Slipped Disc

Slipped disc refers to the displacement of a soft cushion of tissue present between the bones of the spine. This condition may exert pressure on the nerves and cause great discomfort. Our backbone is made up of 26 bones known as vertebrae. Soft cushion-like discs are present between these bones to keep them in place. These discs also facilitate movement like bending or stretching. If these discs rupture or breakdown, it leads to the problem of a slipped disc or bulging disc. When this happens,  the soft jelly-like part at the centre of the disc pushes out of the disc and presses against a nerve of the spinal cord. Slipped discs are most common in the lower part of the backbone (lumbar spine). It is more common among people aged 30-50 years and can cause severe pain.

Based on the location of the slipped disc, it can be of the following types:

• Cervical slipped disc
  The cervical slipped disc involves the cervical spine, and therefore, would affect the neck, head, shoulders, arms, and hands.
• Thoracic slipped disc
  The thoracic spine is connected to the rib cage and is not involved with the bending movements. Hence, thoracic slipped discs are quite rare.
• Lumbar slipped disc
  Lumbar slipped discs are the most common and involve the lower back.

The pain caused by a slipped disc usually occurs on one side of the body. The symptoms vary according to the location of the damaged disc.

The most common symptoms of a slipped disc in the lumbar part of the spine (lower back) are:

• Back pain.
• Sharp pain experienced while bending.
• Sudden pain while sitting down or doing any movement.
• Leg pain.
• Numbness in one leg or arm.
• Pain going down the legs.
• Weakness in one leg.
• Pain in the hip region.
• Pain in the calf or the sole.

If the slipped disc is located in the cervical area of the spine, then the pain may be experienced in the neck or the arms. The symptoms may be as follows:

• Vague discomfort in the neck.
• Pain while moving the neck.
• Shooting pain at the base of the neck.
• Pain near the shoulder blade. (Read more - Shoulder pain treatment)
• Pain radiating down the arm to the fingers.
• Numbness in the neck, shoulder or arm.
• Tingling sensation in the fingers accompanied by neck pain.

The severity of the symptoms depends upon the degree to which the disc in pressing the nerve. The pain due to a slipped disc aggravates while engaging in a physical activity. Sometimes, mild jerks to the body during driving, coughing, sneezing and running may also trigger the pain. This happens because a sudden movement puts more pressure on the nerve and leads to pain.

The causes and risk factors of a slipped disc are as follows:

Causes

A slipped disc could be a result of age-related wear and tear also known as disc degeneration. Other general reasons include:

• Lifting heavy objects with improper posture.
• Being overweight. (Read more - Obesity causes and treatment)
• Exercising too hard.
• Driving for long durations.
• Prolonged inactivity.
• Back injury.

Risk Factors

There are certain risk factors which will increase the likelihood of suffering from a slipped disc. These risk factors include:

• Weight
  Being obese and overweight places stress on the lower back and increase the chances of having a slipped disc.
• Gender
  No gender is at a significantly higher risk of suffering from a slipped disc. However, women are more likely to have weaker bones with progressing age and hence have a slipped disc.
• Age
  People aged 30-50 years are at a higher risk of a slipped disc.
• Improper lifting technique
  Using the back muscles instead of the legs to lift heavy objects or lifting things using a wrong posture can lead to a slipped disc.
• Strain
  Engaging in activities like lifting, pulling, twisting and bending can strain the muscles of the back and increase the pressure on the spine. Performing such activities repeatedly without maintaining a proper posture or warming up increases the risk of a slipped disc. (Read more - Muscle strain treatment)
• Driving
  Driving for extended periods of time not only disturbs the posture but also exposes the spine to constant vibrations from the car engine resulting in back problems.
• Sedentary lifestyle
  Inactivity can increase the risk of having problems with the back as well as the neck.
• Smoking
  Smoking decreases the amount of oxygen supply to the disc and can increase the rate of degeneration of the disc as well.

The most effective strategies and methods for preventing slipped disc focus on maintaining a good body posture and position while performing daily life activities such as walking, running, lifting objects, bending and even sleeping. Hence, doctors suggest that one must remain aware of the way they are making such movements. One must avoid lifting heavy objects when tired or fatigued. Lifting and twisting simultaneously could also create excessive pressure on the back.

There are other lifestyle changes that one can make to prevent slipped disc. These include maintaining a healthy weight, engaging in regular exercise and avoiding smoking.

