If you’ve been diagnosed with a prolapsed disc, or you think you might have one, here are a few pointers that I hope help you to understand.
The Anatomy
Briefly… Your discs sit between the bones of your spine. There’s no disc between the top bone of your neck and your head (cranium), and there’s no disc at the next level, but at every level below that – all the way down to the bottom of your lumbar spine – there is a disc between the bones. They are smaller in the neck and generally get bigger as you go down the spinal column (as the load on them gets bigger). They have a fairly tough outer fibrous structure (annulus fibrosus), connecting the bone above with the bone below. In the centre of the disc is a gelatinous centre (the nucleus pulposus). The structure of the disc allows it to adapt to forces exerted on the spine – a bit like a shock absorber (but better).
Behind the disc, exiting from the spinal canal are the spinal nerves – one on the left, and one on the right. These nerves give off branches – some of which join together to form “peripheral nerves” e.g. the sciatic nerve (see sciatica).
What is a prolapse?
Over time the annulus fibrosus often suffers micro-tears, and then one day (perhaps for no obvious reason at all), the tear gets big enough that some of the nucleus squeezes out through the tear. This is a disc prolapse. And – like trying to get toothpaste back in the tube – it’s impossible to push the nuclear material back to where it came from. “Slipped discs” (prolapses) DO NOT slip back in again!! Disc prolapses are more common aged 35-50, but can occur if you’re younger or older, often depending on how you’ve treated your back.
What is a herniation?
Before the nuclear material squeezes out, the disc often bulges through the tear i.e. the nucleus hasn’t escaped, but it does cause the disc to bulge – think about slashing a tyre; the inner tube bulges through the defect in the outer tyre. That’s what a herniation is like. No escape of nuclear material (air in the tyre), but there is a change in shape of the disc.
Why is it painful?
When the disc has little tears in it, the broken down annular material causes an inflammatory reaction; this inflammation causes pain. If the inflammation irritates the neighbouring spinal nerve, that can cause “nerve pain”. Depending which nerve is affected, different bits of you may hurt i.e. if the “roots” of your sciatic nerve are irritated, you’ll get sciatica.
What can be done to help?
There’s some evidence that manipulation can help; acupuncture can help; surgery can help; cortisone injections can help; anti-inflammatories and painkillers can help; exercises can help. The trouble is, it’s difficult for you to know which approach you might respond best to. There are greater risks attached to some approaches than others. I prefer to try a number of these techniques at the same time (there’s also more evidence that a combination approach works best).
How long does a prolapse take to heal?
The million dollar question… I’m afraid the answer has to be “how long is a piece of string?”. It varies from person to person and often people have more than one prolapse episode in a lifetime, but take different lengths of time to heal on each occasion. I’ve known people to be in raging pain one week with a disc prolapse, and fine a week later. Equally, I’ve known people take years to recover – and gone through every kind of treatment.
What’s the worst-case scenario?
The development of a chronic pain syndrome; if you’re in pain for long enough, sometimes your nervous system becomes sensitized, and then it’s a lot harder to get rid of your pain. One of the most important roles a clinician plays is in helping you to avoid chronic pain.
If you’d like to know anything else about discs, lower back pain, or sciatica then post a question in the comments, or email me directly, and if you know anyone that might find this information useful, please use one of the share options below! Thanks.
