I’ve slipped a disc!

Most people you speak to will have experienced back pain at some point in their lives.  Some of my clients present with symptoms consistent with an intervertebral disc injury. Commonly, this problem is caused by lifting heavy items with poor technique or spending a lot of time sitting and driving.  They might say;  “I’ve slipped a disc”, “ I can’t stand up straight” or “my backs out of alignment”.  Often the symptoms can include severe lower back and leg pain. Occasionally they might have some altered sensation like pins and needles, numbness and lower limb weakness. Thankfully, most of my patients recover well and get stronger as part of their recovery!

In the acute stages many people are worried and wonder whether they need to see a spinal surgeon. In the majority of cases I feel it isn’t necessary and here’s why:

There are a number of published papers that clearly demonstrate large protruded/extruded discs to dramatically lessen in size and potentially completely resolve when managed conservatively or even when left entirely alone. https://www.ncbi.nlm.nih.gov/pubmed/17613504

To demonstrate this more clearly it is useful to study the diagram below on a disc injury taken from an MRI scan. You can clearly see that this patients disc bulge has resolved on its own!

www.consortiumphysio.co.uk

So.. How much do they improve? How long does it take? Does it depend on exactly where and what direction my disc has bulged?  

Benson et al (2010) studied a large number of patients with large disc prolapses on their scan. They monitored them over a 2 year period by repeatedly scanning them and evaluating what was happening to their disc bulges as time went on. Most of the patients initially had severe sciatica but then began to feel less pain in their legs despite it being proven that they had a large disc protrusion on their MRI scan. Interestingly, 83% of the subjects they monitored had a complete and long lasting recovery. On average, over the twenty four months, the size of the disc bulges reduced by 64%. This was the same for both posterior disc bulges and far laterals.

Here’s the twist:

Going to get an MRI might also show something in you’re back that’s not even giving you any symtpoms!

Check out these figures from a study of people without back pain!

Predictors of recovery:

If you make improvements early on then your outcome is likely to be far better when left alone (https://www.ncbi.nlm.nih.gov/pubmed/19887021)

Lack of improvement in the first 12 months unfortunately means natural resolution will be less likely (https://www.ncbi.nlm.nih.gov/pubmed/2218716) (https://www.ncbi.nlm.nih.gov/pubmed/1440010)

Does this rule apply all of the time and to all discs? 

NO, it doesn’t. Just because we now know that it is possible for disc protrusions to improve, it does not mean that you should just go onto ignore it! Some discs can worsen, leading to longstanding issues.

So see us at ESP Physiotherapy if you are experiencing any of these symptoms!

Tom Unwin | Physiotherapist

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