Slipped Disc and Back Pain explained

What is a slipped disc?

Slipped disc MRI -KB annotated
An MRI of a lumbar spine, demonstrating a slipped disc. The disc fluid bulges out, putting pressure on the spinal cord, causing pain in the back and/or the buttock, thigh or feet.

The spine is made up of 24 vertebrae, with soft, gel-like intervertebral discs that sit between each spinal vertebra.  The discs act as padding, absorbing impact and reducing shock to the spine during daily movements.

A ‘slipped disc’ is usually associated with trauma or an accident.  The outer-shell of the intervertebral disc becomes damaged, allowing the gel inside to leak out. The discs lie directly over the spinal nerve root, causing the protruding disc fluid to pressurise the nerve, causing localised back pain. When the nerve is pressed or irritated, people can experience neural symptoms, including numbness, tingling or weakness in the affected area.  Often, the sciatic nerve is compressed, resulting in sciatica or nerve pain into the buttocks, thigh or feet.  A ‘slipped’, ‘herniated’ and ‘bulged’ disc all refer to the same type of injury.  The diagnosis indicates the percentage of leaked disc fluid, and whether or not the nerve has been affected.

What causes a slipped disc?

A slipped disc is often but not always associated with trauma or a bending forward motion. With age, the discs lose some of their water content, making the disc less spongy, and more susceptible to injury following minimal strain. Sometimes twisting or turning whilst lifting heavy objects can cause a sudden sharp back pain.  The pain can be specific to the lower back, or cause burning or tingling down the leg.  Typically, people feel pain on one side only, however it can be more generalised across the lower back.

Management of a slipped disc

According to NHS statistics (2016) a third of UK adults experience some form of low back pain, although only 1 in 20 have a diagnosed disc issue.  Although anyone can suffer with low back pain, slipped discs typically affect people aged between 30-50.  Men are twice as likely to be affected by a slipped disc as women.

If you have slipped a disc, there are different management options available. Often, the pain improves naturally over time as the disc eventually shrinks away, reducing pressure and relieving pain on the nerve (see the Case Study at the bottom of page). This can take 6-8 weeks, or sometimes longer. A combination of pain-relief and physio can usually help to relieve the inflammation, tightness and pain in the back and legs.   A Physiotherapist will assess you and use a range of techniques to speed up healing, reduce pain and increase flexibility.  In severe cases, patients may need to consult an Orthopaedic Surgeon who will advise whether surgical procedures or steroid injections are necessary.

Self-management of a slipped disc or low back pain

If you suspect that you have a slipped disc, try to keep mobile and doing your usual activities. If you rest for too long, your joints may stiffen up further, exacerbating your back pain. You may need to take pain killers or anti-inflammatories and rest from the aggravating factors. This will keep your spine flexible, keep your muscles strong and help to speed up healing.  Pilates is an excellent way to help manage low back pain in the long-run.  This type of exercise has been shown to strengthen the core muscles, improve lumbar stability and control, and consequently prevent recurrent injuries.  A physiotherapist can advise when to start core strengthening exercises as part of your treatment programme.

Case Study:  The scan below belongs to a 29 year old woman who presented with pain and tingling in her right leg.  The patient had a steroid injection, as well as a course of physiotherapy, including massage, stretches and core strengthening. Within five months, her disc herniation had resolved, the pain and paresthesia had gone.  (Hong, J & Ball, P (2016) N Engl J Med 2016; 374:1564)

MRI of a lumbar spine showing slipped disc before and after treatment
MRI of a lumbar spine showing slipped disc before and after treatment Figure A: MRI at the time of injury; the yellow arrow shows a lumbar disc herniation and nerve root compression. Figure B: MRI at 5 months post-injury; the green arrow shows the disc is no longer compressing the nerve or spinal cord (white/grey column next to the vertebrae), with complete resolution of the slipped disc.

 

If your back pain is worrying you, please contact us to discuss how physiotherapy could help you.


