Discs Don’t Slip
Intervertebral discs seen here (beige-grey colour), above, between and below white vertebral bones in this section of the spinal model.
Possibly one of the most common phrases that we hear in the clinic: “I’ve got a slipped disc”, “my Doctor/Osteopath/Physio/Chiropractor has told me that I have a slipped disc”.
What if I told you that intervertebral discs DO NOT slip?
By using the phrase “slipped disc” it suggests that the spine is instable, weak, unpredictable, fragile, and that it is possibly dangerous to move…
So let’s have a look at why this isn’t necessarily the case, what is really going on and how understanding your diagnosis can have an impact our pain experience and recovery.
What is an intevertebral disc?
An intervertebral disc is a strong, shock-absorbing structure that is firmly fixed between two vertebrae (one above and one below). There are typically 23 discs in the spine from your neck to the base of the spine.
The discs consist of concentric fibrocartilaginous layers which circle the outer part of the disc – the outer layers of these sheets attach directly to bone. The central part of the disc consists of a gelatinous substance (5).
Disc functions include (5):
· Allow spinal flexibility without sacrificing strength
· Contribute to stability
· Shock absorbing abilities
· Assist other structures to create a space where spinal nerves exit the spinal column
What’s actually happening
When a disc injury occurs, there could be multiple different effects including
· Localised pain to the site of injury
· Pain could radiate into one/both arms/legs dependent upon the disc(s)
· Other symptoms include weakness, pins and needles, numbness, altered sensation
Why disc injuries occur (2)
· General wear and tear
· Injury trauma or excessive impact e.g. from a fall or car accident
· Repetitive load and strain
Varying levels of disc injury exist:
· Degenerative
· Bulging
· Herniated (protrusion, extrusion, sequestration)
However, underlying disc injuries can exist and be ASYMPTOMATIC i.e. they do not produce any symptoms or pain.
Studies of individuals going through an MRI without any pain or symptoms can often show changes to the intervertebral disc. For example, if we look at a study of individuals without pain:
The prevalence of disk degeneration was 37% of 20-year-old individuals and 96% of 80-year-old individuals (1)
As for disc bulges, prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age (1)
Imaging reports of spine degeneration are present in a high proportions of asymptomatic individuals and these figures increase with age. However, many of these degenerative findings are likely part of normal aging and are unassociated with pain. Imaging findings must be considered and interpreted in relation to the patient’s context, clinical condition and examination findings.
So, what can we take from this?
Treatment and Recovery Time for Disc Injuries
So, our point here is that although a scan may be needed to rule out any other cause of pain such as a more sinister cause, it often isn’t our first port of call.
This is because disc injuries can often resolve by themselves. However, if symptoms haven’t resolved, symptoms may respond well to a combination of manual therapy (manipulation, massage, osteopathy) and physical therapy including both stretching and strength training.
Recovery time is variable and dependent upon many factors. However, most people feel a reduction of pain and discomfort within six weeks (3).
If you are in pain or have an injury you should discuss this with a healthcare expert who can take a thorough case history, examine, and provide you with a diagnosis and an individually tailored treatment and management plan.
Want to know more?
Book an appointment to speak to one of our expert Osteopaths who will discuss your individual case and examine you to find out what is causing your pain and we will speak about how we may be able to help you.
References
1. Brinjikji, W., Luetmer, P., Jarvik, J. (2015) Systemati Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations [Internet]. Available from: < https://www.semanticscholar.org/paper/Systematic-Literature-Review-of-Imaging-Features-of-Brinjikji-Luetmer/84c5cda9173813a45c3a48adb8154ef25ac644cb > Date Accessed: 20.09.2020
2. Department of Health, Australia (undated) Disc Injuries. [Internet]. Available from: < https://www1.health.gov.au/internet/main/publishing.nsf/Content/phi-natural-therapies-submissions-containerpage/$file/Disc%20Injuries.pdf > Date Accessed: 20.09.2020
3. Morrison, W., (2020) Slipped (Herniated) Disc [Internet]. Available from: < https://www.healthline.com/health/herniated-disk > Date Accessed: 20.09.2020
4. NHS (2018) Slipped Disc. [Internet] Available from: < https://www.nhs.uk/conditions/slipped-disc/ > Date Accessed: 20.09.20
5. Physio-pedia.com (2020) Lumbar Anatomy [Internet] Available from: < https://physio-pedia.com/Lumbar_Anatomy?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal > Date Accessed: 20.09.2020
