Slipped Disc (Herniated or Ruptured)
A slipped disc can also be referred to as a ruptured, herniated, bulging or a prolapsed disc; and it is an injury affecting the spine.
The spine consists of intervertebral joints, discs, ligaments, tendons, muscles and nerve roots. The adult spinal column comprises of 33 irregular bones (the vertebrae) and is divided into 5 regions, the cervical, thoracic, lumbar, sacral and coccygeal. Each vertebra consists of a spinous process projecting posteriorly (to the back) and two transverse processes which project laterally (to the side). The muscle attaches on to these processes. The upper 24 vertebrae articulate with each other through facet joints, which are small gliding joints. These joints allow movement. Between each vertebra there is an intervertebral disc. These discs aid movement (flexion, lateral flexion and extension) and act as shock absorbers, and help prevent wear and tear of the vertebrae. Each disc comprises of a soft, gel-like centre (nucleus pulposus) and a harder fibro cartilage outer case. The spinal column is located in the centre of these discs and vertebrae.
A slipped disc occurs when the outer fibrocartilage ring, surrounding the interverbral disc tears, and causes the soft gel-like centre to press out. As the disc collapses it presses on the spinal nerves (the nerve roots that branch out from the spinal cord), and cause numbness. A slipped disc usually occurs in the lumbar region (the lower back) and occasionally happens in the cervical region of the back. It rarely happens in the thoracic area.
The most common age for a slipped disc is between 30-50 years of age.
Excessive strain on the back: often as a result of heavy lifting and twisting, for example when loading a lorry.
Incorrect posture when lifting: It is important to bend the knees and keep a straight back when lifting a heavy object.
Over use: if the muscles in the back are tired, this can result in a slipped disc.
Symptoms can vary depending on where the slipped disc occurs.
Pain tends to be felt in the lumbar region of the back (the lower region).
Patients with a slipped disc have usually had a history of acute lumbago (pain in the muscles and joints of the lower back).
The lower back can be tender to touch, when applying gentle pressure.
Pain can be mild or severe, depending on the severity of the prolapse.
Pain is continuous rather than pulsating, and tends to be less in the morning.
Pain can become worse when sitting, or lifting.
Numbness, tingling and sometimes paralysis can occur, because the bulging disc can press on the spinal cord.
Muscle spasm in lower back.
If the slipped disc occurs in the lumbar region, the lower back it can result in sciatica, as the disc compresses the sciatic nerve. This tends to occur when bending over. The pain spreads down the leg.
Pain can be alleviated when lying down.
The Lasegue test can be used to diagnose a slipped disc. The patient lies on their back and their leg is raised straight by the examiner, and their foot can also be passively dorsiflexed. If pain is felt spreading down the leg, this indicates a positive test.
An MRI scan can confirm a slipped disc.
Rest: to prevent further damage. Bed rest might be recommended.
In the sub-acute (3 days to 3 weeks) and the chronic stage (3 weeks to 2 years) it is important that training should be adapted to avoid heavy lifting or any exercises that put excessive strain on the spine. A physiotherapist or sports massage therapist can advise when exercise should be resumed and what exercise would be appropriate.
Ice treatment: Ice, can be applied for 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary). In the sub-acute stage (3days – 3 weeks) heat therapy can be applied. Hot bath or hot water bottle might alleviate muscle spasm.
NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief. Medical advice should be sought, in case of possible side effects.
Kinesiology taping can aid recovery.
Massage can help aid recovery, and improve joint mobility and range of movement. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
A physiotherapist osteopath or chiropractor can help stretch and relax tight muscles, which improves range of movement and flexibility. They can advise on appropriate strengthening, flexibility and proprioceptive exercises in the sub-acute and the chronic stage of recovery. Exercises should focus on eccentric strengthening; focussing on the quadriceps muscles, the intensity of the exercises should be increased gradually and in a measured way.
A physiotherapist or doctor might prescribe ultrasound or laser treatment to aid recovery; or recommend surgery.
With rest, time and exercises the prognosis for a slipped disc is good.
Published: November 5, 2011Author: Sophia Cross, BA (Hons) MA
Slipped Disc Treatments