Herniated Disk in the Lower Back

Although a herniated disk can develop at any point along the spine, it typically happens most frequently in the lower back. A bulging, protruding, or ruptured disk is occasionally referred to as such. Among the leading factors behind lower back discomfort and leg pain or sciatica, it is one of the most prevalent.

Approximately 60 to 80% of individuals will encounter low back pain at some point in their lifetime. A herniated disk can be the underlying cause of low back pain and leg pain in some of these individuals.

Despite the potential for significant discomfort, nonsurgical treatment lasting a few weeks or months is usually sufficient for most individuals to experience considerable relief from a herniated disk.


The vertebral column consists of 24 vertebrae that are stacked on top of each other. By joining together, these bones form a canal that safeguards the spinal cord. The lumbar spine, which comprises five vertebrae, constitutes the lower back region.

Additional parts of the spinal column consist of:

  • Spinal cord and nerves: Within the spinal canal, these electrical cables transmit messages between the brain and muscles. Nerve roots extend from the spinal cord via foramen, which are openings present in the vertebrae.
  • Intervertebral disks: Flexible intervertebral disks are situated between the vertebrae. Roughly half an inch in thickness, these disks are flat and circular in shape. When walking or running, intervertebral disks function as shock absorbers. Two components comprise them:
    • Annulus fibrosus: sturdy and pliable outer ring of the disk.
    • Nucleus pulposus: gelatinous and pliable center of the disk.


​​The exertion of pressure by the gelatinous nucleus against the outer ring, which can result from either gradual degeneration or a sudden injury, can trigger a disk herniation. Exerting pressure against the outer ring can lead to lower back pain.

Continued pressure can cause the gelatinous nucleus to either protrude entirely through the outer ring or result in bulging of the ring. This compresses the spinal cord and adjacent nerve roots.

Aside from the mechanical compression of nerves, the disk material also emits chemical irritants that can cause nerve inflammation. Irritation of a nerve root can lead to a condition known as sciatica, characterized by pain, numbness, and weakness in one or both legs.


Disk degeneration, a natural process that occurs with age, is typically the cause of a herniated disk. Disks in younger individuals, including children and young adults, contain a high amount of water.

As individuals get older, the disks lose water content and gradually become less pliable. This natural process of aging makes the disks more susceptible to herniation. A herniated disk can also be caused by a traumatic event, such as a fall.

Risk Factors

Some factors can increase the likelihood of a herniated disk:

  • Gender: Herniated disks are more commonly observed in males between the ages of 20 and 50.
  • Improper lifting: Lifting heavy objects using the muscles in the back instead of the legs can be a contributing factor to a herniated disk, as well as lifting while twisting. Using the legs instead of the back to lift may help protect the spine.
  • Weight: The additional weight of excess body fat can place increased pressure on the disks in the lower back.
  • Repetitive actions that put pressure on the spine: Numerous occupations involve physically demanding tasks, such as frequent bending, twisting, lifting, or pulling. However, employing proper lifting and movement methods can aid in safeguarding the back.
  • Driving on a regular basis: Remaining in a seated position for extended periods, coupled with the vibrations from the car engine, can exert pressure on the spine and intervertebral disks.
  • Sedentary lifestyle: One way to potentially prevent a herniated disk is by engaging in regular exercise, as it may help reduce the risk of various medical conditions.
  • Smoking: It is thought that smoking reduces the oxygen supply to the disk and accelerates its degeneration.


A herniated disk typically presents with low back pain as the primary symptom. This discomfort may persist for a few days before subsiding.
Other symptoms may be:

  • Pain caused by pressure on the spinal nerve is often described as a sharp, shooting pain that starts from the buttock and travels down the back of one leg (Sciatica).
  • Leg and/or foot may feel weak.
  • Inability to control bowel or bladder function. This may be caused by the compression of spinal nerve roots, (cauda equina syndrome) and is a rare condition that may indicate a more serious problem.

