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Slipped disc

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Slipped disc


  


 Introduction 

A slipped disc – known as a prolapsed or herniated disc – occurs when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves.

This can cause back pain and neck pain, as well as symptoms such as numbness, a tingling sensation, or weakness in other areas of the body.

The sciatic nerve is often affected in cases of slipped disc. It is the longest nerve in the body and runs from the back of the pelvis, through the buttocks and down both legs to the feet.

If pressure is placed on the sciatic nerve (sciatica), it can cause mild to severe pain in the leg, hip or buttocks.

 

 The spine 

The spine consists of 24 individual bones called vertebrae that are stacked on top of each other.

In between each vertebra there are protective circular pads of cartilage (connective tissue) called discs, which have a tough, fibrous case that contains a softer gel-like substance. The discs help maintain your back's flexibility and wide range of movement.

The spinal cord is highly sensitive and passes through the middle of the vertebral column. It contains nerve cells and bundles of nerve fibres that connect all parts of the body to the brain.

 

 What causes a slipped disc? 

A slipped disc occurs when the outer case of the disc splits, resulting in the gel inside bulging out of the disc.

The damaged disc can put pressure on the whole spinal cord or on a single nerve root (where a nerve leaves the spinal cord).

This means a slipped disc can cause pain both in the area of the protruding disc and in the area of the body controlled by the nerve that the disc is pressing on.

It is not always clear what causes a disc to break down, although age is a common factor in many cases. As you get older, your spinal discs start to lose their water content, making them less flexible and more likely to rupture.

Smoking also plays a role as it causes the discs to lose their natural flexibility.

It's important to note not all slipped discs cause symptoms such as pain, weakness or tingling. Many people will go their whole life and not know they have a slipped disc, even though they have one.

 

Diagnosing a slipped disc

Your GP will usually be able to diagnose a slipped disc from your symptoms and medical history. They may also carry out a physical examination to test your:



posture



reflexes



muscle strength



walking ability



sensation in your limbs



 

Treating a slipped disc

It can take about four to six weeks to recover from a slipped disc. Treatment usually involves a combination of physical therapy, such as massage and exercise, and medication to relieve the pain.

Surgery to release the compressed nerve and remove part of the disc may be considered in severe cases, or if the pain continues for longer than six weeks.

In many cases, a slipped disc will eventually shrink back away from the nerve and the pain will ease as the disc stops pressing on the affected nerve.

Often the slipped disc will stay pressing on the nerve, but the pain goes away because the brain learns to "turn down the volume" on the pain messages coming from the nerve.

If you have a slipped disc, it is very important to keep active. Initially moving may be difficult, but after resting for a couple of days you should start to move around. 

This will help keep your back mobile and stop the joints becoming stiff and the muscles that support the spine becoming weak. Keeping moving will speed up your recovery.

Any exercise you do should be gentle and not put too much strain on your back. Exercises that involve high impact, such as running, jumping or twisting, should be avoided at first as they may cause a flare-up of the pain.

 

Preventing a slipped disc

Taking a few sensible precautions, such as leading a healthy lifestyle, can help prevent back pain and lower your risk of getting a slipped disc. For example, you should:



take regular exercise



use a safe technique when lifting heavy objects



always maintain a good posture when sitting and standing



quit smoking if you smoke



 


Lumbar spine illustration



1. Healthy disc
2. Nerve
3. Slipped disc
4. Damaged disc
5. Spinal cord

 


How common are slipped discs?

Slipped discs are most common in people aged between 30 and 50 years old. The condition affects twice as many men as women.

Slipped discs often occur in the lower back. While around a third of adults in the UK have lower back pain, fewer than 1 in 20 people have a slipped disc.

 

Symptoms of a slipped disc 

Most people with a slipped disc experience pain on one side of the body that starts slowly and gets worse over time.

The pain you experience when a disc presses on a nerve is often worse when you put pressure on the nerve. This can happen when you cough, sneeze or sit down.

However, some people with a slipped disc do not have any obvious symptoms. This is usually because the part of the disc that bulges out is small or does not press on the nerves or spinal cord.

The symptoms can also vary depending on whether the slipped disc is in the neck or lower back.

