Slipped disc, prolapse, or herniation?
Most people will have heard of a ‘slipped disc’, but what actually is it?
It all starts off with the disc, or intervertebral disc, which are essentially the cushions between the vertebra of the spine. They act as a shock absorber and prevent the vertebrae from grinding together, allowing the spine to be flexible, without sacrificing a great deal of strength.
So without discs our spines would not be able to move. This means they are susceptible to injury, hence the phrase ‘slipped disc’, ‘disc herniation’, or ‘disc prolapse’. The actual structure of the disc will help explain what we mean by these terms to describe an injury to a disc.
Picture a jam doughnut, that is a good way to visualise a disc.
A disc is made up of a central nucleus pulposus (the jam). This is a gel-like structure, which is primarily made up of water.
A peripheral annulus fibrosus (the dough) makes up the disc wall. This is made up of layers of collagen fibres, similar to those found in the skin, tendons and cartilage.
And two vertebral endplates (hands holding the doughnut). Again, this is made up of cartilage, this binds the disc to the vertebrae and allows for the transfer of nutrients.
Injury to a disc occurs when the nucleus - the jam - pushes out through the annulus - the dough. So a ‘slipped disc’ is actually a very inaccurate description of what happens.
What is a disc herniation / prolapse?
When the nucleus pushes out through the annulus it can result in a bulging of a disc wall, and in more severe cases the disc wall can rupture causing the nucleus to either ‘pop out’ through the disc wall - herniate - or even cause all of the nucleus to come out of the disc - prolapse.
This can result in compression of the nerves or spinal cord, coupled with an increase of inflammatory chemicals which cause pain, inflammation and irritation to the surrounding structures. Pain often results from this combination of the mechanical compression of the nerve by the bulging nucleus pulposus and the local increase in inflammatory chemicals causing irritation to a nerve.
In many instances, the herniation of the disc does not cause that patient any pain. Herniated discs are often seen on MRI of asymptomatic patients, so patients with no symptoms. And it is VERY COMMON (see Brinjikji et al., 2015 and Nakashima, et al., 2015)
Other names used to describe this condition are prolapsed disc, slipped disc, or disc protrusion.
What causes a Disc Herniation?
The most common cause is due to degeneration – a normal ageing process – whereby there is a weakening of the annulus fibrosus which allows for protrusion of the nucleus pulposus.
The second most common cause of disc herniation is trauma, often seen with bending over and rotating.
There are 23 discs in the human spine, but herniation is most common in the lumbar spine- the lower back.
Common symptoms of a lumbar disc herniation:
Lower back pain, can be severe or a dull ache,
The pain can feel like a burning or stinging sensation:
Radiating or shooting leg pain: aka sciatica whereby the sciatic nerve is compressed or chemically irritated.
Nerves can also produce pain down the leg.
More severe cases can result in weakness or sensation changes such as numbness or pins and needles and loss of bowel or bladder control (you should seek urgent medical attention if you have these symptoms).
Prevention and treatment for disc herniation?
Rehab and prevention is unique to an individual and their aggravating and relieving factors, but most cases of herniated disc heal conservatively.
Posture and altered bio-mechanics can make someone more susceptible to injury so these should be looked at with a clinician.
If you are suffering with back or neck pain, and some of these symptoms sound familiar, get in touch to find out what Holland Osteopathy can do you for you today.