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Slipped Disc – Do you have a slipped disc or want to know more about them?

As a Chiropractor I see many cases of low back and leg pain or neck and arm pain, quite often a patient will walk in and state they have a “slipped disc”. This is quite a generic term for a disc bulge, which can occur in varying degrees.

Different degrees of disc damage

This pictures shows a normal spinal segment, containing a disc and bony vertebra, in between these a nerve exits.

Normal disc and vertebra. This picture shows a normal spinal segment, containing a disc and bony vertebra, in between these a nerve exits.

Phase one. This second picture also shows a spinal segment although, this has a mild amount of wear and tear. Creating a narrower slightly worn dehydrated disc which is then slightly compressing the nerve as it exits.

Phase One. This second picture also shows a spinal segment although, this has a mild amount of wear and tear. Creating a narrower slightly worn dehydrated disc which is then slightly compressing the nerve as it exits.

Phase Two. This 3rd picture shows further wear through the spinal segment. Both discs in the picture are damaged and are now pushing out the thinner jelly like liquid from the centre of the disc creating a disc bulge. Here the nerve is being compressed further, so has now become thinner.

Phase Two. This 3rd picture shows further wear through the spinal segment. Both discs in the picture are damaged and are now pushing out the thinner jelly like liquid from the centre of the disc creating a disc bulge. Here the nerve is being compressed further, so has now become thinner.

Phase three. The 4th picture shows the worst amount of wear and tear, there is extra bony growth on the ends of the bony vertebrae. The discs are very thin so are no longer able to create cushioning between the bones in the spine and the nerves are very thin. This will compromise how they work.

Phase Three. The 4th picture shows the worst amount of wear and tear, there is extra bony growth on the ends of the bony vertebrae. The discs are very thin so are no longer able to create cushioning between the bones in the spine and the nerves are very thin. This will compromise how they work.

A disc bulge occurs when the outer case of the disc splits, resulting in the gel inside bulging out of the disc, an easy way to imagine this is when you squeeze a jam filled donut, however the outer casing of the disc can be more compared to a car tyre, so is actually rather firm.

This damaged disc can then put pressure on the whole spinal cord or on a single nerve root. This means a damaged disc can cause pain both in the area of the protruding disc and in the area of the body where the nerve travels to.

It is not always clear what causes a disc to break down, although age is a common factor in many cases. As you get older, your spinal discs start to lose their water content, making them less flexible and more likely to rupture. Disc injuries most commonly occur between 30-50 years of age. Smoking also plays a role as it causes the discs to lose their natural flexibility.

It’s important to note not all slipped discs can cause symptoms such as pain, weakness or tingling. Many people will go their whole life and not know they have a slipped disc, even though they have one.

Diagnosis and Treatment for a disc injury

First of all, it is important to receive the correct diagnosis. A lot of the information a medical professional can gain from taking a thorough history, this is then backed up by an examination, usually including: posture, spinal movements, reflexes, muscle strength, sensation and walking ability. If it is deemed necessary, your medical professional may send for imaging of your spine to see how severe the damage is.

It can take about four to six weeks to relieve discomfort from a disc injury. Treatment can include a combination of manual/ physical therapy, massage, exercise, and medication to relieve the pain. In severe cases surgery to release the compressed nerve and remove part of the disc may be considered.

In many cases, a slipped disc will eventually shrink back. However, an injury to the disc will remain. Quite often we find that patients have actually had previous episodes of disc pain before a severe episode has occurred. This is because the brain learns to “turn down the volume” on the pain messages coming from the nerve, although the disc will remain pressing on the nerve. The body will continue to do this until it reaches a point where it cannot compensate anymore.

If you have a slipped disc, it is very important to keep active. Initially moving may be difficult, but this will help keep your back mobile and stop the joints becoming too stiff and the muscles that support the spine becoming tight. Keeping moving will speed up your recovery.

Ice should be used immediately to help calm down inflammation and discomfort caused. It is best to ice the back where the nerve and the disc damage is originating from. This should be done 5 times a day for 10 minutes at a time.

Any exercise you do should be very gentle and not put too much strain on your back. Exercises that involve high impact, such as running, jumping or twisting, should be avoided as they may cause worsening injury.

Here at Lushington Chiropractic we genuinely care about our patients and improving their quality of life. We have an extremely professional and dedicated team who deliver the highest service and have over 80 years’ expertise between them.

Whether you’re suffering with a disc problem, a simple muscle spasm in your back / neck or have a more serious injury or long term problem we’re here to help you.

Find out more about me by visiting my website www.clearlychiropractic.co.uk

 

Caroline

 

 

Treating slipped discs through chiropractic

Treating slipped discs

James Revell, chiropractor at Lushington Chiropractic in Eastbourne discusses the complexities of treating slipped discs.