 

Slipped disc in the neck

A slipped disc in the neck can cause:



neck pain during movement 



numbness or a tingling sensation in the neck, shoulder, arm or hand



weakness in certain muscles, which limits your range of movement



Slipped disc in the lower back

A slipped disc in the lower back can cause:



back pain during movement



numbness or a tingling sensation in the back, buttocks, genitals, legs or feet



 

Sciatica

The sciatic nerve is the longest nerve in the body and is made up of several smaller nerves. It runs from the back of the pelvis, through the buttocks and down the legs to the feet.

If a slipped disc is putting pressure on the sciatic nerve, it can lead to pain in the leg, hip or buttocks. This is known as sciatica.

 

Other nerves

If the slipped disc presses on any of the other nerves that run down your spinal cord, your symptoms may include:



muscle paralysis



muscle spasms – where your muscles contract suddenly and painfully



Muscle spasms and paralysis tend to occur in your arms, legs and buttocks.

 

Cauda equina syndrome

Cauda equina syndrome is a serious condition where the nerves at the very bottom of the spinal cord become compressed. Symptoms include:



lower back pain



numbness in your groin



paralysis of one or both legs



rectal pain



loss of bowel control (bowel incontinence)



loss of bladder control (urinary incontinence)



pain in the inside of your thighs



You should seek medical assistance immediately if you develop these symptoms. Visit your GP or the accident and emergency (A&E) department of your nearest hospital.

If cauda equina syndrome is not promptly treated, the nerves to your bladder and bowel can become permanently damaged.

 




Sciatica: animation




 




Sciatica causes pain that radiates out from the lower back, down the buttocks and into one or both of the legs, right down to the calf. This animation explains what sciatica is and what causes it.


Media last reviewed: 03/02/2015

Next review due: 03/02/2017








Back pain guide

Explore this guide for information about different types of back pain, ways of preventing it and advice on treatment

 

Causes of a slipped disc 

A slipped disc occurs when the circle of connective tissue surrounding the disc breaks down. This allows the soft, gel-like part of the disc to swell and protrude out.

It is not always clear what causes the connective tissue to break down. However, slipped discs are often the result of increasing age.

As you get older, your spinal discs start to lose their water content. This makes them less flexible and more likely to split.

There are a number of other factors that can put increased pressure and strain on your spine. These include:



bending awkwardly



jobs that involve heavy or awkward lifting



jobs that involve lots of sitting, particularly driving



smoking



being overweight or obese



weightbearing sports, such as weightlifting



a traumatic injury to your back, such as a fall or car accident



Situations such as these can weaken the disc tissue and can sometimes lead to a slipped disc.

 

Diagnosing a slipped disc 

Your GP will usually be able to diagnose a slipped disc from your symptoms and medical history.

You will also have a physical examination, where your GP will test your:



posture



reflexes



muscle strength



walking ability



sensation in your arms and legs



 

Leg-raising test

While you are lying flat or sitting, your GP will slowly raise each of your legs one at a time to see if it causes any pain or discomfort in your legs.

This test stretches the nerves in the spine. If there is a disc pressing on a nerve, this stretching can cause pain, numbness or tingling.

 

Pressure on a nerve

Your GP may test whether there is any pressure on a nerve in your neck by asking you to bend your head forward and to the sides while applying some pressure to the top of your head.

If this causes any pain or numbness to increase, then it is likely a slipped disc is putting pressure on a nerve in your neck.

 

Further tests

Further tests are not usually required because in most cases the symptoms of a slipped disc settle down within a few weeks.

However, if your symptoms do not ease after four to six weeks, further tests may be required to rule out other conditions and investigate the size and position of the slipped disc.

Some of the tests you may have are described below.

Magnetic resonance imaging (MRI) scan

A magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to produce detailed images of the inside of your body.

MRI scans are effective at showing the position and size of a slipped disc. They can also pinpoint the affected nerves.

 

Computerised tomography (CT) scan

A computerised tomography (CT) scan uses a series of X-rays to scan parts of your body. A computer is then used to build up detailed images of your body.

