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ASK THE DOCTORS
by Eve Glazier, M.D., & Elizabeth Ko, M.D.
Dear Doctor: I’ve been riding my bike a lot this past year, and my lower back hasn’t been quite right. I get a pinching pain, and sometimes my left leg gets pins and needles and feels numb. A friend I ride with wonders if it’s a slipped disc. Can you talk about what that is? Will it heal?
Dear Reader: Cycling has long been a great alternative for people who want a heart-pumping workout but prefer to avoid the jolting impact of running. However, poor posture while riding can lead to lower back strain. So can using the wrong size bike for your frame, or one that isn’t adjusted properly.
Your friend is correct that the pain and numbness that you are experiencing are some of the symptoms associated with a slipped disc. Also referred to as a herniated or ruptured disc, this occurs when one of the specialized pads of tissue that act as shock absorbers in the spinal column becomes damaged.
We owe our upright stance and impressive range of motion to the gentle S-shaped curve of the spine, which allows for an even distribution of weight. The spine is made up of a stack of 24 bones known as vertebrae. They protect and support the spinal cord and also help bear the weight of the upper body. Imbedded between the vertebrae are doughnut-shaped pads known as intervertebral discs. They’re about one-half inch thick, with a tough and flexible outer ring of cartilage and a yielding, jellylike center. The positioning of these discs reduces the stress and impact sustained as we move and bend and interact with the world.
A herniated disc occurs when wear and tear or an injury cause a crack in the tough outer layer of the disc. This allows the soft inner center to protrude, which can put pressure on nearby nerve roots. Improper lifting, poor posture or spinal alignment, and repetitive motions that involve the spine can put you at risk of a herniated disc. Symptoms include the pain, tingling and numbness that you are experiencing. Additional symptoms can include muscle weakness in the leg or foot or a sharp, shooting pain down the side of the leg, known as sciatica.
To know if you have a herniated disc, you need to see a doctor. It’s likely you’ll undergo a neurological exam to evaluate muscle strength, loss of sensation and reflexes. A simple test involves lying on your back and, while your leg is straight, the doctor carefully raises the limb. If there is pain down the leg and below the knee, a herniated disc is likely. An imaging test may be used to confirm the diagnosis. In most cases, nonsurgical treatments bring relief. This includes a range of medications to manage pain and inflammation, and per- haps physical therapy. Some patients find that acupuncture, massage and chiropractic treatment can help. In a small number of cases, surgery to remove the herniated portions of the disc may be recommended. Herniated discs can heal, but it takes time. It’s important to gradually ease back into activity, keep movements slow and controlled, and be patient.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assis- tant professor of medicine at UCLA Health. Send your questions to ask- firstname.lastname@example.org, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.