Herniated disc

During the physical exam, your doctor will check your back for tenderness. You might be asked to lie flat and move your legs into various positions to help determine the cause of your pain.

Your doctor may also perform a neurological exam to check your:

Reflexes

Muscle strength

Walking ability

Ability to feel light touches, pinpricks or vibration

In most cases of herniated disk, a physical exam and a medical history are all that's needed for a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.

Imaging tests

X-rays. Plain X-rays don't detect herniated disks, but they can rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.

CT scan. A CT scanner takes a series of X-rays from different directions and then combines them to create cross-sectional images of the spinal column and the structures around it.

MRI. Radio waves and a strong magnetic field are used to create images of the body's internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.

Myelogram. A dye is injected into the spinal fluid before a CT scan is taken. This test can show pressure on the spinal cord or nerves due to multiple herniated disks or other conditions.

Conservative treatment — mainly modifying activities to avoid movement that causes pain and taking pain medication — relieves symptoms in most people within a few days or weeks.

Medications

Nonprescription pain medications. If your pain is mild to moderate, your doctor might recommend pain medication available without a prescription, such as acetaminophen (Tylenol, others) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).

Neuropathic drugs. These drugs affect nerve impulses to decrease the pain. They include gabapentin (Gralise, Horizant, Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta, Drizalma Sprinkle), or venlafaxine (Effexor XR).

Muscle relaxers. You might be prescribed these if you have muscle spasms. Sedation and dizziness are common side effects.

Opioids. Because of the side effects of opioids and the potential for addiction, many doctors hesitate to prescribe them for disk herniation. If other medications don't relieve your pain, your doctor might consider short-term use of opioids, such as codeine or an oxycodone-acetaminophen combination (Percocet, Oxycet). Sedation, nausea, confusion and constipation are possible side effects from these drugs.

Cortisone injections. If your pain doesn't improve with oral medications, your doctor might recommend a corticosteroid that can be injected into the area around the spinal nerves. Spinal imaging can help guide the needle.

Therapy

Your doctor might suggest physical therapy to help with your pain. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk.

Surgery

Removal of herniated portion of spinal disk

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Few people with herniated disks require surgery. Your doctor might suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to have:

Poorly controlled pain

Numbness or weakness

Difficulty standing or walking

Loss of bladder or bowel control