What is a slipped disc?

What is a slipped disc and how does it occur?

Our spine is made up of a series of bones known as vertebrae. In between each vertebrae bone is a jelly-like cushion known as a disc. The disc is composed of a gel-like interior in the centre and a fibrous tissue exterior. A normal healthy disc functions as a shock-absorber; the gel-like interior helping to evenly redistribute forces as we go about our daily activities and the fibrous tissue exterior helping to keep the disc firmly in place between each vertebrae bone. As we move our body around, the gel-like material deforms and moves within the disc to help distribute the load and additional pressures from movements such as bending forwards or backwards.⁽¹⁾ An unhealthy, degenerative disc however, would not be able to effectively redistribute the load and may lead to a slipped disc.

A slipped disc can be broadly categorised into – a) Bulging disc, b) Herniated disc or c) Sequestered disc. A bulging disc occurs when the fibrous tissue exterior is unable to hold the disc in place, causing the disc to bulge outwards beyond the margins of the vertebrae bone. A bulging disc may over time develop into a herniated disc when cracks appear in the fibrous tissue exterior which renders it unable to contain the gel-like interior and, allowing it to protrude out of the disc completely. Lastly, a sequestered disc occurs when the parts of the protruding gel-like substance detaches completely from the disc and exists as a free fragment that can move freely along the spinal canal. In each case, the spinal cord or spinal nerves is likely to be pinched or compressed, which prevents signals from the brain from reaching our skin, muscles and organs.

Slipped discs can occur anywhere along the spine, but most commonly occurs at the lumbar spine (lower back area) as the lumbar region experiences the highest amount of load compressive forces.⁽¹⁾ The cervical spine (neck) is the next most common area where slipped discs may occur. Slipped discs happen when the fibrous tissue exterior is stretched to its limit, followed by high compressive loads applied onto the disc.⁽²⁾ A classic example is when a person bends forward, rounding the lower back while picking up a heavy object from the floor. Alternatively, a slipped disc may also occur with long-term loading of the disc and vertebrae that cause the fibrous tissue exterior to become weak and lose the ability to function properly.⁽²⁾ This could occur with consistent long hours of sitting slouched in a chair with a forward head posture. The natural aging process may also cause a slipped disc. As we get older, our bones get weaker and the fluid content within the disc decreases, limiting its ability to distribute weight evenly. Over time, the excessive forces on the disc would lead to a degenerative disc and contribute to the occurrence of a slipped disc.⁽³⁾

What are sign and symptoms of slipped disc?

Because a slipped disc may compress a nerve or the spinal cord, common symptoms include pain that may or may not radiate, muscle weakness, numbness and tingling, especially along the arms and legs. Sudden movements would produce pain and oftentimes, leaning your body away from the pain may produce some relief. A sharp pain may be felt when coughing or sneezing. Bending the neck or body forwards may also recreate the pain and lying down would tend to be uncomfortable. However, do not be alarmed if you find that you have some of these symptoms. What we have mentioned here are just some symptoms that may suggest that you have a slipped disc. The only way to know for sure is through a Magnetic Resonance Imaging (MRI) scan. Furthermore, not all slipped disc will reproduce symptoms and in fact many individuals lead normal, pain-free lives despite having a slipped disc.⁽⁴⁾

Can a slipped disc be treated?

Yes, don’t worry! There are both surgical and non-surgical methods that can help with slipped disc. Common surgical methods include laminectomy and discectomy. However, people who undergo spinal surgeries often report poor long-term outcomes and could be subjected to long-term usage of corticosteroids, an anti-inflammatory drug and pain killers.⁽⁵⁾ Not to mention the additional risk that come along with surgery such as infections and disability post-surgery.

Non-surgical methods like rest, exercise, stretching, adequate hydration and chiropractic can also provide relief.⁽⁵⁾ Slipped discs, especially those occurring in the lumbar spine, may spontaneously regress over time with adequate rest.⁽⁶⁾Exercise and stretching helps to ensure the body is mobile, strengthening the muscles and ligament to ensure they can firmly hold the spine in place. Lastly, a major component of the disc is water, and by ensuring adequate water consumption, we can ensure that the disc stays healthy to perform its function as a shock-absorber^.(1) While these methods can provide pain relief, they do not address the root cause of the problem which is the slipped disc. This is where chiropractic treatments come into the picture. Chiropractic treatments are non-invasive and besides addressing the muscles through exercise and stretching, we also address the motion of the joints through adjustments. Chiropractic spinal alignment ensuring the spinal joints are able to move freely without restrictions, we ensure it can perform its function along with the disc to evenly redistribute forces. In addition, chiropractic treatment also involves other tools like the use of flexion-distraction table or spinal decompression therapy. Research has shown that patients who underwent a combination of exercise, chiropractic adjustments and flexion-distraction or spinal decompression experienced pain relief and restoration of their disc height and function.^(7,8) Therefore, chiropractic treatments, despite requiring a period of time for treatments, represents a safer, non-invasive and non-surgical alternative option to treat a slipped disc. Chiropractic treatment at All Well Scoliosis Centre purpose is for rehabilitation of spine, musculature, soft tissue, correction and improvement of posture during activity of daily living, and building a muscles memory to support affected area.

References:

1. Izzo R, Guarnieri G, Guglielmi G, Muto M. Biomechanics of the spine. Part I: Spinal stability. European Journal of Radiology. 2013.

2. Oxland TR. Fundamental biomechanics of the spine-What we have learned in the past 25 years and future directions. Journal of Biomechanics. 2016.

3. Izzo R, Guarnieri G, Guglielmi G, Muto M. Biomechanics of the spine. Part II: Spinal instability. European Journal of Radiology. 2013.

4. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015.

5. https://www.doctorschierling.com/blog/asymptomatic-disc-herniations-the-implications-of-disc-herniations-in-the-absence-of-pain

6. Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: A systematic review. Clinical Rehabilitation. 2015.

7. Choi J, Hwangbo G, Park J, Lee S. The effects of manual therapy using joint mobilization and flexion-distraction techniques on chronic low back pain and disc heights. J Phys Ther Sci. 2014; 8. Gudavalli MR, Cambron JA, McGregor M, Jedlicka J, Keenum M, Ghanayem AJ, et al. A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain. Eur Spine J. 2006;