The prevalence and likelihood of you having a slipped disc increases with age, until you’re in your fifties.  As a person ages, the discs of the back slowly become damaged due to repetitive injury and dehydration – which is one of many reasons to drink more water.

Having worked in Eastbourne for over a decade I’m well used to seeing older people.  Many of my guests (patients) report that at some stage in their life they were diagnosed with a “slipped disc”.  However, it’s not as simple as that.  First of all the term slipped disc is misleading, secondly even if you’ve had a slipped disc part of my commitment to providing advice and information to my guests (chiropractic patients) I’m writing a series of blog articles detailing some of the anatomy of our spine and bodies and how something’s can go wrong. This blog is about your spinal discs.

At Lushington Chiropractic, here in Eastbourne, I’ve had lots of people over the years ask me, “Have I got a slipped disc?”  Slipped discs are very common and have affected 50% of sixty year olds, but there is a lot of confusion about what a slipped disc is and how a slipped disc occurs. So, I thought I’d share why the term “slipped disc” causes confusion and some simple anatomical facts about slipped discs in this blog to help my chiropractic guests understand their back better.

A bit about the spine

The discs within your spine are basically cartilage pads that separate and cushion the 24 moveable vertebrae in your spine.  These discs provide a cushioning effect and create flexibility in your spine. It’s these discs which allow you to move and bend your neck and back.  Chiropractors appreciate the vital importance of these shock absorbing discs, without them your spine would be a solid mass of bone.

Your spinal discs make up about one-quarter of the length of your spine.  Throughout your life your discs are constantly exposed to compression, torque, twisting and injury, resulting in stress to the cartilage disc pad.  I remember whilst doing my chiropractic degree we measured ourselves first thing in the morning and then at the end of the day.  We found (as expected) that we’d shrunk.  This is because some of the fluid in your discs is squeezed out during the day when you’re weight bearing.

Damage to your spinal discs is a topic of considerable discussion and terms such as rupture, bulged, degenerated, or “slipped” and protruded are used interchangeably; however, they are not the same.

 

Can a disc “slip” out of place?

First of all the label “slipped disc” isn’t accurate.  Your disc never slips.  In fact, it’s so firmly attached to the bone that the vertebrae is more likely to fracture than the disc slip or be pulled off it.

Your spinal discs are made of tough cartilaginous material, which can bulge and tear but never simply slip out of place.  So when you hear the term “slipped disc” you now know it’s not slipped but may have bulged.

This process of a bulging (slipped) disc usually takes years to develop.  The damage to the disc is a symptom of poor spinal biomechanics.  It’s usually the end product of years of repetitive functional stress.

 

Disc and Joint Degeneration

Your spinal discs are constantly subjected to gravity and torque from body movements and are therefore susceptible to degeneration from basic wear and tear.  The terms “degenerative disc” or “degenerative joint disease” most accurately describes the steady minor degeneration associated with day-to-day life.  On an MRI scan a disc degeneration will show as a reduced height disc space, often with osteophytes on the vertebra (bony spurs projecting out from the end plate of the vertebra) and the disc may appear darker on the MRI if it’s dehydrated.

 

Title: Diagram Showing Lumbar Vertebra, Spinal Disc and Disc Rupture (aka slipped disc)

James Revell Doctor of Chiropractic, Licentiate Royal College of Chiropractors, MSc(Chiropractic Sciences), BSc(Chiropractic Sciences), Bsc(Biological Sciences)

 

 

 

 

 

 

 

 

 

 

Picture shows an anatomical diagram of the vertebra and discs, taken from http://www.spine-inc.com/

 

So what causes a disc to bulge?

Discs are extremely tough and resilient.  It usually takes years to damage them from repetitive stresses and strain.  When I’m explaining this to my chiropractic guests that report they’ve been told they have a slipped disc, I compare the bulging of a disc to the slow deformation of asphalt that’s been used to fill a pothole in the road.  The asphalt dips in or bulges up with repetitive pressure of cars driving over it, your discs will slowly bulge with repetitive pressure associated with bad posture or poor lifting techniques etc. Disc bulges take years or even decades of over-straining to form.

 

Title: Like the Bump in Asphalt, Bulges to Your Disc Usually Take a Long Time to Develop

James Revell Doctor of Chiropractic, Licentiate Royal College of Chiropractors, MSc(Chiropractic Sciences), BSc(Chiropractic Sciences), Bsc(Biological Sciences)

 

Picture shows a large lump on tarmac road where the asphalt has risen to a lump, picture taken from http://bikeportland.org/2012/08/09/man-suffers-serious-injuries-in-crash-after-hitting-bumps-on-n-vancouver-75732

Disc bulges (and the bulges seen in asphalt) don’t usually occur from a sudden force.  For example, if you hit the asphalt with a hammer it stays the same.  Similarly sudden onsets of back pain are more likely to be due to a strain or tearing of your softer tissues like muscles, ligaments or tendons rather than an immediate damage to the tough disc.