The first step in diagnosing slipped disc is taking down a detailed medical history and understanding the symptoms. After gathering enough information, the following tests may be carried out:

• Neurological examination
  A neurological examination is performed primarily to determine if there is any muscle weakness or loss of sensation. During the examination, the doctor may examine the muscle strength of the legs and arms. The doctor may want to detect any loss of sensation by checking whether the individual can feel a light touch in the leg or the foot. One may be asked to bend or stretch slightly to locate the area from where the pain is originating.
• Straight leg raise (SLR) test
  In this test, the doctor will detect the presence of a slipped disc by gently lifting the leg while the knee stays straight. Experiencing pain in doing so can be indicative of a slipped disc or a herniated disc.
• Imaging tests
  The magnetic resonance imaging (MRI) scan is widely used for diagnosing slipped disc, especially in the lower back. It also helps to know more about the nerves which are being compressed by the bulging disc. Another imaging diagnostic tool is the computed tomography (CT) scan. These tests help in confirming the diagnosis by providing clear pictures of the soft tissues such as the intervertebral discs.
• Nerve and muscle tests
  Tests like electromyograms may be helpful in determining the electrical activity of the muscles and location of the nerve damage. Before conducting the MRI and CT scans, the doctor may also recommend an X-ray to rule out any other possibilities of back pain such as infection, fractured bone or a tumour.

Many people with a slipped disc report improvement over a period of 3-4 weeks. Some may get complete relief from the symptoms within 3-4 months. However, others may experience recurrent pain. Management of slipped disc includes:

Non-surgical treatment

A non-surgical treatment is very helpful in providing relief from symptoms like pain. Non-surgical treatment options include:

• Bed rest
  Rest for up to 3 days can be beneficial and may provide the damaged tissue some time to heal. However, prolonged inactivity is not recommended. Once the symptoms begin getting better, you may return to daily life activities but making sure that you refrain from actions which strain the affected area.
• Pain Medication
  Nonsteroidal anti-inflammatory medications (NSAIDs) include painkillers like ibuprofen and naproxen which can help in providing relief from pain.
• Physiotherapy
  Physiotherapy is widely recommended for strengthening the muscles of the back. Specific exercises recommended by the physiotherapist will assist in regaining mobility and managing the symptoms. The therapist may also recommend other treatment modalities such as treatment with heat, short-term bracing for the back or the neck to provide support while the tissues heal or electrotherapy for pain reduction.
• Epidural injection
  An epidural steroid injection may be given for providing a short-term relief from inflammation.
• Other medications
  These include muscle-relaxants and anticonvulsants to prevent muscle spasms.

A few Asian treatment methods have had some success in treating the slipped disc. These techniques include:

• Acupuncture (using fine needles to locate the distress points in the affected area).
• Reiki (pain relief by using specific hand placements).
• Moxibustion (using heat for pain relief).

Surgical treatment

Surgical treatment is not very common for a slipped disc. It is only recommended if the symptoms have not been relieved with the help of medications. People with muscle weakness, motor difficulties or loss of bowel movements may have to undergo surgical treatment. Surgical treatment options include:

• Microdiscectomy
  It is the most common surgical technique used for treating a slipped disc. In this procedure, the bulging part of the disc is removed so that there is no pressure on the nerves. Following the surgery, one may return to daily life activities gradually while making sure that the treated area is not stretched or pressurized.
• Artificial disc replacement
  This is another surgical procedure which makes use of artificial discs made of metal or biopolymer to replace the damaged disc. According to the need, either the entire disc may be replaced or only the soft centre of the disc (known as the nucleus) may be replaced. However, the availability of this treatment is minimal.

Lifestyle management

Several home care measures can help in treating a slipped disc. These include:

• Maintaining a good posture while standing and sitting will help to reduce pressure on the back. The most general yet useful guideline regarding stance is to stand and sit straight.
• When lifting something, bend your knees and hips while keeping the back straight.
• When carrying something, hold the object close to your body. This will prevent your spine from getting exerted.
• While you are receiving treatment for a slipped disc, avoid wearing high heels or any footwear which lays stress on your back.
• Avoid sleeping on your stomach.  
• Do not sit for long durations of time.
• Perform flexibility exercises as advised by the physiotherapist to regain mobility and help reducing tension and back pain.
• Practising yoga can be helpful in strengthening the abdominal muscles which in turn support the back muscles.

In a large number of people, the ruptured disc or the slipped disc heals over time, provided that optimum rest and care is taken. Ongoing precautions will also help in preventing the possibility of having a slipped disc in the future.

Prognosis

A slipped disc may be a commonly reported condition but is quite unpleasant to endure. While some people may experience severe symptoms, some may not report any symptoms at all. The chances of improvement with the proper treatment are high, although it can take a few months to get back to the daily life activities without experiencing any pain at all. There are several measures to be made to keep the symptoms from aggravating and managing the condition effectively.

Complications

Just below the waistline, the spinal cord divides into a bundle of nerves called the cauda equina. Under rare circumstances, if the bulged disc presses upon the entire group of nerves, the consequences can be severe. This may result in:

• Permanent weakness in the leg.
• Paralysis.
• Partial loss of sensation.
• Loss of bowel control.
• Loss of bladder control. (Read more - Urinary incontinence causes and treatment)
• Sexual dysfunction. (Read more - Erectile dysfunction causes and treatment)

If such complications arise, then surgery may be the best option available to minimize the risk.