This produces cross-sectional images of your spinal column and the structures that surround it. Like an MRI scan, a CT scan can pinpoint a slipped disc, although it is often not as effective.

 

X-rays

X-rays are not generally used as a test to look for slipped discs as they only see the bones and do not give a view of the nerves and spinal cord.

 

Other causes

The tests listed above can be used to check that your back pain is not being caused by another health condition, such as:



a tumour (growth)



an infection



arthritis – a painful condition that affects the joints and bones



 

Treating a slipped disc 

In most cases, a slipped disc will slowly improve with rest, gentle exercise and medication. It can take up to four to six weeks to recover from a slipped disc.

 

Keeping active

It is very important that you keep active if you have a slipped disc.

Initially, it may be difficult to move around. If you are in severe pain, you may need to rest completely for the first couple of days.

However, after this period, you should start to move around as soon as you can. This will keep your back mobile and speed up your recovery.

You should ensure any exercise you do is gentle and does not put a strain on your back. Swimming is an ideal form of exercise because the water supports your eight and it puts very little strain on your joints.

Movement and exercise will also help strengthen any muscles that have become weak. Avoid any activities that could aggravate your condition, such as those that involve:



reaching



lifting



sitting for a prolonged period of time



You may find your pain increases at first when you start moving around.

This is normal and doesn't mean you are causing more damage to the spine or the slipped disc. This pain should settle quite quickly, allowing you to gradually increase the amount of exercise you are doing.

 

Physiotherapy

As part of your treatment programme, you may be referred to a physiotherapist. Physiotherapists are healthcare professionals who use physical methods, such as massage and manipulation.

A physiotherapist will be able to draw up an individually tailored exercise plan for you. This will keep you active, minimise pain and help prevent any further damage to your back.

 

Osteopathy and chiropractic

Some people choose to try osteopathy or see a chiropractor. Both types of therapy are used to treat back pain.

 

Medication

You may be prescribed a number of different medicines to help ease any painful symptoms of a slipped disc. These are outlined below. 

 

Analgesics

Analgesics are painkillers, such as paracetamol. They are available over the counter from pharmacies or on prescription.

Some people worry that taking painkillers may mask something more serious going on with their back.

This isn't true – painkillers taken regularly can help you get back to moving around, which will help make the pain better more quickly.

Always read the manufacturer's instructions before using analgesics.

 

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen, can help relieve pain and reduce any inflammation.

NSAIDs may not be suitable for people with hypertension (high blood pressure), asthma, heart failure, or kidney failure. Again, you should always read the manufacturer's instructions before use.

 

Codeine

Codeine is a stronger painkiller that is often taken in combination with paracetamol. It is usually only prescribed when other painkillers and NSAIDs have not worked.

Codeine can cause side effects such as constipation.

 

Corticosteroids

Corticosteroids are a type of medication that contain hormones (powerful chemicals that have a wide range of effects on your body). They may be injected into your lower spine to help reduce inflammation.

 

Muscle relaxants

You may be prescribed a muscle relaxant, such as diazepam, to take for a few days if your back or leg muscles are very tense.

 

Surgery

Surgery is required in about 1 in 10 cases of a slipped disc. It may be considered if:



there is evidence of severe nerve compression



your symptoms have not improved using other treatments



you are having difficulty standing or walking



you have very severe symptoms, such as progressive muscle weakness or altered bladder function



The aim of surgery is to cut away the piece of the disc that bulges out. This is known as a discectomy and it can be done in several ways.

Some of these procedures are explained in more detail below.

 

Open discectomy

An open discectomy is a procedure to remove part or all of the slipped disc. It will be carried out under anaesthetic (painkilling medication).

An incision is made in your spine and the disc is removed. For more information about this type of surgery, see the lumbar decompressive surgery topic.

 

Prosthetic intervertebral disc replacement

Prosthetic intervertebral disc replacement involves having a prosthetic (artificial) disc inserted into your back to replace the slipped disc.

An incision is made in your spine and the damaged disc is either partially or completely removed. A replacement disc is then inserted into the space.

One study found 87% of people felt their quality of life had improved three months after having a prosthetic intervertebral disc replacement. However, as the procedure is still quite new, long-term results are not yet available.

