Bouts of back pain are common with up to 80% of people worldwide experiencing back pain at some point in their life. Most episodes are a result of minor problems such as a strained muscle, ligament and usually resolve soon. Less than 1 in 20 cases of sudden onset back pain are due to a slip disc and are often inappropriately managed. Here are some myths about slipped disc.
Myth #1: Discs slip out of place
The name slipped disc is a misnomer as the disc does not slip out of place. It is firmly supported in its place surrounded by strong ligaments on both sides. The discs have a tough outer layer that surrounds a jelly-like material in the centre. Slipped disc is used to refer to a condition where the disc looses its shape and/or consistency and either the central jelly-like material of the disc leaks or bulges out. In medical terminology other terms such as degeneration, bulging, protrusion, extrusion and sequestration are used to refer to varying magnitudes of the problem.
Myth #2: Slipped discs are always caused by injury
Slipped disc results from a magnitude of factors causing weakening of the disc such as genetic factors, age related wear and tear, lifestyle including physical activity, body weight, smoking etc. They may however come to light after a sudden movement/ injury but the predisposition is already present and sometimes even trivial activities can trigger the symptoms.
Myth #3: Slipped discs always cause excruciating pain
Whilst slipped discs can be quite painful, this is not the case always as the severity of pain can vary. It is possible for a person to have a slipped disc and feel no pain or show no symptoms. For most people, a slipped disc will cause some pain and discomfort, and this generally reduces with time.
The pain from a slipped disc may be felt in the back and/ or the arms/legs. This may be accompanied by other symptoms such as numbness, tingling and muscle weakness.
Myth #4: My x-ray is fine so I cannot have a slipped disc
X-rays of the spine are not good at looking at discs. Although they may show problems such as reduced disc height, they are not good for evaluating slipped discs. MRI scans are better at looking at the spine anatomy in detail. X-rays are used more for evaluation of bones.
Myth #5 : MRI imaging will show the cause of my back pain
Technological advancements have enabled us to identify minute changes in disc structure using investigations such as the MRI. A significant number of normal individuals with no symptoms, when scanned will show disc abnormalities on the MRI. This emphasises the point that not every slipped disc causes pain and the findings need to be interpreted in relation to your history and examination findings. Discs normally wear down as we age, so just because the MRI showed a disc problem doesn’t mean that it is the cause of your pain.
Myth #6: Slipped discs require Surgery Sooner Or Later
In an overwhelming majority of cases the problem will NOT require surgery and can be managed conservatively. Disc bulges are NOT forever. A recent study revealed that spontaneous regression of disc injury can occur with conservative care.
Understandably the idea of being under the knife can be terrifying for most people and this option is required only for severe/ non resolving cases. Experienced, knowledgeable medical professionals always try less invasive treatments first. Non surgical interventions, such as medications, physical therapy and injections, can help in reducing the symptoms. Spinal injections such as nerve root block can sometimes play a key role in controlling symptoms and speeding up recovery. Such injections are administered under x -ray guidance to ensure accuracy.
Myth #7: Movement will make my disc problem worse
Whilst extreme pain episodes may require rest, continued activity is generally advised. Simple activities (such as walking, mild stretches) as recommended by your specialist, can reduce the loss of muscle strength and endurance. It can reduce deconditioning of muscles which in itself can be a source of pain. It may be sensible to avoid certain types of activities such as heavy lifting, impact sports etc whilst the body attempts to repair itself. Movement can plan an essential role in the healing process.
Myth #8: Slipped disc is a permanently disabling condition
Many believe that once they get a slipped disc it’s a lifetime problem and they will never be able to return to normal activity. I have seen patients with normal spine who have not bent forwards for years as they were advised not to do that during a back pain episode. Such strongly embedded negative beliefs are disabling and dealing with them can be challenging. With patience, correct knowledge and timely treatment most individuals can return to 100% prior level of function without pain.