Discs Don’t Slip!
We often have people who come in and say they have “slipped a disc”. This is a commonly used phrase and means absolutely nothing, it is frustrating it has become so widely used because it does give the impression that not only is your spine vulnerable and discs could “slip” out at any time – but also suggests we can just pop it back in and everything will be fine.
I hope with this article I will be able explain what a disc is, how amazing and strong the spine is and how, even if you have a disc problem there is a lot that can be done.
First the anatomy, the disc is actually called an intervertebral disc. These are structures found between the vertebrae (the building blocks of your spine). They are like a tyre with the tyre part being a tough fibrous outer ring and the centre being gel-like.
There are usually 23 discs in the spine. The disc acts as like a shock absorber, they contribute to the spines curves and connect the spine together. The areas in the spine where we are most mobile have the biggest disks, so the neck and low back which is where most movement comes from has nice big spongy disks which allow us to have more flexibility and absorb forces.
When we are upright through the day, we squeeze the disc and fluid leaves the disc – so we are losing height as the day goes on. Then overnight we rehydrate the disc when we sleep and get taller – so we are taller in the morning than we are at night!
Unfortunately we generally lose more fluid than we gain in the disc, so through our lifetime the shock absorbing capability reduces as the disc wears (one of the reasons we lose height as we get older). Therefore, as we age, we can lose flexibility and stiffen a bit as the disc narrows but also can find we are more vulnerable to getting pain when we put our backs under pressure. This process is extremely slow and with healthy lifestyle and exercise it really can be slowed even further – the fitter healthier you are the chances are the fitter healthier your discs will be as you age.
When it comes to disc damage I like the analogy of a balloon – if you imagine a small balloon you can hold in your palm, if you squeeze it gently it will change shape and possibly bulge, release the pressure and it returns to normal – this is called a disc bulge. If, however you squeeze hard the balloon can burst which obviously is more significant to the balloon and your disk – we call this a disc prolapse. But, just like the balloon cannot slip in and out of your hand, the disk cannot slip in and out of your spine.
More technically speaking sometimes small cracks can appear in the outer walls of the disc and, if put under undue strain, the disc can start to be pushed out of shape and bulge. If the strain on the disc continues, the inside gel-like nucleus pushes through the outer walls (anulus) causing what is called a disc prolapse.
Disc bulge or prolapse can press on the nerves of the spine and can cause a variety of symptoms including tingling, numbness, pain or power loss in the arms or legs depending on whether the problem is in the neck or low back. In some cases, severe prolapses can press on the spinal cord causing compression which requires urgent medical attention.
Brinjikji et al. (2015) American Journal of Neuroradiology. 36(4)
So this all sounds potentially bad but how common are disc problems? This table shows the results of a study on over 3000 people who had no symptoms and as you can see 37% had disc degeneration at 20, and 96% at 80 so problems are common, but just because you have a disc problem does not mean it will cause you any symptoms.
We have many patients who have scans for other reasons, and it shows up a disc injury – just because you have damage does not mean it will cause a problem. However, this works both ways as just because you have pain does not mean you have damage. This is one reason we will only scan if we feel it will be productive, many scans on people with significant pain show nothing as pain can be caused with no visible damage.
Hopefully it now makes sense that we can’t just pop the disc back in as it hasn’t slipped out, but what can we do?
Firstly we need to diagnose what the problem is, if you have a disc bulge which is causing symptoms the vast majority will improve without surgery. There is an awful lot that we can do to help with treatment to mobilise the area, encourage circulation and advise you on exercises and lifestyle which will encourage less pressure on the disc so can allow the bulge to reduce or to disappear altogether.
If however your disc has prolapsed this more likely to lead to some form of medical intervention, we can help with symptom relief and the lifestyle changes you can put in place and most importantly where you need to go next to get better.
So, if you are having problems give us a call and we can hopefully help