You may have heard, or been told, that a disc in your back has "slipped" or is "out". When someone mentions this, I ask a couple of important questions:
What did your disc slip on? An oil slick? A skateboard? A banana peel?
If your back is out, where did it go? To the beach? To the supermarket? When are you expecting it to come back in?
What people often refer to as a “slipped disc” is known in the biz as a disc herniation; Which, in short, involves a portion of the interior part of your lumbar disc moving toward, or into, the spinal canal, potentially causing irritation, inflammation and impingement of surrounding structures.
It's important to know that discs cannot "slip" – the spine, especially the lumbar spine (or lower back), is inherently a very stable structure, with thick bones, strong ligaments and an armoury of muscles, which give it all the wonderful moving, bracing and bending capabilities that we need to get around.
If we dig into what exactly a herniation is, it involves the following stages (best shown by the picture below):
Disc degeneration
Prolapse/Protrusion
Extrusion
Sequestration
Overall, for the majority of disc injuries, the prognosis is good, and with appropriate management, usually resolve within 3-4 months. It is important to note that you can experience episodes of pain during your recovery and that this is normal – rehabilitation is (unfortunately) not linear!
But wait, there’s more!
Research has recently discovered that the worse your disc herniation is, the more likely it is to regress (ie. improve). “The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs.” (Chun-Chieh Chiu et al, 2015).
And yet, there is more still; Researchers have investigated disc injuries in asymptomatic people (ie. people that have no back pain), finding that up to 37% of people in their 20’s have signs of disc degeneration and 96% of people in their 80’s have signs of disc degeneration (Brinjikli et al, 2015).
A similar study by Nakashima, found that 73-78% of asymptomatic individuals in their 20’s had bulging discs on imaging (Nakashima et al, 2015). The same study found that by the age of 60, 90% of us will show signs of disc degeneration.
Confused yet?
So, what does all this mean? It most likely means that degeneration in our discs is part of the normal aging process – if you were 60 and showed no signs of degeneration, you would be the unicorn we’re all looking for!
In saying all of this, I am not trying to diminish your pain experience. Pain is always real, and it is multifactorial and that’s what we're here to help you with - understanding what you’re going through and how we get you back doing the things you want to do!
Treatment for lower backs is different for everyone – but overall, it may involve:
A thorough assessment to ensure it's nothing serious!
Hands on treatment to help calm things down and relieve some tense structures
Gentle movement homework to help you maintain movement in the short term
Structured rehabilitation to build you back to performing your valued activity
I'll leave you with a few thoughts about disc injuries that I’ve picked up along the way:
Disc don’t "slip". Never have, never will.
Don’t fear disc injuries – they’re just one factor involved in a complex pain process.
Backs like to bend and move!
Backs are inherently stable, with thick bones, ligaments, and pliable muscles!
Motion is lotion!
Retrain Health is based in the Northern Rivers, NSW. From our Byron Bay and Ballina clinics, our team provides a range of quality healthcare services and products.
Retrain Health offers osteopathy, remedial massage and strength and conditioning sessions with qualified practitioners.
If you are interested in finding out more information or would like to book an appointment, please contact the clinic by phone (02) 6680 7447, send us an email or click here to book an appointment online.