When you slip a disc
People often describe a range of complaints, including low back pain, neck pain and sciatica as being due to a slipped disc. This is often not the case.
A true slip (or prolapse) of the intervertebral disc is not as common as muscle and joint problems of the spine. Disc injuries are also more serious and recovery takes longer.
When a prolapse of the disc does occur, it usually happens at the lower end of the spine and less often in the neck. It affects men more than women.
The discs join the spinal bones (vertebrae) together and provide a degree of shock absorption. They consist on an inner jelly-like substance called the nucleus pulposus and a tough outer fibrous ring called the annulus fibrosis.
Injuries occur when the annulus tears. This allows the nucleus to prolapse (bulge out) and either directly, or though inflammation, compress the spinal nerves as they branch off the spinal cord and exit the spine.
Because the inner part of the annulus has no pain innervation, injuries of this nature may develop over time and occur without obvious pain in the early stages. One study showed that up to 20% of adults with no back or leg pain show evidence of disc prolapse on a CT scan.
Prolapsed discs can be caused by uncorrected spinal imbalance, poor lifting techniques (especially when combined with twisting), prolonged sitting, poor fitness and lack of core stability, improper work ergonomics, jarring forces, or injury. Smoking and poor diet can affect disc nutrition, increasing the risk of disc prolapse.
Although the problem may develop over a period of time, the symptoms of a disc prolapse often appear suddenly. They may be associated with a seemingly trivial incident such as coughing, bending to pick something off the ground or turning to get something out of the back of a car.
In the case of a low back disc prolapse, pain may be felt in the low back, buttocks or it may radiate into the leg and foot (sciatica). Leg pain may be worse than the low back pain, or may exist without any back pain at all.
In severe cases, loss of bowel and bladder function or progressively worsening muscle weakness may occur. This is called cauda equine syndrome and requires urgent surgery. Fortunately most cases of disc prolapse do not require surgery and will respond well to conservative chiropractic care.
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