The National Institute for Health and Care Excellence (NICE) has published guidance on the use of artificial discs.

 

Endoscopic laser discectomy

During endoscopic laser surgery, a small incision will be made to gain access to the spine and an endoscope will be used to view the disc. An endoscope is a long, thin, flexible tube with a light and camera at one end.

The procedure is performed under either local anaesthetic or general anaesthetic, depending on where in your spine your slipped disc is. 

After the incision has been made, the compressed nerve causing you pain will be released and part of your disc will be removed with a laser.

A study found 67% of people could move around more easily six months after having endoscopic laser surgery, and around 30% needed less pain-relieving medication. Around 2-4% of people needed another operation.

Another study reported that, on average, people returned to work seven weeks after having endoscopic laser surgery. 

As endoscopic laser surgery is still a relatively new procedure, it is often only performed with special arrangements – for example, as part of a clinical trial (a type of medical research that tests one type of treatment against another). 

The National Institute for Health and Care Excellence (NICE) has published guidance on the use of laser treatment for damaged discs.

 

Recovery

For most people with severe symptoms, back surgery helps ease their symptoms.

You will usually be able to return to work after two to six weeks. However, the surgery does not work for everyone, and you may need to have further operations and treatment if the initial surgery is not effective.

Possible complications resulting from surgery may include:



infection



nerve injury and paralysis



haemorrhage (severe bleeding)



temporary dysaesthesia (impaired sense – for example, losing the sense of touch)



Before having surgery, you should ask your surgeon about their experience in doing the surgery, and their success and complication rates.

They will advise whether you are at risk of developing complications and how long it will take to recover. You may be given a rehabilitation programme to follow.

One review of a number of studies found exercise programmes that started four to six weeks after surgery on the lumbar spine (lower back) helped decrease pain and improve a person's ability to function.

 

Lumbar surgery








 




Around half of us have back pain at some time in our lives. It often heals in time, but for some people the pain doesn't go away and surgery is the only answer. Watch this video to see how lumbar surgery can relieve pressure on the spinal nerves in the lower back.


Media last reviewed: 11/03/2014

Next review due: 11/03/2016










Exercises for sciatica: slipped disc

In this video a physiotherapist demonstrates gentle exercises for a herniated or slipped disc, a form of sciatica

Preventing a slipped disc 

To avoid back pain and help prevent a slipped disc, you should keep mobile, exercise regularly, maintain good posture and lift heavy objects correctly.

 

Exercise

Regular exercise can slow down the age-related deterioration of the discs in your back. It can also help keep your supporting back muscles strong and supple.

You should warm up and cool down properly before and after any workout or sports activity. Your warm up and cool down should incorporate stretching exercises.

If you are recovering from a slipped disc, avoid high-impact activities, such as running and aerobics.

 

Maintain a healthy weight

Being overweight can put extra strain and pressure on your back, so maintaining a healthy weight will help ease the pressure.

Use the healthy weight calculator to find out whether you are a healthy weight for your height.

 

Lifting

It is very important that you use the correct technique when lifting. When lifting heavy objects, you should:



think before you lift and make sure you can manage the weight



slightly bend your back, hips and knees at the start of the lift



keep the load close to your waist



avoid twisting your back or leaning sideways



keep your head up and look ahead as you carry the load



 

Sitting

When sitting or driving for long periods, make sure your seat is comfortable and supportive. If possible, take regular breaks to stretch and walk around.

If your job involves using a computer, take regular breaks away from the computer screen. Make sure the computer screen is at eye level and directly in front of you so you do not have to twist or bend to see it.

Sit in a comfortable position with enough space to move around, and do not stay in the same position for too long.

Your employer should give you information about working with computers and provide advice about the best way to sit and position your equipment.

 

Posture

Always try to keep a good posture. Walk or stand with your head and shoulders slightly back.

When sitting at a desk, make sure your chair is the correct height for the desk. Your feet should be able to rest flat on the floor with your knees bent at 90 degrees.

 


Supportive mattress

To help avoid back pain, sleep on a bed with a mattress that matches and supports your spine's natural curves
Slipped-disc