So you've been told you have a "slipped disc" or disc bulge or herniation. Let's clear one thing up straight away: discs don't just "slip" out. This terrifying prospect often leads to fear, increased pain, believing we are damaged beyond repair catastrophising and a long process of frustration and poor recovery. So this article aims to help you on your way to recovery, bring down your anxiety by dispelling a few myths about disc injuries, and sharing some evidence-based tips.
Anatomy of an intervertebral disc
In order to understand the injury, it helps to understand the anatomy. If that's not interesting for you, scroll down.
Discs have 2 main parts: a toothpaste-like middle called the nucleus pulposus - literally translated at the ‘squishy middle’. This is surrounded by layers of fibrous tissue called the annulus fibrosus - the fibrous ring that encases the squishy middle and attaches very firmly to the vertebra above and below it. Don't believe me? Go buy some lamb barn chops and try to take off the disc and you'll see just how attached they are. This is what makes it impossible for them to "slip" out of place.
The fibres of the annulus fibrosus are strong and thick and overlap in a criss-cross formation which makes them super strong.
There is a theory that discs are like burgers - bite (apply pressure to) one end and the contents push out the other. Physios and Osteopaths often recommend people do back bends to help the disc squish back into place (and I've done this too).
In reality, it doesn’t work that way, since discs are living entities and the mechanics don't really work that way. Plus, the annulus fibrosus is there keeping it in.
Despite their infamy, disc injuries account for a relatively small proportion of back pain, with minor muscle strains, joint irritations and psychological stress being the most common causes.
So what is a slipped disc?
A "slipped disc" is when the nucleus pulposus pushes on the annulus fibrosus which may have become weakened for some reason (often unknown, but sometimes a sudden, jolting force can do this), and bulges out of its contained space within the annulus. Medical professionals use the terms bulge or herniation. The bulge can sometimes be found to press on adjacent nerve roots exiting the spinal cord at that level. But this doesn't happen in every case.
Never does the entire disc slide out of its position, as the term might suggest.
Many people who have had disc injuries or issues believe their backs are fragile and unstable or that their disc could "blow out" at any moment. This is not true.
They are not like tyres so can't just ‘go’ or blow out or even spontaneously combust. What does happen in a sudden bang of pain is usually just your brain perceiving a particular movement as potentially harmful so it sends a pain signal to your back in order to protect you. Pain is a often a protective mechanism.
It's important to note that around half of the people who have an MRI for back pain have no structural changes, and around half of those who have no pain are found to have structural changes (such as a disc bulge). This tells us that it's not the disc causing the pain - if it were, EVERYONE who has a disc bulge would be in pain, but they're not.
The symptoms of a disc bulge...
...Are often pain in the buttock or posterior thigh and calf and outside of the foot, numbness, pins & needles around the same areas. Often there is no pain in the back, despite the origin being in the back. Often back pain is not related to a disc injury, or if it is, it is muscles spasming or contracting around the area of the disc, decreasing their oxygen supply and that is what creates pain.
Often a sharp increase in pain upon movement is not the result of the disc pressing on a nerve root, but the brain anticipating potential damage so creating a pain signal in order to protect this vital area of the body.
Now here’s a crazy idea: Think for a moment of your funny bone. That part of your elbow that if you bang it, it's bloody painful and can send you into a writhing, swearing frenzy.
Do this as you read: try pressing on your funny bone. Specifically your ulnar nerve, which sits at the back of your elbow just above the big bony bit (olecronon) and the smaller bony bit on the inside of your elbow (medial epicondyle). Apply a bit of sustained pressure and note what you feel. Not pain, right? It's can be a bit uncomfortable but after a period of sustained pressure you're more likely to experience numbness, or pins & needles and weakness of your forearm and baby finger side of your hand. That's because pressing on a nerve generally doesn't hurt it, it just reduces its blood supply and potential for conducting impulses, hence the changes in sensation.
The same thing happens with discs - the pain is usually not caused by the disc pressing on the nerve root, it's either from localised inflammatory chemicals irritating the nerve or the brain trying to protect the back, as I mentioned earlier.
This brain activity is especially the case when pain has been there for a long time, but I'll explain that in a separate post.
So how to recover from a disc injury?
The common perception of a person with a slipped disc is someone bedbound in agony for weeks. That was my aunt when I was growing up. Don't get too close, don't touch her, any slight movement could send her reeling!
The good news is that discs have capacity to heal and about 80% of people with a disc bulge get better within 8-12 weeks without the need for injections or surgery.
In the roughly 20% of people who don’t, it’s usually not that the disc hasn’t healed, it’s often because their brain has learned that it needs to protect them by creating a pain signal every time they do a movement that has previously been potentially harmful.
Thankfully things have moved on a long way since then and now we know that bedrest is not helpful for back pain of any kind and that moving is a great way to help them recover.
No surprises here - movement is fantastic for them and helps them get stronger because like all body structures, they respond to the forces that are applied to them, like muscles get bigger and stronger when we use them, discs get more hydrated which keeps them healthy and malleable and helps stimulate the maintenance process. It also helps to train your brain not to generate a pain signal unnecessarily.
Small, rhythmic movements are great for helping the brain tolerate the movement. Start small within the pain-free range of motion and gradually build up over time.
Walking is fantastic for helping discs recover - that rhythmic motion again. Avoiding sitting for long periods helps too. The pain experienced with sitting is usually your body's message that it wants to move - it's time to get up and move around or change position.
That's the physical.
Then there's the mental.
Reminding yourself that discs recover on their own (without needing pharmaceuticals, injections or surgery) will really help.
Remember that pain is not an indicator of damage. Often the pain far exceeds the actual damage (think of a paper cut - tiny injury, massive pain).
Telling yourself it is a temporary thing will also help.
Consider that injuries are here to teach us something. This can help minimise catastrophising, frustration and suffering, and help to see your disc bulge as your friend, not your enemy.
Look for the lessons, the blessings, the ways in which your pain is here to help you. It can be super hard to fathom when the pain is so awful, but they're there when you start looking.
Identify the stressors in your life that could be contributing to your pain. That is one of the least spoken about but usually the most relevant.
Often physical pain serves as a distraction from an emotional pain. When we deal with the emotional, the physical tends to dissipate by itself.
I hope you found this useful. If you want help with your pain consider joining one of my courses or workshops or having 1-2-1 sessions with me. Working with someone makes a real difference. You can contact me HERE.