You Can’t ‘Slip’ a Disc!
It’s about time we got rid of the term ‘slipped disc’
Just like we need to get rid of COVID!
It’s the common term that has been hanging round for years to describe injuries to the back that involve the spinal disc.
It’s outdated, misleading and doesn’t do you any favours if you have had a back injury and you’re trying to get better!
Let’s put the record straight with some simple facts and description about what does happen with discs when you injure them and what can be done!
Why has it been called a slipped disc in the past?
We aren’t too sure who coined the phrase but it’s disappointing that the NHS still has pages like this:
Their description of a slipped disc is correct and they do start to use the more modern term of herniation or herniated disc which is more accurate and correct.
The term usually applies to when the disc structure itself has become herniated and can cause the structure of the disc to bulge.
Professions such as Chiropractors have been particularly bad for this in the past – they advise the disc is slipped, and claim that they can ‘put the disc back in’ with forceful manipulation.
This just isn’t possible. I’ve seen countless people and heard many stories describe these interactions with certain practitioners, as well as some physiotherapists and osteopaths who haven’t kept themselves up to date with the latest evidence.
If you visit any healthcare practitioner that says they can put a disc back in – run a million miles – as fast as you can!
How do I know if I’ve slipped a disc?
I’ve heard countless stories from people who have been diagnosed with a ‘slipped disc’ without actually having a scan.
A therapist or medical professional can give you an educated guess based upon your presentation and symptoms – following a thorough assessment.
They cannot see through your back with XRAY/MRI vision!
The only way you can tell if you have slipped a disc is with an MRI scan. Most disc injuries shouldn’t need a scan. You would only need a scan for your lower back if you were going to need surgery – which most back issues do not need.
Signs of a disc injury which are common in clinic are:
- Longer healing times – 3 months for symptoms to reduce – this can extend to a year for more serious injuries
- Poor lower back bend – struggling to put socks on or bend over is a common feature
- +/- pain extending down your leg with pins and needles or numbness can be common
- Poor tolerance to being in the same position for short periods of time
As a safety note: if you are experiencing problems with your toileting such as increased frequency, retention or numbness in the area where you wipe and pain in one or both of your legs - you should proceed to A&E for immediate exam.
If these symptoms occur with your new back injury - this can indicate CAUDA EQUINA SYNDOROME.
This is compression of the nerves that supply your important functions such as bladder and bowels. If a disc injury is causing pressure on these structures then this needs urgent attention to avoid permanent dysfunction being caused.
Can a disc be put back in?
No, No and finally – NO!
When the substance of a disc bulges or herniates – it cannot be put back in.
Your disc is made up of a cartilage like body which looks similar to cooked pork and its centre is a softer nucleus which is made of a firm jelly like material.
Disc herniation’s cause tears to the cartilage like structure and more severe bulges can involve the jelly like centre moving towards the outside of the disc.
The most severe of all disc injuries is a prolapse – these however are rare!
The diagram above shows the different stages of disc injury. This is a very simple overview which can help to simplify the explanation.
When a disc bulge or herniation occurs – it will have a degree of inflammation around the site – this can cause extra swelling to the disc – this can reduce with medication, rehab and time, but the body of the disc will not return to its original form.
This isn’t a bad thing! Through exercise and treatment you can help your spine to adjust and return to its normal function.
Why do I get leg pain with a disc injury?
It is common for disc injuries to cause leg pain also – this can be due to a disc pressing on a nerve. This can vary in severity and symptoms:
- Pain - which can extend to the foot
- Pins and needles / tingling
- Loss of power / strength in your lower limb
If you experience a total loss of power in your foot and ankle which causes you to be unable to flex your foot upwards or trip over. You should again proceed to A&E as this can indicate an impingement of a nerve in your back which may need further attention.
If you have any of these symptoms – go and see a physiotherapist or GP who can assess your nerves and provide you with reassurance through testing.
How are disc injuries caused?
Disc injuries are typically caused when moving weight in flexed positions. The most common injury you will hear is when someone tries to lift something heavy they aren’t used to and they ‘put their back out’.
This is due to there being a lot of pressure going through the spinal disc and if you aren’t used to doing this or you are in a poor position then this will cause too much pressure on the disc and it will herniate – this does not however mean that lifting in flexed positons is bad.
There really isn’t one reason which causes disc herniation – it’s typically a common set of factors which contribute towards your back being more at risk:
Top 4 factors which lead to disc injury:
- Poor conditioning - lack of exercise / strength
- Poor lifestyle – being sedentary / sitting for long periods
- Repetitive jobs which encourage flexed spinal positions (sitting roles/production roles/manual work)
- Poor technique with lifting from the floor
For some perspective on how much force goes through your discs during different activities and why it’s so important to remain active, strong and perform movements with good technique – take a look at this diagram:
Even when lying flat you have some pressure going through your discs, but your spine has the most pressure with sitting and flexed positions holding weight.
This isn’t to say pressure going through your discs is a bad thing – but you have to be aware of how you are doing it. Disc’s just like anything else can be strengthened but they can also be injured!
Spines and discs are such a broad topic and this blog could go on forever but that’s all for today. We will be bringing you some more in-depth spine based blogs over the next few weeks so that you can become an expert for your own health!
The next blog will focus on spine strengthening and what you can be doing to make your back more resilient and robust and how to do it safely.
Thanks for reading – please share this with anyone you think this could help.
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