The spine is made up of individual bones (or vertebrae) that stack up on top of each other, and in between these vertebrae are the intervertebral discs. The discs act as shock absorbers for the spine and are made up of a fibrous outer shell (annulus fibrosis) and a softer gel-like centre (nucleus pulposus).
When people state that a disc has “slipped”, it usually means that the disc has ruptured, and the inner gel has bulged outwards (or herniated); however, the term “slipped” can be misleading as it does not truly describe what has actually occurred. When the disc ruptures and the nucleus protrudes outwards, it can put pressure on the nearby nerves.
The symptoms of a bulging disc can include:
- Pain: pain can be felt not only in the back or neck (where the disc is located), but also radiating down into the arms or legs. It can range from mild to severe.
- Pins + needles and/or numbness: these symptoms may be experienced in the same region as the pain or in a different area to the pain.
- Muscle weakness: if there is nerve involvement, signals from the brain may be interrupted causing muscle weakness.
- Reduced reflexes: this can be measured by assessing your response to reflex testing.
There are other symptoms that are associated with disc problems and they can range from being mild pain in the back or neck to severe nerve pain and bowel or bladder problems which need to be seen to immediately.
How does it happen? A herniated disc may happen suddenly (e.g if you lift a heavy object while bent over), but it also may occur over a period of time if there is repetitive strain on the spine (e.g if you sit or bend for long periods, or repetitively). They are most common in people aged between 30 and 50, and occur more frequently in men. The lower back is the most common place for disc bulges to occur.
In most cases, treatment for a herniated disc involves a combination of medication, strict avoidance of activities that put more pressure on the disc (in most cases, this means avoiding flexion or bending forward activities), Physiotherapy to improve movement and reduce pain as well as advise on exercises, and core exercises such as Pilates to improve the muscular control of the area.
In severe cases, where there may be a lot of nerve compression, a specialist review is recommended and surgery may be considered. A number of different surgical procedures can release the compressed nerve and associated symptoms, however, this should be viewed as a last resort when conservative treatment has been effective. Following any type of surgery, Physiotherapy is required to rehabilitate movement loss and improve core muscle control of the effected area.