What actually is a ‘slipped disc’?
Many of us have heard the terms ‘slipped disc’ and ‘sciatica’ but what do they actually mean and how can Osteopathic treatment help?
What is a Lumbar Disc Prolapse?
Spinal discs act as shock absorbers between vertebrae to which they are bonded. A lumbar disc prolapse – also known as a ‘herniated’ or ‘slipped’ disc – is a condition where a fragment of soft central disc material squeezes out under pressure through a tear in the disc capsule (annulus). This can be likened to firm jam squeezing out of a tough donut! The prolapsed fragment may compress a spinal nerve root or multiple roots to cause nerve symptoms down the leg (also known as sciatica). Discs in the neck are also able to herniate and cause nerve pain in the arms, although this is not as common.
What are the symptoms?
Lumbar disc prolapse is most commonly seen between the age of 35 and 55. The episode can be caused by heavy lifting, bending and twisting of the spine, or even mild activity or at rest. Patients usually experience sudden onset low back pain followed by pain radiating into the buttock, thigh, calf, or shin (sciatica).
At first, the pain is very severe but tends to settle after about two weeks with the help of pain medication, reduced activities and osteopathy. The pain is often described as a deep dull ache but can be a sharp stabbing pain. This may be accompanied by numbness, tingling or muscle weakness in hip, knee or ankle movements. The sciatica is typically worsened by coughing, sneezing, bending or prolonged sitting.
What investigations are required?
A spinal disc prolapse disc is best seen on a spinal MRI scan which provides very detailed images of the spinal structures including the nerves and discs. This can be arranged privately by an osteopath in any of our three clinics or through your health care provider. X-Rays are not useful for diagnosing this condition and involve unnecessary radiation.
What are the prognosis and treatment options?
The majority of patients improve over a period of 4 to 8 weeks with conservative osteopathic treatment which includes pain medication and reduced activity. Your osteopath will help reduce the muscle spasm in your back with massage to gently free up the pressure on the nerve. Osteopaths will also look for reasons why the disc herniation occurred. This maybe from a spinal curvature (known as a scoliosis), short leg length or hip problem. Patients may also benefit from acupuncture.
Osteopathy is the number one way to help manage non-surgical slipped discs and is recommended by the NICE guidelines.
Despite these initial conservative treatment measures, about 1 in 4 patients do not improve or continue to worsen. These patients are usually referred to a consultant spinal specialist for further assessment and advice. Depending on the individual case, the specialist may recommend ongoing conservative osteopathic management, a steroid Nerve Root Block or a Lumbar Microdiscectomy operation.
If a patient develops worrying leg or ankle muscle weakness, or problems with bladder or bowel function, then urgent referral to a spinal surgeon is usually advised, as it may be necessary to operate sooner rather than later.
Osteopathy is also highly effective post surgery helping with your Rehabilitation program. Your osteopath can help with getting your mobile again, a stretching routine and a Core muscular abdominal strengthening program.
At all of our three clinics we have close links with many Neurosurgeons , in particular Nitin Patel who works from the Spire and Nuffield Hospitals in Bristol.
If you have any of these symptoms or know friends who do please feel free to ring the clinic for advice and speak to one of our expert osteopaths.