One of the easiest ways to protect your back and discs is to be aware of your posture. You can see from the graph that compared to standing (which is 100%), sitting slouched puts almost twice the pressure on your lumbar discs (185%) and lifting an item whilst slouched puts more than double the pressure on it (220%).

 

Title: Graph Showing Pressure on Disc When in Different Postures

James Revell Doctor of Chiropractic, Licentiate Royal College of Chiropractors, MSc(Chiropractic Sciences), BSc(Chiropractic Sciences), Bsc(Biological Sciences)

Picture shows: graphical comparison of the pressure put on the lumbar discs when in different postures.

 

So you can really see why at Lushington Chiropractic we’re always reminding our guests (patients) about the importance of their posture. We believe that part of a chiropractor’s role is to educate and coach people about their own spine and health (which is why I’ve written this blog J).

What do you do to look after your spine on a day-to-day basis? As you read this blog now, what’s your posture like?

 

Disc Herniation

Like thousands of other chiropractors I’m always advising people to improve their posture. One main reason is that it reduces repetitive strain to your back.  Disc herniation is when a repetitive strain like bad posture, or a sudden injury has caused the outer layers of the disc (annulus fibrous) to tear.

The actual tearing is the defining factor in a disc herniation.  This allows the inner, softer material in the centre of the disc (nucleus pulposus) to bulge out.  Tears are almost always at the back corners of the disc (posterolateral), which is naturally a weak spot, especially given our predisposition to bad slouched, flexion postures and activities.

Although the pain can come on suddenly, the root of the problem may lie in decades of bad posture or repetitive injury.  So, listen to your chiropractor when they recommend sitting and standing straight – we know what we’re talking about.

Sometimes the disc bulge can become so large that it impinges on the nerves as they exit the spine.  If the nerve root gets trapped (radiculopathy) then you might feel a “sciatic pain”, numbness, pins and needles or weakness in the area that the nerve goes to.

In my experience people are often worried about whether their sudden trip, or injury has caused a “slipped disc” but the real problem would have been the repetitive injury that caused the damage in the first place.

 

Someone told me I had a slipped disc?

One of the most common mistakes people about their discs is that they think once they’ve had a slipped disc that it’s the cause of all their back pain for the rest of their lives.

A slipped disc can often be used as a throw away comment as a reason for someone’s pain.  However, to diagnose it with certainty you need an MRI scan combined with a thorough consultation and assessment.

 

Seeing a disc bulge does not mean that it’s the cause of your pain.

Remember, disc bulges and herniations are very common, so it shouldn’t be a surprise to see them on a scan.  Just because we can see a dehydrated, bulging or “slipped” disc on your MRI does not necessarily mean that’s what’s causing your pain.

James Revell Doctor of Chiropractic Showing Disc Bulge on Vertebral Model

 

Bulging Disc

Image shows: James Revell Doctor of Chiropractic, Liciencate of the Royal College of Chiropractors, MSc(Chiropractic Sciences),BSc(Chiropractic Sciences),BSc(Biological Sciences) pointing to an anatomical model of a vertebrae and spinal disc to show a slipped disc, picture taken in his Eastbourne Chiropractic Clinic.

I’ve even seen people who’ve had their slipped disc “removed” with surgery, but it’s not helped with their pain at all, proving (all be it too late) that the disc was not the cause of the problem.  We’re lucky to have a number of fantastic orthopaedic consultants here in Eastbourne.  So if you’re considering surgery take time to talk to the surgical expert and ask them for any advice they may have.

Remember, it usually takes years for the disc bulge to form (like the asphalt in a pot hole after repetitively being driven over).  So if you’ve suddenly experienced an onset of pain we should consider more than just the disc (which has most likely been bulging for years).

 

Summary:

So in summary a slipped disc has not slipped.  Discs are so tough in fact that your vertebrae is more likely to fracture than the disc slip away from the bone.

Like the lumpy asphalt in the road, a bulging disc takes years to form and is due to repetitive injury and pressure from bad posture or lifting and twisting.  Sudden onset of pain is more likely to be due to damage of your “soft tissues” like muscles, fascia and tendons.

Disc dehydration and bulges are common, so seeing them on your MRI scan does not automatically mean that it’s the cause of your pain.  At Lushington Chiropractic we currently charge £300 for MRIs, per region imaged. There are three facilities in Eastbourne and one in London that I use when needed.

I hope this blog has shed some light on the terms used regarding your back and some of the problem that can occur with it.  The more you can understand the better placed you are to take control.  Remember to look after your discs, you need to look after posture!

 

This article was written by Chiropractor James Revell