We sometimes get people coming into the practice thinking they have a “slipped disc”? In reality an intervertebral disc does not actually slip, but it can tear through the outer layers of fibrous tissue (called the annulus fibrosis) which sometimes allows the gel-like centre (called the nucleus pulposus) to push through, causing the disc to bulge out.
When this happens, it can sometimes pinch the central nerve which exits between the vertebra and this can cause radiating pain down the arm if it is in the neck (cervical spine) or down the leg if it is in the lower back (lumbar disc herniation).
Herniated Disc video from www.spine-health.com
Disc injuries are most common in the lower back and especially at the L4/L5 and L5/S1 levels and are have a higher incidence in the 30 to 50 age group. Although a disc injury can cause significant pain and disability, the good news is that most people do recover within 3 months, with only about 10% considering surgery after 6 weeks*.
Although a disc injury can occur spontaneously as a result of significant compression trauma such as a fall, most develop over time as the annulus gradually tears, exposing the nucleus. This means that the final onset of symptoms such as lower back pain and nerve pain down the leg (sciatica) can occur with a relatively minor movement such as bending forward or even coughing!
It can sometimes be difficult to accurately diagnose some disc injuries, especially in the early stages, as the initial back pain symptoms can be the same as several other problems such as a lower back sprain/strain injury but a comprehensive examination and diagnostic imaging such as CT or MRI scan are usually required to confirm the diagnosis.
MRI Scan of an L4/L5 disc herniation
While a combination of conservative treatment such as chiropractic spinal manual therapy and non-steroidal anti-inflammatory medication with rest and home exercises usually allows the disc to naturally heal itself within 3 months, a few people do require surgery to remove the herniated section of the disc which is pressing on the nerve.
Although we don’t always know why some people develop a disc injury, we do know that there are some general risk factors:
Combine these factors with the affects from daily wear and tear, injury, incorrect lifting, or twisting and it is easy to understand why a disc may tear and herniate.
Herniated Lumbar Disc BMJ Clin Evid Jo Jordon, Research Information Manager,# Kika Konstantinou, Research Physiotherapist/Spinal Physiotherapy Specialist,# and John O'Dowd, Consultant Spinal Surgeon#