Positive Health Online

A herniated or ‘slipped’ disc is amongst the most debilitating of back pain problems - sometimes with added symptoms such as the grinding leg pain of sciatica. There are many levels of back and neck pain but a herniated or ‘slipped’ disc is one of the most painful and it can cause long-term immobility if it’s not treated correctly.

Image: Wikipedia Blausen 0484 HerniatedLumbarDisc

A slipped or herniated disc refers to a condition where the centre of a spinal disc bulges outwards and presses onto a nerve.  The spinal discs act as shock absorbers and through a variety of causes, including injury, poor posture and general “wear and tear” (meaning gradual deterioration), the walls of the disc can become weaker.

If the centre of the disc pushes out, this can cause the disc wall to bulge and that can be when pain strikes.

There are six steps of management to consider in this situation:

1. Pain Killers;
2. Manual therapy;
3. IDD Therapy;
4. Injections;
5. Surgery;
6. Others options including exercise and acupuncture.

Pain Killers

When you have a disc problem or simple back pain, the first thing the NHS recommends is to take some anti-inflammatories such as ibuprofen.  Relieving pain is the first step to being able to move, because if you can move, the mechanisms which keep our backs healthy can operate. 

This will be what your GP will recommend because in approximately 90% of cases, back pain resolves within six weeks.  But if the pain isn’t going away or it is so severe that you can’t carry out your normal functions, then some form of manual therapy is advisable.

Manual Therapy

There are a variety of types of therapy and we typically think of physiotherapy, osteopathy and chiropractic.  Where there is pain, the body usually limits how we move – it hurts! 

Some conditions have built up over time leaving the spine stiff and unable to move properly.  This can put tremendous pressure on the discs.  So, generally speaking, manual therapists will seek to ease muscle spasm and then, through either some manual mobilization or manipulation, free the joints which may be stuck.  They will also look at how our bodies are moving.

This is where we consider the ‘cause’; what led the disc wall to get weak?  Often some gentle stretches and exercises can help to get movement back, all with the goal to help the body heal itself. Typically, four to six sessions are enough, although you may need to additional exercise sessions.

IDD Therapy

IDD Therapy is the next step when manual therapy and exercise alone aren’t enough.  IDD Therapy is a computer-controlled treatment which helps physiotherapists to decompress the specific spinal segment where the disc is ‘slipped’ or herniated.  Patients lie on a treatment couch where they are connected to a machine with a pelvic harness and a chest harness. 

IDD Therapy is delivered using the Accu SPINA machine which applies a gentle pulling force at a precise angle to take pressure off the targeted disc and to gently mobilize the joint and surrounding muscles.  The treatment is controlled by computer and offers a very precise treatment option, without resorting to invasive options.

The goal with IDD Therapy is to relieve muscle spasm, reduce or reverse disc bulging and gently stretch the tissues to free the movement in the spine.  As pain subsides therapists use gentle exercise and possibly some manual therapy to strengthen the back or neck to help avoid a recurrence. 

Patients typically have a programme of IDD Therapy; long-term problems can need 20 sessions over a six-to-eight week period.  IDD Therapy is still relatively new to the UK but there is a network of providers around the country.  It is used by physiotherapists, osteopaths and chiropractors alike as part of a programme of care.

Injections

Injections are quite controversial because until recently they have been given widely to people with long term disc problems.  When a patient has a slipped disc and pain, there can be inflammation in the area.  This inflammation can cause pain on its own. 

There are different injections, but a steroid injection with or without some local anaesthetic may be given to reduce the inflammation.  Injections can provide temporary relief with the goal to create a window of pain relief where the body can move or where therapists can work with a patient to address the causes of the problem. 

The controversy about the effectiveness of injections is because injections do not address the causes of the problem. They can address inflammation but a slipped or bulging disc will still be bulging after the injection.  Hence the question of whether injections really help or not, and why many NHS trusts are scaling back the availability of injections as the cost/benefit is not clear. 

Surgery

Spinal surgery can be a very important step for patients with a slipped disc which has not responded to any of the treatments described.  This is particularly the case if the disc is putting pressure on nerves to such an extent that it causes weakness in the legs or arms, or in very severe cases, if a slipped disc puts pressure on the spinal cord and affects our bowel or bladder control; then emergency surgery can be essential.

The most common surgery for a slipped disc is a “microdiscectomy”.  If the disc material is stubbornly pressing on a nerve, the offending disc material may be cut out surgically and removed.  Such surgery is commonly given for leg pain (sciatica) where the disc is pressing on the sciatic nerve and the pain is intolerable.

Surgery can remove the pain immediately.  However, it is not without risks and surgery does not address the causes which led to the weakness in the first place.  Thus, some patients can get complete relief whilst for others the pain may remain or even get worse. 

Generally, surgeons will operate as a last resort and it can be advisable to get a second opinion before embarking on surgery.  When surgery is the preferred route for treatment, it is essential that patients embark on and stick to a rehabilitation programme and to follow the lifestyle recommendations given by the surgeon or rehab team. 

Six months after surgery when the tissues are healed, coupled with exercise, some patients will embark on a programme of IDD Therapy to take pressure off the disc and improve that all-important spinal mobility. 

Other Treatments

Yoga and Pilates can be helpful in maintaining your body once you resolve the pain. It is important to find a teacher who suits you and understands your condition. 

We hear a lot about ‘core muscles’ and whilst there is some debate about how important our core is, generally the more our muscles can support our spines and move freely, the better our discs are protected. 

Acupuncture can relieve muscle spasm and back pain, though for a slipped disc it would work best in conjunction with manual therapy and IDD Therapy, rather than as a stand-alone treatment.

A word about self-discipline and exercise ….  For many of us, the way we sit and live can mean that we don’t look after our backs as well as we should.  Most people know that they should move more and be more active.  It can be difficult to self-motivate or have the self-discipline to do the exercises or stretches which our body needs, especially if we are in pain.  If we try to do things on our own, there is sometimes a danger that exercises we think are good, are in fact detrimental for our discs. 

Specific classes which are aware of looking after our backs help to ensure that we do the right exercises.  At the same time fixed class times give us structure in the week to actually do the exercises.  As an added bonus, doing exercise with other people in the same situation can be very empowering and even … fun! 

When something is fun or leaves us feeling good, it makes it a lot easier to be self-disciplined.

What Next for Slipped Discs?

We are potentially going to see more slipped discs because generally people are a lot less active than they used to be and spend a lot more time sitting.  Discs hate to be squashed! 

There is a general move in healthcare away frbackom invasive treatments such as injections and surgery.  This is because of concerns about the effectiveness of some procedures and the high costs of invasive care. 

The emergence of treatments like IDD Therapy, which has replaced traction, means that, combined with increased knowledge about the spine and better exercise, it is increasingly possible to keep more people with slipped disc problems on the non-invasive side of spine care. 

If pain is persisting longer than six weeks, I would advise seeing a professional who works with spines.  If some intervention is desirable, this makes it far more likely that something short term doesn’t progress into something more debilitating and long term.  It is much easier and usually quicker to address problems early in the pain cycle.