MRI of a lumbar spine showing slipped disc before and after treatment

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

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