There are many different terms used to describe spinal disc pathology and associated pain, such as “herniated disc”, “pinched nerve”, and “bulging disc”, and all are used differently by doctors.
Unfortunately, there is no agreement in the health care field as to the precise definition of any of these terms, and patients are often frustrated when they hear their diagnosis referred to in different terms by health care practitioners. A variety of additional terms such as ruptured disc, torn disc (or disc tear), slipped disc, collapsed disc, disc protrusion, disc disease, and black disc often add to a patient’s confusion.
Rather than try to reconcile the terminology used to refer to a herniated disc or other disc problems, it’s generally more useful for patients to gain a clear understanding of the precise medical diagnosis, in other words, to gain an understanding of the actual cause of the upper or lower back pain, leg pain, neck pain or other symptoms.
The spine care professional arrives at a clinical diagnosis of the cause of the patient’s pain through a combination of a review of the patient’s medical history, a complete physical exam, and, if appropriate, the results of one or more diagnostic tests.
Two causes of Pain: Pinched Nerve vs. Disc Pain
In identifying th ecause of the patient’s pain, there are two general types of spinal disc problems physicians classify as the cause of pain:
Pinched Nerve – When a patient has a symptomatic herniated disc, it is not the disc space itself that hurts, but rather the disc herniation is pinching a nerve in the spine. This produces pain that is called radicular pain or radiculopathy (e.g., nerve root pain) leading to pain that may be referred to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain stemming from a pinched nerve in the lower spine is usually described as sciatica.
On spine-health, this type of condition where there is nerve root pain is referred to as a herniated disc. Other causes of pinched nerve may include spinal stenosis and bone spurs form spinal arthritis.
Disc pain - When a patient has a symptomatic degenerated disc( one that causes low back pain and/ or leg pain), it is the disc space itself that is painful and the source of pain. This type of pain is typically called axial pain. On Spine-health, this type of condition where there is actual disc space pain is referred to as generative disc disease.
Either of the above two conditions can occur in the neck, upper back or lower back. They ted to be most common in the lower back because the lower back bears the most torque and force on a day to day basis.
It should be dkept in mind that all the terms – herniated disc, pinched nerve, bulging disc, slipped disc, ruptured disc, etc.- refer to radiographic findings seen on a CT scan or MRI scan. While these test results are important, they are not as meaningful as the patient’s specific symptoms and the doctor’s physical exam results are in determining the source of the back pain and then evaluating potential back care and pain treatments.
Diagnosing Disc Problems
A physician’s medical diagnosis ( also known as a “clinical diagnosis”) focuses on determining the cause of a patient’s back pain, neck pain or other symptoms. There are three steps to arriving at a clinical diagnosis for a pinched nerve or disc pain.
Medical History. A complete review of symptoms will include the location of the pain, a description of how the pain feels, and whether certain activities , positions or treatments make the pain feel better or worse. A full medical background is important to rule out (or identify) other possible conditions that may cause the patient’s pain and will include information such as an recurring health problems, previous diagnoses, past treatments and surgeries, reactions to those treatments, current medications, family history of illness, and any other health concerns.
Physical Examination. Depending on the patient’s symptoms, a physical exam may include one or more of the following tests:
- Nerve function in certain parts of the leg or arm. Tapping different areas with a reflex hammer, with little or no reaction, is possible indicative of a compressed nerve root. Sensory tests may also be conducted, utilizing hot and cold to determine how the nerve roots react to such stimuli.
- Muscle Strength. In order to get a better understanding of whether the spinal nerve root is being compressed by a herniated disc, the doctor will likely conduct a neurological exam to assess muscle strength. The doctor may also ask the patient to undress in order to examine the muscles, particularly whether there is muscle atrophy, twitching or any abnormal movements.
- Pain in certain positions. The doctor may raise and extend the arms or legs, with any resulting pain a potential indicator of a pinched nerve from a herniated disc. The doctor may exert gentle pressure on the spine, with ensuing pain likely another indication of nerve root problems. Usually, this series of physical test will give the doctor a good idea of whether or not the specific back problem or neck problem is caused by a herniated disc, degenerative disc disease, or another problem.
- CT Scan. Computerized technology (CT) scans work like an x-ray in that an x-ray beam goes through the body, with a computer reformatting the image int cross sections of the spine.
- MRI Scan. Magnetic Resonance Imaging (MRI) allows doctors a sensitive and accurate assessment of the spinal nerves and anatomy, including disc alignment, height, hydration and configuration.
- Discogram. If surgery for disc pain is considered, some practitioners may recommend a discogram with the goal of confirming which disc is painful. In this test, radiographic dye is injected into the disc, and if the patient’s normal pain is recreated, then it is likely that specific disc is the cause of the patient’s pain. This test is controversial as to whether or not it is a valid, accurate test, and may doctors do not use discography except in rare situations.