I am using the term "slipped disc" as it is the most common descriptive diagnosis that I hear from patients. In actual fact its not a very helpful term as discs are very solidly attached to their vertebral bodies above and below and they don't slip anywhere, ever. They do bulge and occasionally herniate but bare with me.
“Slipped” or herniated disc is one of those diagnosis that no one wants to hear, it sounds scary and permanent. Dr Google can be blamed for most of the catastrophizing about slipped discs (please don’t tell google your symptoms because I’m fairly sure he will confirm your darkest fears!). I have heard slipped discs described as “crumbling” discs, "lacerated" or degenerative disc disease - terms that are likely to inspire dread in the heart of those who hear them in relation to their own backs and terms that Dr Google will cheerfully chew up and spit out a horror story or two.
The purpose of this blog is not to explain exactly what a slipped disc is, I have done the googling for you and here is that information ( What is a slipped disc? ). What I want to do is try to explain what happens to a disc once it has undergone this injury.
Firstly, let me explain that not everyone with a slipped disc has any symptoms. In actual fact slipped discs are a very frequent incidental finding on MRIs (in other words it is a finding that is there when the patient who had the MRI had no lower back pain or symptoms), there was a 2014 study ( Link ) that showed just how commonly disc degeneration is found on MRI of healthy patients – this image helps to illustrate it perfectly.
A recent met-analysis (conducted by Zhong et al Pain Physical Journal ), of 11 studies where patients with slipped discs were followed up and rechecked up to 8 years after the initial diagnosis, found that a surprising 66% of patients who received conservative treatment like chiropractic or physiotherapy (not surgery), had discs that resorbed/un-bulged/de-herniated/ popped back into place/were no linger slipped! As if this isn’t counter intuitive enough it turns out that the more severe the herniation the more likely it is to disappear.
Of course, that does also mean that about 34% of bulged discs remain bulged, is this a problem? The answer is not really. Because in the vast majority of cases it’s not the physical bulging of the disc that causes the pain often associated with it – see above for how common bulging discs actually are – the symptoms associated with disc bulges are normally caused by chemical irritation from inflammation. Inflammation is the bodies normal response to physical insult – just think of it like sprained ankle; When you sprain your ankle, there is a proportion of the pain that is a result of the mechanical injury to the tendons, but all of the heat, swelling, redness and most of the pain is a result of the inflammation that the body sets in action in order to heal the injury. Inflammation is self-limiting, it can last up to 6 weeks but it normally fades as the injury heals. Eventually there is no inflammation which means that there is no chemical irritation to the nerves = no lower back pain or sciatica!
This is all very good news for you, the patient. More than 80% of people who suffer from acute lower back pain will get better with time, simply because your body does an amazing job of looking after itself.
This begs the question – why see a chiropractor? Well, it’s my job to find out why you have your pain, what damage Dr Google has done and what can be done to get you back to moving well and living well quicker rather than slower (because when you’re in pain 6 weeks is a very long time!).
