A slipped disc was the reason I became a physiotherapist. I was told I had a slipped disc after a basketball injury, which left me with leg pain and took me out of my favourite sport. It wasn’t getting better so – long story short – I became a physiotherapist so I could fix it.
In the process, I discovered that slipped discs don’t really exist. While the vertebrae themselves can slip, the discs in between can’t. What’s commonly known as a slipped disc is in fact a disc bulge, or disc prolapse, and it’s far more common than most people think.
Imagine your invertebral disc as a slice of onion. The outer layers of this onion are made up of strong, fibrous collagen able to withstand a great deal of compression, while the inner layers are made of a toothpaste-like gel called the nucleus which acts as a sort of shock absorber. This is a simplified description, but hopefully you get the idea.
Sometimes, trauma to the spine or long term degeneration can cause the nucleus to protrude through the outer layer or burst out – known as a disc bulge or prolapsed disc.
However, there’s a high chance you currently have a disc bulge without having any symptoms whatsoever.
If you’ve been following our blogs, you may remember David’s feature on the problems with MRI scans, where he wrote:
“If a physician was to tell you that you had a disc bulge, you might find that news very worrying, but would you still be worried if you knew that around 40% of 30 year olds without any back pain were found to have a disc bulge as well?”
That’s right: disc bulges are actually incredibly common and, the older you get, the more likely you are to have one. As we age, the nucleus in our disc starts to dry out, making it less able to absorb loads and more likely to cause strain or bulging. The reason why people can still live happy, healthy lives is that often a simple disc bulge doesn’t cause many problems. I liken it to my face. While the skin is getting less elastic (degenerate) I’m not getting any pain from it. This is typically the case with most degenerative discs.
Where problems occur is when nerves get trapped between the disc bulge and the bone, causing compression that inhibits normal functioning. Most will have heard of sciatica! Symptoms include numbness, pain or loss of function in one of your legs – making it difficult or impossible to walk or even stand.
Because of the seriousness of the symptoms, a lot of people with symptomatic “slipped discs” worry that they’ll end up spending their lives in a wheelchair but with a little help from a good physio you can recover and enjoy a healthy, active life – just as I do. A scan of my back reveals a decent sized disc bulge, yet I can still be as active as I want. In fact we know that activity is great for discs. It’s inactivity that is the biggest cause of most of our problems.
The most important thing is to get moving, and get strong. A compressed nerve causes pain, which often gives rise to muscle spasm, with the combination causing weakness. This can lead to issues with the muscles of the buttock, and can affect other joints such as the hip.
Physiotherapists treat all of these issues. We loosen muscles and joints with manual therapy, dry needling, and mobilisation and find specific movements that can “offload” the disc. However quite early on its important to start strengthening, as it’s the strengthening that does the most to prevent recurrence in the future. Counterintuitively, that usually involves exercises that include lifting weights.
While injections or even surgery may be required in rare cases, the vast majority of symptoms of a disc bulge can be relieved with an unobtrusive course of physiotherapy and training.
In terms of prevention, a good posture, lots of walking, activities with a variety of movements and strengthening exercises work best. Common causes for disc bulges outside of natural degeneration are sudden twists of the spine, extended periods sitting and even bouts of violent coughs and sneezing.
Every body and every injury is unique, so a symptomatic disc bulge is not the sort of issue you can treat yourself with general advice. If you’re feeling symptoms, visit a physiotherapist as soon as possible because the longer you leave it, the longer it will take to heal and the higher the risk of long term damage.
If you have any concerns over your spinal health or want to find out about our prevention programmes, please get in touch with us today by calling 0207 937 1628 or firstname.lastname@example.org.
Clinical Director, West London Physiotherapy