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Slipped Disc?

Back pain is one of the most common injuries in Canada. 4/5 adults will experience an episode of back pain in their lifetime, and it most often occurs between the ages of 30-50 years old. (1) If you have injured your back, you may have been told that the cause of your pain is a slipped disc, or if you have pain radiating down your leg that you have sciatica. You may be thinking, what does this mean, and how can I get rid of this pain? It is important to look at what makes up our lower back, and how all of these components work together to allow us to move.

Spinal discs are located between each of your vertebrae. There are 23 spinal discs in our spine. The disc is made up of two components which we can think of like a jelly-filled doughnut:

1. The outer portion is called the annulus fibrosus. It is composed of strong rings of collagen that help to house the inner core of the disc. This is like the breading of the doughnut.
2. The inner portion is called the nucleus pulposus. It is a gel-like substance that holds the body’s weight through the spine. This is like the jelly in the centre of the doughnut.

At birth, the discs are primarily made up of water, up to 80%! (3) As we age, our discs begin to dehydrate, and they start to loose their ability to adjust to compression. This can be seen on an x-ray, and it is referred to as degenerative disc disease. This is a normal process of aging, however, it can sometimes become painful and stiff.

Myth Buster: The outer portion of the disc has strong attachments to the vertebrae above and below it, so it is not possible for a disc to slip out of place! Ok, so then what is causing my back and leg pain?

One cause could be a disc protrusion or a herniation.

A bugling disc occurs when the jelly-filled center starts to push outward on the bread of the doughnut, but the doughnut stays intact. However, because the disc is starting to protrude, it can still compress the nerve root.

When a disc herniates the jelly spurts through the breading of the doughnut. As there is limited space in the spinal canal, the jelly (nucleus) can compress the nerve root or the spinal cord. This is what is commonly referred to as a “slipped disc.”

When the disc presses on the nerve root, you can experience pain radiating down your leg. Depending on the nerve this pain can be felt in different area of the leg.

I have a herniated disc, what do I do now?

Research has consistently shown that exercise, education, and remaining active are the most recommended treatment options for combating lower back pain. Physiotherapy can help get you started with all of these treatments! The physiotherapist will first learn about your injury, measure your range of motion through your lower back, establish what activities or positions aggravate your pain, and assess your strength through your back and legs.

Your physio will often begin with exercises that involve repeated movements either forwards or backwards. This is what is called establishing a directional preference, which means that when you move that direction it draws the pain out of your leg. This repeated movement helps to draw the jelly back into the centre of the disc and is taking the pressure off of your nerve. As your symptoms improve, core and functional strengthening will become part of your exercise program to help prevent re-injury.

A physiotherapist can help you on your way with reducing low back pain associated with a disc. If you have any further questions, or would like to reach out to book an appointment, we would be happy to schedule you in to one of clinics!

References:

1. https://www150.statcan.gc.ca/n1/pub/82-619-m/2006003/4053542-eng.htm#:~:text=Back%20problems%20are%20among%20the%20most%20common%20chronic%20conditions%20in%20Canada.&text=Four%20out%20of%20five%20adults,ages%20of%2030%20and%2050.
2. https://en.wikipedia.org/wiki/Intervertebral_disc
3. https://www.spine-health.com/conditions/spine-anatomy/spinal-discs
4. https://novachirowellness.com/bulging-disc-vs-herniated-disc-whats-the-difference/
5. https://my.clevelandclinic.org/health/diseases/12792-sciatica