Medical History and Physical Examination

Tests that may be included in the examination are:

  • Neurological examination: can help identify any muscle weakness or loss of sensation (numbness or tingling). This can be assessed by:
    • Assessment of gait on both heels and toes may be done to check for muscle strength in the lower leg, and muscle strength in other areas of the body may also be evaluated.
    • Loss of sensation can be detected by examining whether there is a response to a light touch on the leg and foot.
    • Reflexes at the knee and ankle can be tested, and their absence may sometimes indicate a compressed nerve root in the spine.
  • Straight leg raise (SLR) test: A specialized test that can be performed to determine the presence of a herniated disk, particularly in younger patients.If a person experiences pain below the knee and along the leg, it can be a significant indicator of a herniated disk.

Imaging Studies

  • MRI: They offer high-quality images of soft tissues within the body, including intervertebral disks. It can aid in confirming the diagnosis and identifying the specific spinal nerves that are impacted.


In the majority of cases, a herniated lumbar disk tends to gradually get better within a few days to weeks for most patients.

Nonsurgical Treatment

The first-line treatment approach for a herniated disk typically involves non-surgical methods:

  • Rest: Taking bed rest for one to two days is often recommended for relieving back and leg pain caused by a herniated disk, but patients should avoid staying off their feet for extended periods. After bed rest, the patient should make sure to take frequent breaks throughout the day, and try not to sit for extended periods of time, slow down and control all physical activities, especially when bending forward or lifting, and modify daily activities to prevent aggravating the pain.
  • NSAIDs: Pain relief can be achieved by taking anti-inflammatory drugs like ibuprofen or naproxen.
  • Physical Therapy: The lower back and abdominal muscles can be strengthened with targeted exercises.
  • Epidural steroid injection: Injecting a cortisone-like medicine into the area around the nerve can help reduce inflammation and provide short-term pain relief. There is compelling evidence that epidural injections can effectively alleviate pain in many patients who have not experienced relief from other nonsurgical treatments for at least six weeks.

Non-surgical treatments do not cure the herniated disk but can alleviate symptoms while the body naturally heals the disk. In most cases, the herniated disk dissolves and is reabsorbed by the body over time.

Surgical Treatment

Surgery is only necessary for a small proportion of patients with lumbar disk herniation. Typically, spine surgery is advised only if the painful symptoms persist after a period of nonsurgical treatment or if the patient experiences the following symptoms:

  • Weakness of the muscles
  • Problems with walking
  • Loss of control over the bladder or bowel


The surgical procedure used to treat a single herniated disk is microdiscectomy, which involves the removal of the herniated part of the disk along with any additional fragments that may be compressing the spinal nerve. A more extensive surgery may be necessary if there are disk herniations affecting multiple levels.


A medical professional or a physical therapist may suggest a basic walking regimen, such as 30 minutes per day, in addition to targeted exercises to improve the strength and flexibility of the back and legs. To minimize the possibility of recurring herniation, patients may be advised to avoid bending, lifting, and twisting during the initial weeks after the surgery.

The recurrence rate of a herniated disk is about 20 to 25%, regardless of whether the patient undergoes surgical or nonsurgical treatment. A potential drawback of nonsurgical treatment is that it may take a prolonged time for the symptoms to alleviate.

Patients who delay surgery and opt for nonsurgical treatment for an extended period may experience lesser improvement in pain and functioning than those who opt for surgery sooner.

Literature has indicated that surgical outcomes may not be as favorable if surgery is performed beyond 9 to 12 months after the onset of symptoms compared to those who undergo surgery earlier. Our doctors at Complete Orthopedics will discuss with you the duration for which you should attempt nonsurgical treatments before contemplating surgery.

Surgical Risks

  • Injury to the nerve
  • Infection
  • Dural Tear
  • Nerve compression caused by a hematoma.
  • Herniated disk returns
  • Possibility of requiring additional surgery

A microdiscectomy surgery typically yields positive outcomes. Patients usually experience greater improvement in leg pain than in back pain after microdiscectomy surgery. After a recovery period following surgery, the majority of patients are able to resume their normal activities.

The usual pattern of improvement after surgery is for pain to be the first symptom to subside, followed by improvement in the overall strength of the leg, and finally improvement in sensation.

If you are interested in knowing more about Herniated Disk in the Lower Back you have come to the right place!

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Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
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20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

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