Introduction
Symptoms and complaints that can cause a herniated disc are different and manifold. The most common cause is pain. Mostly these are indicated as pressing and pulling in the back.
Many alternative causes for which a pulling in the back can trigger can also be found under our topic: Pulling in the backLocalized they are so mostly pain symptoms of a herniated disc only inaccurate. Patients usually point to areas of the spinal column that cover an area of 4-5 vertebrae (medically referred to as L4/5). Although this helps to delineate the approximate spinal area, the exact vertebra can only be determined by means of imaging.
The specified pain is often described as pulling towards the foot. In some cases it is stated that they extend to the tip of the foot of one half of the body. Almost always, however, patients complain that the pain extends towards the buttocks.
Symptoms of a slipped disc
Among the symptoms of a slipped disc are
- Symptoms of pressure against the nerve roots: Compression of the nerve roots causes intense pain that can radiate into the arms and legs. These pains can also be accompanied by sensory disturbances. Depending on the stage and extent of the herniated disc, symptoms can also lead to a reduction in muscle strength or paralysis of individual patients.
The cervical spine (cervical spine) consists of 7 cervical vertebrae where a herniated disc can occur. A synonym for the herniated disc of the cervical spine is the term cervical disc prolapse or also called NPP of the cervical spine. In the cervical spine, a prolapse is less frequent than in the lumbar spine.
In the case of a herniated disc, the lower cervical spine is more frequently affected than the upper. Most herniated discs are found in the segments C5/6 and C6/7, partly because the lower part is moved much more and more complex. The symptoms vary depending on the severity of the herniated disc.
If it is only very small, it is possible that neither nerves nor the spinal cord are compressed, so that a herniated disc is completely without symptoms and remains undetected for years. Otherwise, typical symptoms such as pain and paresthesia in the neck, shoulder and arm area occur. The pain is stabbing and can be centred on the neck area as well as radiate over the shoulders and arms to the fingertips.
A herniated disc of the cervical spine, which strongly compresses a nerve root, can cause extremely severe pain. Sometimes it is also described by patients as dull, pulling or pressing. Paresthesia is a painful sensation, which is a collective term for physical sensations such as tingling, numbness and temperature perception disorders.
Furthermore, there is a knocking pain in the corresponding cervical vertebrae. The stage of the cervical herniated disc is reflected in the nature of the symptoms. The described pain is considered the first sign of a herniated disc.
At first it occurs in the immediate vicinity of the cervical vertebrae, i.e. in the neck/neck area. Over time, the pain begins to radiate into the shoulders and arms and even into the hands. The more nerve fibres are compressed by the herniation, the stronger the symptoms become, so that the first numbness and a slight tingling sensation then occur.
The herniated disc is serious when it actually leads to muscle weakness and restricted movement; then a doctor should definitely be consulted. Ultimately, a herniated disc of the cervical spine can be so serious that complete failure symptoms or paralysis occur. Although this is rather rare, it is possible in principle.
One can then also speak of a paraplegic syndrome. Not only are nerves compressed, but even the spinal cord running centrally in the spinal canal is damaged in its entire diameter, resulting in paralysis of the muscles and a loss of sensitivity below the lesion. In general, an aggravation of the pain symptoms in a herniated disc of the cervical spine can be provoked and intensified by tilting the head sideways and/or backwards.
Also the lying position is perceived by patients as very uncomfortable due to an increased intensity of pain, therefore patients suffer from stronger pain at night. Often unconsciously, a relieving position, such as holding the head inclined depending on which side is affected by a herniated disc, is taken, as the symptoms may be a bit more bearable. Neck pain is a typical symptom of a herniated disc in the cervical spine.
The intensity of the neck pain depends on how severe the herniated disc is. The painful perception without the occurrence of other symptoms such as sensory disturbances, for example tingling and numbness, and a reduction in strength in the neck, shoulder and arm area tend to indicate a mild disc herniation. The development of neck pain due to a herniated disc in the cervical spine occurs as follows: Increased pressure can damage the outer fibrous ring of the disc more and more until it is finally so unstable that the gelatinous core can escape through the fracture site.
This is accompanied by a compression of the spinal nerves, whereupon a pain stimulus is triggered. If such a herniated disc occurs in the area of the cervical spine, the complaints can primarily manifest themselves in the form of neck pain, but also headaches, impaired vision or ringing in the ears. The character of the pain in the neck can vary individually.
Some affected persons report stabbing and suddenly shooting pain. In contrast, diffuse and rather dull pain is also repeatedly described. The exact localisation of neck pain due to a herniated disc is not always possible.
The neck pain also often radiates into the head and shoulders. Not infrequently, the pain even extends into the arms. An increase in the intensity of the pain is provoked by further strain and movement in the area of the cervical spine, so that those affected often adopt a relieving posture.
