Help! I've got a slipped disc!
We often hear the phrase in clinic "I've got a slipped disc!" often coupled with "X practitioner clicked my disc back in" but did you know that these 2 statements are very misleading and that they are not exactly true? Let's have a look why…
A little anatomy lesson.
The discs themselves are really known as Intervertebral Discs, which are located between 2 bones in your spine, the vertebrae. The discs are comprised of several incomplete rings of ligaments, known as the anulus, with a jelly like substance in the middle, the Nucleus Pulposus and have tougher fibres above and below them, the End Plates, that connect into the bones above and below. Discs allow a wide range of movements to happen in the spine whilst also acting as shock absorbers.
As you can see from the disc's construction, they are tough, and will oppose almost any type of force placed on them. Thanks to the surrounding ligaments of the spine, and the disc's thick end plates which attach directly into the vertebrae, the disc itself cannot physically "slip" anywhere. Studies have investigated how tough discs are, and suggested that to squash a disc 1mm, it takes around 760lbs of force! There is no way a human can apply that amount of force during treatment to "put a disc back into place"! It's worth noting thatwhen a therapist 'manipulates', or clicks your back, the noise is due to an air bubble popping within the joint fluid, and nothing to do with the disc.
So, why does my back hurt?
The phrase "slipped disc" is a bit of a misnomer, as we've already shown, and should really be replaced with other descriptions of disc pathology such as a disc bulge or a herniated disc. These generally describe what happens when the disc structure is altered, commonly from a bugle which is created when the nucleus of the disc squeezes through the side of the disc. This can then contribute to pain felt.
Any disruption of the disc's anatomy can lead to the disc losing height, failing to absorb shock properly and becoming problematic. The disc only has nerves on the outer fibres of its ligaments that create the annulus, therefore some disc injuries can happen yet are painless, and some produce a strong, chronic ache that is occasionally linked to some movements.
However, more sudden, acute pain that can be accompanied with symptoms of a pinched nerve, such as sciatica, is more likely to be due to disruption to the outer layers of the disc. When a bulge or hernia to the disc occurs like this, it can pinch one of the nerves leaving the spine and cause symptoms of sciatica to your leg or nerve pain in your arm. This will depend upon where around the disc the bulge occurs. Severe cases where the bugle heads backwards can cause spinal cord compression and is a medical emergency that requires urgent attention.
When the structure of the disc changes, the disc becomes less able to resist compression and movement from the spine. This increases the workload on the surrounding ligaments, muscles and joints of the spine making them work harder and often contributes to pain in your back.
How can Osteopathy help me?
When we consider the more acute, sudden onset of back pain, whether it relates to a disc or not, there are many other structures involved in the bigger picture which is often mistakenly described as a "slipped disc". Osteopathy can help to relieve the symptoms in the surrounding structures, such as muscles, ligaments, and spinal joints, helping you to feel better and move more easily, rather than misleadingly "put the disc back in"!
References
Bogduk, N., (2005). Clinical anatomy of the lumbar spine and sacrum. 4th ed. New York: Churchill Livingstone.
Urban, J., Roberts, S., (2003).Degeneration of the intervertebral disc.Arthritis Research and Therapy, 5(3), pp120-130.
