Here, Dr Gary Bartlett a fully qualified GP and member of team GBR Snowboarding, discusses the causes, treatments and prevention of herniated discs and back pain
Back pain! Troublesome, painful, debilitating and a very common disorder which involves the intricate muscles, nerves and bones of the back.
The spinal column is made up of bones called vertebrae. The human spine is made up of 33 vertebrae and subdivided into the cervical, thoracic, lumbar, sacrum and coccyx. Vertebrae are roughly circular in shape and between each vertebrae are discs. Intervertebral discs are strong rubbery like cushions which help to hold the spine together allowing for slight movement and to act as shock absorbers for the spinal column.
Discs are made up of a soft jelly-like central portion called the nucleus pulposus which is surrounded by a much stronger tough fibrous outer part. There are strong ligaments which attach to vertebrae providing extra support and strength to the spine. Muscles surround and attach to various parts of the spine. The delicate spinal cord runs down the spinal column with nerves running off from the spinal cord and exit between each vertebrae.
What is a herniated disc?
A disc prolapse or commonly known as a ‘slipped/herniated disc’ (whereby a disc doesn’t actually slip) is in fact when the soft-jelly like central inner part (the nucleus pulposus) bulges or herniates through a weakness in the fibrous outer part of the disc. The bulging or herniated disc can press on the delicate nerves that exit from the spinal cord between vertebrae. As well, local inflammation can develop around the disc bulge further adding pressure on these nerves. Pressure on these nerves can result in localised back pain, referred pain (so pain in the area where the nerve supplies) and other neurological symptoms such as altered sensation and weakness again often experienced in the areas where the nerve supplies. Symptoms can range anyway from very mild to excruciating.
It is important to remember that bouts of back pain are incredibly common and that sudden onset (acute) back pain due to a prolapsed disc actually accounts for less than 1 in 20 cases of back pain. This means that back pain due to a prolapsed disc is actually relatively uncommon. Far more common causes of sudden onset back pain are often due to less complicated causes such as a pulled ligament or muscle in the back.
Adults aged between 30-50 years old are most at risk of a prolapsed disc and men are twice likely than women to be affected.
What causes a prolapsed disc?
It is unclear as to why some people develop a prolapsed disc and others do not even when they do the same job or lift objects in the same way. Those who do go on to develop a prolapsed disc tend to have a weakness in the outer fibrous part of the disc. Added strain/pressure on a disc from things like lifting in an awkward position, coughing or sneezing can cause the soft jelly-like inner part to prolapse through the weakened outer part of the disc. There are certain factors that make a prolapsed disc much more likely to happen. These include a job involving lots of lifting or sitting (especially driving), weight-bearing sports (weight lifting, etc), smoking, obesity, and increasing age.
What are the symptoms of a prolapsed disc?
Back pain – often severe and comes on all of a sudden. This is made worse with movement, coughing or sneezing.
Nerve root pain (most commonly sciatica) – when a nerve coming from the spinal cord is pressed (trapped) by a prolapsed disc or the nerve is irritated from the inflammation caused by the prolapse. Pain is felt along the course of the nerve which may be anywhere from the buttock down the leg and into the sole of the foot. The sciatic nerve is the large nerve that runs down the back of each leg and is formed from the small nerves that exit from the lower part of the spine. The sciatic nerve is most commonly affected with a disc prolapse.
Cauda equina syndrome – rare but important to know about! A medical emergency and sometimes caused (but not always) by a disc prolapse. This is when the nerves that emerge from the very bottom of the spinal column that supply the bladder and bowel are pressed upon. If not dealt with in a timely manner can result in permanent disability leading to permanent bladder and bowel dysfunction as well as paralysis of the lower limbs. Symptoms include severe back pain, bladder and bowel dysfunction (usually inability to pass urine and incontinence of faeces), numbness around the anus and weakness in one or both legs.
Research studies where routine scans were performed in a large number of people have shown that not everyone with a disc prolapse experience symptoms like back pain etc. More often, people do not present with symptoms if suffering from a prolapsed disc. A disc prolapse/bulge can, in fact, be a normal feature of ageing and symptoms only occur if there is enough pressure on nerves.
In most cases, symptoms will improve over a few weeks. Repeated MRI scans on affected individuals have shown that over time the prolapsed part of the disc gets smaller and inflammation tends to settle. 1 in 10 cases will persist with symptoms beyond 6 weeks of an initial prolapse.
Your doctor can often diagnose a disc prolapse without the need for scans; most cases will settle down in 6 weeks. An MRI may be needed in severe cases, if symptoms persist or if surgery is being considered.
Treatment for a disc prolapse
Keep mobile and keep moving around. Try to get back into normal activities as soon as you can. Avoid activities that cause an exacerbation of your symptoms. Keeping active is very important in order to aid a faster recovery.
Regular pain relief such as paracetamol and ibuprofen is advisable (if tolerated), not only to keep you more comfortable but allows you to be more mobile and less likely to remain inactive.
Physiotherapy can provide short term treatment as well as speed up recovery in some cases.
Surgery to remove the disc prolapse and relieve pressure on nerves may be indicated in more severe persistent cases that fail to resolve with the above treatments. It is important to remember that surgery can sometimes fail to relieve symptoms and carries certain risks.
Some studies have shown that Infra-red therapy effective at reducing chronic back pain by as much as 50% over 6 weeks. Infra-red therapy has a very low risk of side effects.
Regular exercise, stay mobile, avoid smoking and maintaining a healthy normal weight are the best ways to prevent a disc prolapse from happening as well as preventing relapse.
SO STAY PHYSICAL!
