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)
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
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
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?
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
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).
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