However, this is the beginning of a vicious circle, as the relieving posture can lead to tension, which in turn is accompanied by neck pain. It is therefore very important to treat neck pain adequately in order to achieve freedom from symptoms as quickly as possible. A herniated disc in the cervical spine area C5/6 can result from increased pressure on the discs due to incorrect posture or traumatic events.
As a result, a typical symptom with sensations such as numbness, “tingling” and pain in the corresponding skin area (=dermatoma; skin area which is supplied by sensitive fibres of a certain spinal nerve) occurs. If the spinal nerve C5 is compressed by the herniated disc at the level of C5/6, one can also speak of a C5 syndrome, which is accompanied by tingling sensations in the shoulder and upper arm area, since the C5 dermatome is located here. Another symptom is an extinguished or at first only weakened “biceps tendon reflex”.
However, if the spinal nerve C6 is compressed by the herniated disc, it is a C6 syndrome. Typical of this are on the one hand the sensory disturbances, which extend from the elbow on the outside along the outer side of the forearm to the thumb and are partly also felt on the index finger. On the other hand, as in the case of the C5 syndrome, a reflex can fail here, in this case the so-called “radial periostreflex”.
Since the spinal nerve also gives off motor parts, it is possible that affected persons with a herniated disc at the level of C5/6 report a weakness in raising their arm. A herniated disc in the cervical vertebral region at the level of C6/7 expresses itself with similar symptoms as a herniated disc at the level of C5/6. In addition to the characteristic sensitivity disorders in the area of the dermatome C6, namely from the outer elbow along the forearm to the thumb and parts of the index finger, the “radial periostreflex” is extinguished.
If, on the other hand, the spinal nerves C7 are compressed by the herniated disc, this leads to sensations in the corresponding dermatome C7. This extends over both the front and back of the forearm and hand. More precisely, it extends over the entire middle finger and the adjacent skin areas of the ring and index fingers.
The reflex that is lost in a C7 syndrome in the context of a herniated disc is the “triceps tendon reflex”. The most common location of a herniated disc is in the lumbar spine. Compared to the cervical and thoracic spine, the lumbar spine has a significantly increased risk of a prolapse.
In principle, a herniated disc can occur in all 5 lumbar vertebrae, but it is preferable that it occurs between the 4th and 5th lumbar vertebrae (herniated disc L4/5) or between the 5th lumbar vertebrae and the 1st sacrum (Os sacrum) (herniated disc L5/S1). The main symptom is the classic severe lower back pain with a radiating component into the buttocks, along the thigh, over the knee and into the tips of the feet. Especially when the N. ischiadicus, the most powerful nerve in our body from the nerve roots L4 to S3, is compressed, the pain radiates.
The pain can be sharp, pulling, but also dull and pressing. Usually the pain occurs suddenly, e.g. when lifting something heavy. In general, the pain symptomatology can be intensified by certain movements, so that patients adopt a relieving posture.
Sneezing, coughing and pressing are also very unpleasant and aggravate the stabbing pain in the back region. In addition to the pain, neurological deficits such as tingling and numbness can also occur. A special type of paraesthesia (tingling) is called breeches anaesthesia because of its localization.
This is the loss of sensitivity in the buttock and genital area and on the inside of the thigh. The reason for this is nerve root damage to the sacral segments S1-3. Depending on the extent of the herniated disc of the lumbar spine and the compression of surrounding structures, paralysis in the leg region may occur (herniated disc with symptoms in the leg).
As a rule, patients notice these serious symptoms by stumbling more often or having no stability in their knees when climbing stairs. For examination, the patient can be asked to stand on his heels once and then on his toes. If there are any difficulties, a herniated disc of the lumbar spine should definitely be clarified by means of an MRI of the lumbar spine.
The most frequent herniated discs of the lumbar spine occur in the segments L4/5 and L5/S1. However, it is not only the leg muscles with paralysis symptoms that worry the patients, but also the nerves regulating the bladder and bowel function can be affected with the consequence of incontinence (= urination and bowel movement can no longer be controlled). The incontinence mostly occurs in connection with the already mentioned anaesthesia of riding breeches.
It can also lead to a disturbance of the sexual function. . Pain is felt by every affected person and therefore it belongs to every herniated disc.
Mostly the pain has a stabbing quality. In addition to the pain, sensations can be noticeable. These include, among other things, tingling or numbness.
In severe cases, muscle paralysis – mainly on the thighs – can also occur. A herniated disc L4/5 is the second most common disc in the human body. Only a herniated disc L5/S1 occurs more frequently.
A herniated disc L4/5 can basically affect the nerve root L4 or L5. In most cases the 5 root is affected. Because depending on where the patient states the symptoms of the movement restrictions, it can be concluded which area of the spine is affected by the herniated disc.
An example is the disturbed foot lift. If the patient is no longer able to do so, a herniated disc of the lumbar spine between L4/5 can be assumed. In this case, the intervertebral disc is pushed between the two vertebral bodies 4 and 5 and presses the nerves L5 running there, which leads to the weakness of foot lifter described above. Pain that ends in the big toe also speaks for a herniated disc L4/5.
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