looking for any loss of sensation, which indicates a neurological issue.

After physically examining and discussing your condition with you, your physician will decide whether it is necessary to proceed with further testing. In many cases, if the pain is tolerable and there are no signs of complications, patients are advised to wait and see if the condition self-resolves within six weeks. If symptoms are still persistent at that point, your physician will advise you as to the best course of treatment. At this point, they may order further tests if they are uncertain as to whether you are experiencing disc herniation or another condition.  Additionally, if neurological damage is a concern, your physician will want to perform imaging tests to ascertain exactly which nerves are being affected.

Whether your physician recommends further testing immediately or recommends it after the six week waiting period, the next diagnostic step will be to perform imaging tests. X-rays and computerized tomography (CT) scans can be used to eliminate other possible diagnoses but they are not indicative of disc herniation on their own. Magnetic resonance imaging (MRIs) are very useful in assessing disc herniation as they actually enable the doctor to see the herniated disc, as well as determine which nerves may consequently be under pressure. In more infrequent cases, a myelogram — in which dye is inserted into the spine – is performed but the medical community has not reached consensus as to the efficacy of this test, especially given its invasive nature. Electromyography (EMGs) and conduction tests can be done to further evaluate neurological functioning.  None of these tests are definitive on their own but in conjunction with your doctor’s observations from the physical exam and diagnostic interview, they can be very helpful in determining the most likely diagnosis and thus the ideal treatment plan for you.

What to Expect after the Diagnosis of a Herniated Disc

Disc herniation refers to the process by which the outer layer of one or more of the cushiony discs between the vertebras in your spine becomes compromised, often resulting in nerve compression. If after all appropriate examinations and tests your doctor diagnoses you with a herniated disc, do not despair! As has already been mentioned in this article, many cases of disc herniation resolve on their own after a few weeks and many herniated discs are asymptomatic from the start. If neither of these situations apply to you, you still have no reason to lose hope as the prognosis remains positive. For those individuals whose herniated discs are causing symptoms and are not resolving on their own, there are a wide variety of effective treatment options available.

Unless you are in unbearable pain or your physician suspects a serious complication, you will be started on a conservative treatment regimen which may include such things as temperature therapy, medication, and physical therapy. Passive treatments like medication and temperature therapy help to manage your pain and reduce inflammation while active treatments like specific stretches and exercises help to strengthen the muscles supporting your spine and thus increase spinal stability. In almost all cases, these non-surgical methods will prevail and surgery will not be necessary.

However, if after months of conservative treatment your symptoms still significantly reduce your quality of life, your doctor may recommend a surgical intervention. Surgery for a herniated disc is focused on eliminating the cause of any pressure on any nerves as well as ensuring the spine is stabilized and able to heal correctly post-surgery.  There are several procedures that your doctor may recommend depending on the specifics of your case.

In many situations, it is preferable to have a minimally invasive surgery done as opposed to a traditional open surgery, as minimally invasive herniated disc surgeries have a significantly shorter recovery time and typically cause substantially less trauma to the tissues surrounding the affected disc and nerves.

Be sure to thoroughly research all of your treatment options both on your own and with your doctor, and do not be afraid to ask questions. Actively participating in your treatment decisions and bringing up all potential concerns prior to surgery can help to make sure that things go as smoothly and effectively as possible.

Click here to learn more about herniated disc treatment.