No doubt most of you will be aware of the term a ‘slipped disc,’ but what actually is a slipped disc, how does it come about and what treatments are available?

In short, a ‘slipped disc’ is not a medically recognised diagnosis. It is common parlance for what is more accurately known as a herniated disc.

As shown in the image above, the intervertebral discs sit between the bony vertebrae of the spine, acting as both spacers and shock absorbers. They enable the spine to move as a flexible, adaptive column rather than being a solid bony structure.

The disc has a dual structure, around the outside are annular rings of very tough fibrous cartilage known as the annulus fibrosis. In the middle is a gel-like fluid known as the nucleus pulposus. This fluid centre moves and deforms depending on movement and loading to enable dissipation of force and load.

With time the annulus can start to become weakened and damaged. This affects its ability to hold the nucleus in place and it can start to push into the annulus, causing it to bulge. This is the first stage in the herniation process. If this bulging continues the fibres of the annulus can start to split and the nucleus can push out yet further and eventually may extrude through the annulus in what is known as a herniation. The stages of this process are shown in the image below:

In severe cases the extruded nucleus material or the bulging disc can compress the spinal nerve roots that exit from the spinal cord between the vertebrae. This may cause pain, pins and needles, numbness and even loss of muscle function in the structures supplied by that nerve root. In the low back, the site of the vast majority of disc herniations, this can affect the nerve roots that go to form the sciatic nerve leading to symptoms in the legs – the much reported ‘sciatica.’

What are the Symptoms of a Hermiated Disc?

Damage to the lumbar (low back) discs themselves can cause pain locally in the back, buttock and upper thigh. However, should the nerve roots be affected then symptoms can include shooting pain into the leg and foot, pins and needles and/or numbness in the legs and feet and loss of power in the legs. The pain caused when the nerves are affected can be very intense and patients can struggle to achieve any relief, work and sleep becoming very difficult.

What Treatments are Available?

The first thing to do should you suspect that you may have a herniated disc is see a professional, such as an osteopath or a physiotherapist. They will take a detailed case history and examine you, often including testing to detect damage to the nerves. They will then be able to diagnose your problem and advise the most appropriate course of action. They may recommend that you undergo diagnostic imaging, such as an MRI (magnetic resonance image) to help to confirm the diagnosis.

Treatments for herniated discs that an osteopath can provide would include gentle hands-on massage and mobilisation techniques to reduce the pain and stiffness and accelerate healing. In addition, advice may be provided regarding the use of ice or heat, home exercises and stretches, over the counter medication use (in conjunction with advice from your GP), posture and activity. Often patients  find it beneficial to have an accurate diagnosis and plan of action.

What’s The Long Term Prognosis?

The vast majority of herniated disc problems will resolve with time and the correct treatment and advice. Occasionally (less than 4%) disc herniations can result in surgery to remove some of the bulging disc material and/or decompress the nerves. However, these cases are few and far between. Once herniated, discs repair slowly and they can cause frustration in patients. On average disc pain takes between 8-12 weeks to significantly decrease. This is because they have a poor blood supply and therefore heal slowly.

Following a herniation patients may find that the disc can cause further problems of pain and stiffness from time to time. To avoid such ongoing issues advice is usually given regarding stretches and exercises to maintain flexibility and strength in the spine and surrounding musculature.

We hope this information is of use. Should you have any other questions or need any further advice please don’t hesitate to make contact on the practice phone on 0208 9773295 or via email;enquiries@teddingtonosteopaths.co.uk.

Stuart Walker
Registered Osteopath