[Medical Q&A] My legs hurt but my waist doesn’t. How could it be a lumbar disc herniation?

Planner: Chinese Medical Association

Reviewer: Han Liqiang, deputy chief physician, Tianjin Third Central Hospital

Many patients visit the outpatient clinic because of lower limb pain. Some of them are told that they have lumbar disc herniation after examination by the doctor. How can it be lumbar disc herniation if the pain is only in the legs but not in the waist? In fact, this situation can occur with lumbar disc herniation.

The lumbar intervertebral disc is a soft tissue structure located between the lumbar vertebrae, consisting of annulus fibrosus and nucleus pulposus. When the lumbar intervertebral disc undergoes degeneration or the annulus fibrosus is damaged for some reason, it will bulge outward together with the nucleus pulposus, thereby compressing nearby nerves or spinal cord, causing a series of neurological symptoms. If the protruding disc tissue stimulates the sinus nerve, it can cause low back pain. In addition, the immune response of the protruding nucleus pulposus tissue and the body can also cause low back pain. As time goes on, the inflammatory stimulation will gradually decrease or even disappear, and the low back pain will gradually ease. However, as the lumbar disc protrusion gradually worsens, it will compress the nerve roots of the corresponding segment, causing radiating pain in the lower limbs. The pain may extend to the buttocks, thighs, calves and even toes. The course of lumbar disc herniation is often relatively long, which is also the reason why many patients do not have obvious low back pain when they visit the doctor. However, when asking about the patient's medical history, they often state that they have had low back pain in the past, but it is not obvious recently. Of course, the clinical manifestations of lumbar disc herniation are not exactly the same in everyone. Some people may mainly show low back pain, while others may mainly show leg pain. Once you feel unwell, the best way is to go to a regular hospital for treatment. Avoid self-diagnosis and treatment to avoid aggravating the condition.