Truth vs. Fiction on “Slipped Disc”
“Slipped disc” is a term commonly associated to low back pain, especially the kind involving a diffused pain down the leg or around the buttock area. Despite the misleading wordings used in this term, our spinal discs, also known as intervertebral discs do not slip out between our spinal bones (vertebrae) so easily. Rather, In the clinical setting, this condition is referred to as an Intervertebral Disc Prolapse (IVDP) or a herniated disc.
However, common as it is, there are still misconceptions on low back pain due to IVDP. Before delving deeper, let us understand a little more on the nature of this condition.
What is Intervertebral Disc Prolapse (IVDP)?
A prolapsed (herniated) disc occurs when the outer fibres of the intervertebral disc are injured, and the soft material known as the nucleus pulposus, ruptures out of its enclosed space.
(Kerr et.al, 2015)
In some instances, a herniated disc can compress the nerve or the spinal cord that causes pain consistent with nerve compression or spinal cord dysfunction also known as myelopathy.
The incidence of herniated disc is about 5 to 20 cases per 1000 adults annually and is most common in people in their third to the fifth decade of life, with a male to female ratio of 2:1.
(Fjeld OR et.al,2019)
A herniated or rupture disc may be caused by mechanical or degenerative factors which includes:
i. Inheritance
ii. Sudden bending and straightening of the spine.
iii. Obesity
iv. Old age
v. Work that requires physical labour such as lifting heavy objects
vi. Sports activities
As mentioned earlier in this article that intervertebral discs do not just “slip out”, here are four stages of how discs herniate:
i. Bulging: Extension of the disc margin beyond the margins of the adjacent vertebral endplates.
ii. Protrusion: The posterior longitudinal ligament remains intact but the nucleus pulposus impinges on the annulus fibrosus.
iii. Extrusion: The nuclear material emerges through the annular fibers but the posterior longitudinal ligament remains intact
iv. Sequestration: The nuclear material emerges through the annular fibers and the posterior longitudinal ligament is disrupted. A portion of the nucleus pulposus has protruded into the epidural space
(L. G. F. Giles, et.al, 2006)
Truth or Fiction?
Myth #1: Pain equals damage Fact #1 : Though this is an easily acceptable fact, low back pain does not always necessarily mean that you’ve torn a muscle/ligament or worse, herniated a disc. Pain is usually a warning sign for something amiss in our body that requires our attention but the feeling of pain is often amplified as compared to the actual problem. Hence, the next time you feel a pull or jerk in the back, consult a professional before panicking.
Myth #2 : A scan can definitely confirm the cause of my pain Fact #2 : Not definite. Yes, X-rays & MRI scans are useful and mostly accurate in scanning our bodies internally but whether they correlate with the source of pain can be a different story. Recent studies have shown that in about 30% of the asymptomatic and otherwise normal persons, some abnormalities may be detected by MRI. So even a completely painless person may have a herniated disc.
Myth #3 : I should avoid moving too much when I feel pain Fact #3 : Rest is important for recovery but when pain has reduced, gentle exercises are recommended to help with full recovery as compared to prolong immobility or inactivity.
Myth #4 : Only surgery can resolve a herniated disc Fact #4 : Studies related to the treatment of low back pain have recommended conservative treatment in the beginning stages and this includes physiotherapy. Despite leaving the disc space, the nucleus pulposes can still return to the core after a period of time.
Myth #5 : A slipped disc will cause permanent pain/disability for life Fact #5 : As mentioned in myth #4, lumbar disc herniation is capable of regression after a period of time. Hence, full recovery is possible along with a good rehabilitation program to strengthen the core to prevent future reoccurrences.