Herniated disks may result from severe trauma or strain or related to intervertebral joint degeneration. In an elderly person with degenerative disk changes, minor trauma may cause herniation. A person with a congenitally small lumbar spinal canal or with osteophytes along the vertebrae may be more susceptible to nerve root compression with a herniated disk. This person is also more likely to exhibit neurologic symptoms.

Neurologic deficits (most common) and bowel and bladder problems (with lumbar herniations) are complications of herniated disk.

Initially, the patient may seek relief for usually unilateral, lower back pain radiating to the buttocks, legs, and feet. Typically, he may report a previous traumatic injury or back strain.

When herniation follows trauma, the patient may tell you that the pain began suddenly, subsided in a few days, and then recurred at shorter intervals and progressive intensity. He may then describe sciatic pain that began as a dull ache in the buttocks and that grows with Valsalva’s maneuver, coughing, sneezing, or bending. He may also complain of accompanying muscle spasms and may add that the pain subsides with rest.

Inspection may reveal a patient with limited ability to bend forward and a posture favoring the affected side. In later stages, you may observe muscle atrophy. Palpation may disclose tenderness over the affected region.

Tissue tension assessment may reveal radicular pain from straight leg raising (with lumbar herniation) and increased pain from neck movement (with cervical herniation).

Thorough assessment of the patient’s peripheral vascular status—including posterior tibial and dorsalis pedis pulses and skin temperature of the arms and legs may help to rule out ischemic disease as the cause of leg pain or numbness.