Naomi Sofer, Specialist Physiotherapist

March 2017

The Power of Posture

When it comes to posture, it seems like your mum did know best – her shouts of “sit up straight!” and “stop slouching!” were great advice.
At the beginning of the year, lots of us look to refocus our health and set ourselves goals for the upcoming year.  But most people forget one of the most important areas to concentrate on; bad posture can counteract hours spent in the gym and derail your fitness goals.  Improving posture will help to activate more muscles and boost their efficiency, meaning that by sitting up straight you burn more calories.
Good posture can help your muscles work more efficiently and improve your overall health and fitness
Slouching or stooping causes muscles to fatigue and ligaments to strain in order to support your spine, which can lead to back pain, headaches, muscle tension and injuries.  Correcting your posture may feel awkward and unnatural to begin with, but if you work at it, your muscles and joints will strengthen.  Over time, maintaining good posture will feel much more comfortable.
Postural awareness is the one guaranteed method to improve it long-term.  Sadly, the nature of habit means that maintaining good posture requires a lasting commitment.  However, with a few tips and tricks, you can be sitting taller and walking straighter in no time.


Benefits of good posture:

slouched posture
If you spend a large part of your day hunched over your computer, iPad or phone (let’s be honest, who isn’t guilty?!) you may well have a sore or tight neck by the end of the day.  Sitting with better posture will improve muscle efficiency, therefore reducing strain and tension through neck and upper back muscles.   Even more crucially, sitting up straight will reduce pressure going through discs and joints in your neck, therefore reducing the wear and tear that occurs naturally over time.

Good alignment can not only improve your posture, but can make you look taller, slimmer and more confident. Look at a photo of yourself where you’re slouching and compare it to one where you’re posing – unless you’re a natural ballerina, your posture and overall appearance will be much better with a few tweaks.

Good posture will make you look taller, slimmer and more confident
Good posture will make you look taller, slimmer and more confident

So lose the rounded shoulders and Dowager’s hump for an instanta-improvement.  If you’ve put better posture on your 2017 resolution list, follow this advice for a healthier spine, better muscle flexibility and improved confidence this year.



Top tips for posture: Balloon posture

1) Exercise to improve sitting posture: Imagine you have a helium balloon attached to the crown of your head.  Allow your neck to lengthen, gently tuck your chin in and allow your shoulders to relax.  This will eliminate the tendency to round your shoulders and gives the impression of a more elongated neck.


2)  Whilst sitting, lift your sternum forwards and upward, lengthening your collarbones whilst keeping your shoulder blades relaxed down.  This automatically straightens the upper back, making you look taller and relieving any pressure that might be accumulating between your shoulder blades and trapezius muscles.


Side plank
Core strengthening exercises are a great way to support your spine

3) Improve your core strength.  It sounds simple, but your core is your ‘powerhouse’, stabilising your pelvis, hips and spine.  The stronger your deep core muscles are, the more effectively the rest of your muscles will work (which is why there’s such a strong focus on alignment in Pilates and yoga).


4) Posture Prompts

Set yourself a reminder as a prompt to sit up straight.
Set yourself a reminder as a prompt to sit up straight.
Despite the best intentions, most of us forget about posture about thirty seconds after correcting it, so it’s essential to be reminded regularly. Whether it’s while you’re waiting for the kettle to boil or setting a reminder on your phone, find something to cue you to stop slouching, roll your shoulders back and take some deep breaths.  Not only will you feel calmer, posture-prompts will support your neck and spine and temporarily relieve tense muscles.

Lumbar lordosis
Wearing high heels, extra belly weight and tight hamstrings can make the natural curve of your spine appear more pronounced.

5) Everyone has a natural curve in their low back, known as a lordosis, however in some people this can be more pronounced.  Lumbar lordosis can be exaggerated by excessive weight, pregnancy and wearing high heels.  Doing regular glute strengthening exercises such as squats, clamshells and bridges can help correct standing posture and improve the appearance of a bum that sticks out (or in my family, affectionately named the ‘Donald Duck’ posture).


6) Sit well.  If your bum is too near the edge of the chair, you may find yourself leaning forward or slouching.  Ensure that your bum is as far back in the chair as possible, you have some lumbar support and that your feet are balancing your body weight on the floor.

Try and sit with feet on the floor, bum back and your lumbar spine supported
Try and sit with feet on the floor, bum back and your lumbar spine supported

7) Make ergonomic changes.  Make sure you have a good work-station setup with your shoulders relaxed, back and feet supported and computer screen at eye-level to avoid slouching all day.  And most importantly, try and take regular breaks and keep active to prevent bad postural habits from building up.

proper-office-chair-sitting-form



Remember, awareness of good posture is the first step to breaking poor postural habits.  Bear these things in mind and make 2017 the year where you sit up and take control of your posture.


Naomi Sofer
January 2017