Why do people get herniated discs in the lower back?

The disc is a joint between the vertebrae that acts as a shock absorber, allowing us to move our torso in all directions. Before the age of 20, the discs are elastic and stretchable, but over the years, their water content gradually decreases and cracks may form in the disc's capsule (disc degeneration/age-related changes). In these cracks, parts of the disc's core may protrude as a herniation, which in some cases presses on one or more nerves.

Herniated discs often occur without any specific incident, though sometimes they can result from lifting, twisting the back, or an accident. Not all herniated discs are painful. It is possible to have a herniated disc without ever experiencing pain in either the back or legs.

What are the symptoms?

Symptoms often start gradually with just pain in the lower back, but they can also appear suddenly during an activity. The pain may worsen and after a few days be followed by pain that radiates down the leg. Leg pain often worsens when sitting down and also from abdominal pressure, for example during coughing or using the toilet.

The best way to alleviate the symptoms is to lie on your back with hips and knees bent at a 90-degree angle. Besides pain, the pressure on the nerves can cause weakening of the leg muscles and/or numbness in the leg—often below the knee. To confirm it is a herniated disc, an MRI of the lower back is performed.

What treatments are available?

Most herniated discs heal without surgery and the pain subsides. If symptoms do not disappear within 2 months and you have significant pain in the leg, surgery may be considered.

The need for surgery is determined by the level of pain you are experiencing and how much the herniated disc affects sensation and muscle function. If you have severe leg pain or if the pain worsens, an earlier surgery may be necessary. In rare cases, emergency surgery may be required if, for example, you cannot empty your bladder or have reduced sensation in the pelvis or weak anal muscles.

Are there any risks associated with surgery?

As with all surgeries, there is a small risk of infection. If it occurs in the disc itself, prolonged antibiotic treatment is needed, but this is very rare—less than 1% are affected. To reduce the risk of infection, all patients receive antibiotic prophylaxis during surgery.

A clear risk factor that you can influence is smoking. If you are a smoker, you are at greater risk for complications such as infection and delayed healing. If you quit smoking, you significantly increase your chances of a successful treatment outcome.

How long is the hospital stay?

For surgery, you will come to us in the morning and in most cases can go home the same day, just a few hours after the operation. If you live far away or don't have someone at home, you may need to stay overnight.

How long will I need to be off work?

The length of time you will need to be off work after surgery depends on your job, but it is usually 2-4 weeks.

What does rehabilitation involve?

Rehabilitation exercise after your surgery is crucial for achieving the best possible results and function. As a natural part of your treatment with us, we develop an individual rehabilitation plan tailored to your needs. The goal is to restore full strength, function, and mobility and increase your confidence in your back. This will provide you with the best conditions for a good quality of life and help prevent future problems. You are often fully rehabilitated after 6-12 months, after which we recommend that you continue fitness training to maintain the best possible back health. All physiotherapists at RKC have extensive experience in treating, diagnosing, and rehabilitating back conditions and pain.

Is there anything I shouldn't do when I get home?

After surgery, we usually don't impose any restrictions on normal activities. Before going home, you will receive information about activity from a physiotherapist.