Disc problems are one of the most common issues osteopaths see in practice. In our North Finchley practice disc problems account for around 25% of problems we see.
You will have probably heard the term “slipped disc” and maybe you have even been diagnosed with one, but what does it really mean? Sometimes you will hear people also talking about a “disc bulge”, “disc prolapse” or “herniated disc” and you may have also heard about people who have been to see an osteopath or chiropractor and had the “disc put back in”. Technically this is not very accurate so we will discuss this later.
Symptoms of a disc prolapse
Back or Neck Pain
Pain is the first thing most people notice with a disc prolapse. It is usually severe and has a sudden onset, often immediately after a particular movement. The pain will generally be aggravated by coughing, sneezing or bearing down to go to toilet.
In the back, pain may also spread to the hips or buttocks while walking and may have a sensation of tingling or numbness. In the neck, pain may radiate to the head, shoulders or down the arms and into the hands.
Nerve Root Pain
When a disc is prolapsed, part of that disc may press on a nerve root (a nerve coming from the spine) or the inflammation caused by the prolapse can irritate the nerve roots and thus cause pain down through the distribution of the nerves affected.
If the disc prolapse is in the lower back (the lumbar spine) then there may be pain down through the buttock and down the back of the leg, sometimes into the foot. If this is the case then the Sciatic nerve is the nerve most likely to be affected. There is a sciatic nerve running through the back of both legs. You may have heard the term “Sciatica” which literally refers to the referral of pain along the sciatic nerve.
If there is a disc prolapse in the neck (the cervical spine) then you will have pain in the neck and possibly down one or both arms.
Other Nerve Related Problems
With many disc problems aside from pain you may also experience pins and needles, numbness or weakness in the areas supplied by the nerves affected. In the example of the Sciatic nerve you may get pins and needles along the side of the foot or lower leg.
Cauda Equina Syndrome
This problem is where the nerves in the lower part of the spine are impinged and can cause “Saddle Anaesthesia”; numbness where you would normally sit on a horses saddle (inside of the thighs, around the genitalia and anus). There may also be an inability to pass urine. This is an emergency because there is risk of permanent bladder dysfunction or sexual dysfunction.
The causes of Cauda Equina Syndrome are numerous but include; disc prolapses, vertebral slippage and spinal tumours.
The vast majority of disc problems will not lead to cauda euina syndome.
Many of us will have some degree of a disc prolapse through years of wear and tear but the degree of the bulge or prolapse may not be severe enough to press on a nerve root or cause pain.
Anatomy of the spine and discs
The vertebrae are the 33 bony sections of the spine and are what give us our central structure. They have very specific shapes depending on the location because that shape influences the function and movement. In between each vertebra are the discs.
Discs, or properly known as Intervertebral Discs, can be thought of as cushions or pads that go in between each vertebral segment. Without discs in between each vertebra there would be no possibility of movement throughout the spine. Their primary function are to act as shock absorbers.
Discs are made up of two parts; a central gel like substance called the Nucleus Pulposus, and the outer part which is made up of layers of collagenous fibres called the Annulus Fibrosus. An easy way to think about discs is to liken them like Jam Doughnuts!
Common Disc Problems
Over years of wear and tear the annlus fibrosus becomes weakened and thinned. As continued load on the disc occurs, together with poor posture or bad lifting techniques the nucleus pulposus gradually gets pushed further and further outwards, initially starting as a bulge in the annulus fibrosus but eventually more of the internal rings of the disc tear and the nucleus pulposus is pushed out further becoming a prolapse. At this stage the annulus fibrosus is still intact but can press on one of the nerve roots.
An extruded disc happens when the annulus fibrosus becomes torn exposing the nucleus pulposus. It is this stage that can cause constant pain due to the chemicals of the nucleus pulposus causing inflammation.
As more of the nucleus pulposus is squeezed out further it is classified as a Sequestration. The gel like substance of the nucleus pulposus can compress nerve roots causing pain along their distribution.
Disc Degeneration/ Disc Thinning
As we age we tend to actually get a little shorter. Part of the reason for this is due to the intervertebral discs becoming dehydrated due to a loss of water and protein content over time. Therefore the discs become thinner as we age. The good thing about thinning discs is that if we haven’t already had a disc related problem then one is unlikely to develop. What is likely to happen though is wear and tear of the articular surfaces of the vertebra due to a rubbing together of the vertebra followed by bony growth formation called Osteophytes.
Thinning discs can occur at any spinal level and can result in different symptoms depending on the pathology involved.
There are various treatment options available depending on the extent and severity of the disc problem.
In the initial phases of a disc prolapse you will experience pain. At this stage the best thing you can do is to apply ICE (for up to 15 minutes at a time) to help reduce any inflammation in the area. The muscles around the area affected will most likely spasm so try to keep moving gently.
If you suspect you have disc problems, get yourself booked in to see an Osteopath as soon as you can for an initial diagnosis. While this initial stage may be extremely painful you may receive some benefit from treatment. The osteopath should be able to advise whether you need referral for an MRI scan.
Treatment with an osteopath or chiropractor for disc problems may involve manipulation/adjustments (clicking of the spine). On occasions you may hear people say they had their disc “put back in”. This is actually not true because firstly the discs don’t move out of place (only the central part may bulge or leak out). Secondly adjustments may release some of the restriction at any given spinal segment but it is unlikely that the disc material is pushed back in. Many osteopaths will actually not manipulate a suspected disc problem for fear of making them worse.
It is also worth arranging an appointment with your GP for a second opinion and referral for further investigations.
Sub Acute Phase
As the pain starts to reduce and become more of an ache this is when you’re most likely to receive the most benefit from treatment as inflammation will have reduced slightly allowing the area to be treated and reduce the muscle tightness around the area.
You may benefit from some decompression at this stage. This is something you can do yourself. If it is your lower back that is affected then simply hang by your hands from the top of a door frame and let the weight of your legs stretch out your lower back. If the area affected is coming from the neck then decompression may be more difficult but having your head lifted slightly may help.
In some cases if manual therapy doesn’t work then surgery may be an option. There are many types of procedure available and the procedure performed will depend on the structures affected.
Essentially however the main type of surgery will involve removal of the part of the disc protruding. On occasions surgery may involve removal of part of the vertebra to help decompress the area and in most cases both of these procedures have good success rates.
How can we at Ashley James Health help you?
Our osteopath will thoroughly assess you, taking into consideration your lifestyle, causing factors, predisposing factors and maintaining factors to build up a picture of the exact problem. Our aim will be to help you regain the normal pain free function of your spine using many specific hands on techniques and advise you what to do in between treatments, whether that is in the form of exercises, hot or cold packs or some other advice.
One thing you can be sure of is that we will do everything we can to get you better as soon as we can! So why don’t you give us a call on 0208 445 1020 or
About The Author
Ashley Ridout has treated people of all ages, physical abilities and professions including professional athletes, so he knows the importance of getting you back to normal as quickly as possible.
Ashley has history of being a personal trainer in one of London’s top Mixed Martial Arts gyms so he can not only treat injuries but he can also help you with your rehab or prevention of injuries too.
Having been involved with various competitive sports himself, Ashley has also been on the receiving end of many injuries so knows the importance of good treatments and sound advice.