What is a ‘slipped’ disc and what should you do about it?
Discs are ‘spacers’ between each vertebra to give our spines lots of mobility. They contain a squidgy centre called the nucleus, surrounded by thick fibrous walls. A disc ‘bulge’ is usually caused by lots of bending forward often with some twisting which strains the fibrous walls of the disc. At this point, the nucleus is intact within the disc, but the disc wall is inflamed and the inflammation can cause the nerves exiting the spine right behind the disc, to be irritated.
The most commonly affected nerve in the lower back is the sciatic nerve, located at the very bottom of the spine, between the last lumbar vertebrae and the sacrum.
If the disc problem is severe, the fibrous walls of the disc separate to allow some of the squidgy centre to come out. This is called a disc ‘prolapse’ and it is often associated with severe leg or back pain and sometimes weakness or numbness in the foot / toes as both the nucleus and the associated inflammation can compress the sciatic nerve.
So what should you do?
Best disc care is to keep on moving – walking in particular, and avoid repetitive bending of your low back. Rest frequently – lying down for a few minutes if necessary if this is your only pain-free position. Avoid prolonged periods of sitting or standing still – more than an hour at a time – without moving. When you have to bend and pick things up, either squat down in a sumo-wrestler style keeping your back as upright as possible and using your butt and leg muscles to lift you up against gravity, or bend forward with a flat back like a rice paddy worker and again use your butt muscles to lift the load. Ideally when possible get somebody else do to the lifting for you! The thing to avoid is curling your spine over like a banana and using your spinal muscles to pull you up!
Painkillers (paracetamol) and anti-inflammatories (Ibuprofen) are often usefully combined to give more relief than they would in isolation. If tablets disagree with you (they make some people feel funny) they are best used before bed to give you a good night’s sleep, as this is when your body does its best repair work. Some people like to use a hot water bottle on the back muscles to help them relax (these muscles can get fatigued from irritation of their nerves, and begin to feel bruised and achey).
Discs can heal very well, just like a scab on the knee, but you need to not keep straining the disc (or breaking the edge of the scab) to optimise the healing process.
There are a couple of red flags when the nerves that supply your pelvic organs and floor are affected. You may feel numbness in your pelvic floor (can’t feel toilet paper when you wipe after emptying your bowel or bladder) or numbness in your legs, lose the urge to wee (and realise you haven’t been for 12 hours), or lose control of your bowel. If any of these things occur, go to A&E pronto.
Spinal surgery is nowadays considered very much as last treatment option. However, if the disc is too severely damaged and the impact on the nerves too great, a surgical procedure to trim and hoover up debris might be needed.
A local steroid injection might also be suggested before surgery as a way to reduce inflammation around the disc. However, research has shown that not all people gain significant benefits from this form of treatment.
Conservative management of symptoms such as physiotherapy, osteopathy and dry needling acupuncture have proven to be in many cases the most successful and least invasive approaches.
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