A herniated (slipped) disc is quite common, with around 5 to 20 adults in every 1,000 suffering from one each year. It is most common in people in their 30s to 50s, and men are twice as likely to suffer from one as women.
The spine consists of bones (vertebrae) that are stacked upon one another. Each vertebra is connected to the other by an intervertebral disc. The intervertebral discs help increase the flexibility of the spine and function as shock absorbers. Each individual intervertebral disc consists of a tough outer fibrous layer surrounding a jelly-like inner layer.
A slipped disc (disc herniation) can describe a tear of the outer fibrous layer of the intervertebral disc with or without protrusion of some of the inner gelatinous layer. In a slipped disc, a tear of the outer fibrous layer can cause significant pain that is usually specific to one area of the neck or back, depending upon which disc is involved. If there is also a bulging of the inner gelatinous layer that irritates or compresses one of the nerves around the spine, this can result in significant pain, numbness, weakness or tingling that extends into a limb. This is most often seen in the legs and is commonly referred to as sciatica.
Slipped discs can occur following a specific injury or episode of heavy lifting. More commonly, however, slipped discs occur as a result of age-related wear and tear. As we age, our intervertebral discs become stiffer and are more at risk of rupturing.
Slipped discs are often caused by excessive strain or pressure on one part of the spine. Things that make slipped discs more likely include:
Fortunately, for the majority of people who suffer from a slipped disc, the outlook is good. In people with a slipped disc who have symptoms (such as pain), 90% will resolve with simple treatment after an average time of six weeks, although the usual range is two to twelve weeks. If surgery is needed to treat a slipped disc, this can give rapid relief of any symptoms, although the long-term results are similar to people who do not have surgery after one year. The exact healing time for a slipped disc depends on a number of factors, such as the severity of the slipped disc, your age, general health, flexibility, whether you smoke, and activity levels.
Because the symptoms of many simple slipped discs settle relatively quickly after injury, physical treatments are not usually recommended unless symptoms persist after three weeks. For the same reason, investigations such as an MRI scan are not usually recommended until there have been at least six weeks of persistent symptoms, severe sciatica, or worsening symptoms.
It is usual for the most severe symptoms of a slipped disc - such as sharp, shooting nerve pain - to begin to settle away first, along with a slow relaxing of any muscle spasm in the area of the affected disc. This means that you may slowly start to feel more flexible in the weeks following a slipped disc, provided you do not do excessive activity or exercise. If you have a slipped disc that is bad enough to press hard on a nerve in your back, this may take longer to heal.
There are thought to be three main ways that the body helps a slipped disc to settle. The first is the absorption of water from any slipped disc, which causes it to shrink in size over time. As it shrinks, it stops pressing on any nerves nearby. The second is through gentle activity and exercise that slowly moves any slipped disc back towards its normal place. The third is an immune response by your body, which helps to reduce inflammation in the affected area.
Although you may need to rest in the first 48-72 hours following a slipped disc, remaining inactive or in bed will actually slow down healing. As soon as you feel able to, light walking, swimming, and gentle movement are recommended to help encourage blood flow to the disc area and stimulate the muscles there. However, be careful not to over-do it, so do not lift heavy objects, bend awkwardly or be tempted to exercise too soon. For most people, this means avoiding lifting anything significant for eight to twelve weeks. If you smoke, try to stop, as smoking slows down disc healing. Make sure you stay as hydrated as possible and eat a healthy diet.
This depends on the stage of the herniation. If you have a bulging or prolapsed disc and your symptoms are not too severe, simple measures such as staying active, taking painkillers, and heat treatment can all help. Painkillers such as paracetamol and non-steroidal anti-inflammatory drugs (or NSAIDs for short) may help with symptoms, but be sure not to take more than the recommended dose of painkillers. You can buy these from our shop here.
Some people find that using ice packs or heat treatments can help ease back pain, but remember not to put ice or strong heat directly on your skin, as this may damage it and don't use it for more than 15 minutes at a time. Your doctor may also refer you to a physiotherapist who can help strengthen your back muscles and stop them stiffening up.
If your symptoms do not respond to this conservative treatment, your doctor might suggest other treatments including painkillers, or injecting long-lasting anaesthetics or steroids into the spine. Long-lasting anaesthetics or steroids help to numb the pain and reduce any swelling. Your doctor may also recommend muscle-relaxing or <u>antidepressant</u> drugs, as some of these have been shown to help with pain relief.
With a severely prolapsed disc, many people require an operation to repair it as stopping the disc from pressing on a nerve usually relieves the pain. An MRI scan is normally done beforehand to make sure that it is a disc problem causing the pain because if the pain is not caused by a disc, surgery won't help. The operation is called a discectomy, and as with any surgical procedure, it has potential risks, including bleeding, infection, and having an allergic reaction to the anaesthetic.
As a general rule, if you develop severe neck or back pain following an injury, you should seek urgent medical attention.
If your slipped disc symptoms have any of the following associated features, you should seek urgent medical attention;
If you do not have any of the above symptoms, you should see your doctor if your back pain has failed to improve after six weeks. Additionally, you should see a doctor if your symptoms are associated with swelling, pain worse at night or recent unintentional weight loss.
A professional massage or manipulation can help ease aches and pains in the back and improve movement. This is best done by a professional who understands anatomy and injury. A sports therapist, physiotherapist, chiropractor or osteopath are all highly trained, with the latter two working specifically with back problems and alignment. They can also advise on stretches to alleviate pain and rehabilitate, and exercises to prevent future back pain or injury.
With sciatica symptoms, once you’re over the initial spasms of pain, stretching out the hamstring muscles at the back of your thighs helps to ease the sciatica with time and can prevent it in future.
A transcutaneous electrical nerve stimulation (TENS) machine can help relieve pain by providing small electrical impulses to the lower back area, giving a mild tingling sensation and reducing pain signals to the brain. It’s a good idea to try if you have long-term back pain.
Acupuncture has evidence to back its role in short-term relief of chronic back pain, and it may allow a little more movement to encourage further rehabilitation and repair. Tiny needles are inserted into the skin and muscles, which is thought to release natural painkillers in the body called endorphins.
<u>CBT</u> and mindfulness may help to treat the brain’s interpretation of pain, if your back pain lasts several weeks or months. Sometimes our bodies malfunction to continue making us think we’re in pain, even after we’ve recovered from the initial injury. So CBT cognitive behavioural therapy (CBT) or mindfulness can be beneficial in reducing your sensitisation to chronic pain and thereby dampening its impact.
Taking care of your mental health is essential with injuries that are slow to recover, as chronic back pain can take its toll. Consider what you enjoy and what helps you relax – music, reading, catching up with friends – and work on releasing those natural painkillers, the endorphins. Be aware that low mood, anxiety and depression can sometimes set in with chronic pain. See your doctor if you think your condition is affecting your mental well-being.
Core strength and conditioning can help with longer-term back pain and help to prevent future injuries. Pilates, yoga and weight training can all help to build up core muscles, including the paraspinal muscles that hug the spine, and flexibility to keep the spine supple. They also improve posture, which helps if you sit at a desk for long periods or have a physical job requiring lots of lifting.
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