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‘Slipped Disc’ What is a disc protrusion or herniated disc?

Patients will often come to me and give me a history of having a slipped disc in the past, which still bothers them to this day. A ‘slipped disc’ does not really describe what actually happens when someone is experiencing back pain, and can often mislead people to thinking their problem is worse than it is. A slipped disc is also called a prolapsed or herniated disc. It refers to when the softer, shock absorbing tissue between the vertebrae (bones) of the spine pushes outwards. This can in turn then touch a nerve which can give pain down the arms or legs, as well and pins and needles and numbness. This can happen in the neck (cervical), lower back (lumbar) and even the thoracic spine.

The easiest way to picture the discs in your spine is as tubes of toothpaste. If you compress one end of the disc (or tube) the contents shifts in the opposite direction. If you compress from the other side the contents shifts in the opposite direction. This means, a significant force into flexion that the spine is not used to, or the muscles are not prepared/strong enough for, can put large amounts of force on the front of the discs, pushing the contents of the disc backwards with enough force to cause a herniation(bulge) in the disc. It can also form over prolonged periods of flexion, e.g being sat at a desk job for many years, loading the front of the discs for prolonged periods of time and gradually pushing the disc to a bulging position.

The most important symptoms to look out for are a sudden loss of bowel or bladder control, numbness in your private region or back passage. These symptoms or a different form or manifestation of these symptoms should be treated as a medical emergency. A rare but serious condition called cauda equina is when the disc protrusion is compressing on the spinal cord, affecting the central systems (sensation to genitals, toileting etc). You should go to A+E if you suddenly present withy any of these symptoms. A neurological assessment should be performed by your physio to help check for any signs of more serious issues should you have pins and needles or numbness.

Disc protrusions will often resolve with adequate pain relief, movement and appropriate exercises. Physiotherapists are experts in working out which exercises can help settle the pain. You should avoid any form or spinal manipulation when you have nerve pain caused by a disc, as this sudden movement can worsen symptoms just as easily as improve them. Most of the time, there is no need for imaging, as it is easy to diagnose a disc protrusion with a physical examination. The best investigation is MRI should we suspect anything more serious. You should avoid X-ray as this gives a large dose of radiation to all the soft tissues of the abdomen, which is never a good thing!

In the rare worst cases, should conservative management fail, then sometime surgery is warranted. This should be avoided at all costs, and most surgeons expect a minimum of six months physiotherapy due to the very high success rate of physiotherapy in resolving pain and keeping it away.

Once the pain has gone, physiotherapy can help to strengthen the muscles that stabilise the spine and protect the discs. Keeping these muscles strong is essential to helping prevent future events. If you have not completed a structured strengthening programme after your pain with a qualified physiotherapist, you are leaving yourself potentially exposed to having future issues.

Prevention is better than cure! Physiotherapists are the masters of preventative treatment!

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