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Slipped disc Content Supplied by NHS Choices
Introduction

A slipped disc means that one of the discs of cartilage in the spine is damaged and pressing on the nerves.

It's also known as a prolapsed or herniated disc.

This page covers:

The spine

Symptoms

Causes

Who's affected

Diagnosis

Treatment

Prevention

The spine

The spine, or backbone, is made up of 24 individual bones called vertebrae, which are stacked on top of each other.

In between each vertebra there are circular pads of connective tissue (cartilage) called discs. These discs have an inner gel-like substance and a tough outer case. They help maintain your back's flexibility and wide range of movement.

The spinal cord is a sensitive bundle of nerve fibres that passes through the middle of the spine. These nerve fibres connect all parts of the body to the brain.

Symptoms of a slipped disc

A slipped disc can cause back pain and neck pain. Other typical symptoms are numbness, a tingling sensation, and weakness in other areas of the body.

The sciatic nerve is often affected in cases of slipped disc. It's the longest nerve in the body and runs from the back of the pelvis, through the buttocks, and down both legs to the feet.

If pressure is placed on the sciatic nerve (sciatica), it can cause mild to severe pain in the leg, hip or buttocks.

Not all slipped discs cause symptoms such as pain, weakness or tingling. Many people will go their whole life not knowing they have slipped a disc.

Read more about the symptoms of a slipped disc.

What causes a slipped disc

A slipped disc occurs when the circle of connective tissue surrounding the disc breaks down, allowing the soft, inner gel-like part of the disc to bulge out.

The damaged disc can put pressure on the whole spinal cord or on a single nerve root, where a nerve leaves the spinal cord.

This means a slipped disc can cause pain in the area of the protruding disc and also in the area of the body controlled by the nerve that the disc is pressing on.

It's not always clear what causes a disc to break down, but age is a common factor in many cases.

As you get older, your spinal discs start to lose their water content, making them less flexible and more likely to split (rupture).

Smoking can also be associated with a slipped disc because it causes the discs to lose their natural flexibility.

Other factors that can put increased pressure and strain on your spine include:

  • bending awkwardly
  • heavy or awkward lifting
  • sitting for long periods, particularly when driving
  • being overweight or obese
  • weight-bearing sports, such as weightlifting
  • severely injuring your back, such as during a fall or car accident

These situations can weaken the disc tissue and sometimes lead to a slipped disc.

Who's affected

Slipped discs are most common in people aged between 30 and 50. They affect twice as many men as women.

Slipped discs often occur in the lower back. Around a third of adults in the UK have lower back pain, but fewer than 1 in 20 people have a slipped disc.

Diagnosing a slipped disc

Your GP will usually be able to diagnose a slipped disc from your symptoms and medical history.

They may also carry out a physical examination to test your:

  • posture
  • reflexes
  • muscle strength
  • walking ability
  • sensation in your limbs

Read more about how a slipped disc is diagnosed.

Treating a slipped disc

It can take about one to three months to recover from a slipped disc. Treatment usually involves a combination of physiotherapy, such as massage and exercise, and medication to relieve the pain.

Surgery to release the compressed nerve and remove part of the disc may be considered in severe cases, or if the pain doesn't settle down over time.

In many cases, a slipped disc will eventually shrink back away from the nerve and the pain will ease as the disc stops pressing on the affected nerve.

Sometimes the slipped disc will stay pressing on the nerve, but the pain goes away because the brain learns to "turn down the volume" on the pain messages coming from the nerve.

It's very important to keep active if you have a slipped disc. Moving may be difficult to start with, but you should start to move around after resting for a couple of days.

This will help keep your back mobile and stop the joints becoming stiff and the muscles that support the spine becoming weak. Keeping moving will speed up your recovery.

You should only exercise gently to ensure you don't put too much strain on your back. At first, avoid high-impact exercises, such as running, jumping or twisting, as they may cause the pain to flare up.

Read more about treating a slipped disc.

Preventing a slipped disc

Taking a few sensible precautions, such as leading a healthy lifestyle, can help prevent back pain and lower your risk of getting a slipped disc.

For example, you should:

Read more about preventing a slipped disc.


Symptoms

Lower back pain is often the main symptom of a slipped disc.

The pain is caused by a disc pressing on a nerve, and is often worse when pressure is placed on the nerve. This can happen when you cough, sneeze or sit down.

The pain will usually settle down in one to three months, but in some cases it can last much longer and become chronic. There's also a risk of recurrence.

The symptoms can also vary depending on whether the slipped disc is in your neck or lower back.

Slipped disc in the neck

A slipped disc in the neck can cause:

  • neck pain during movement
  • numbness or a tingling sensation in the neck, shoulder, arm or hand
  • weakness in certain muscles, which limits your range of movement

Slipped disc in the lower back

A slipped disc in the lower back can cause:

  • back pain during movement
  • numbness or a tingling sensation in the back, buttocks, genitals, legs or feet

Sciatica

The sciatic nerve is the longest nerve in the body and is made up of several smaller nerves. It runs from the back of the pelvis, through the buttocks, and down the legs to the feet.

If a slipped disc is putting pressure on the sciatic nerve, it can cause pain in the leg, hip or buttocks. This is called sciatica.

Other nerves

If the slipped disc presses on any of the other nerves that run down your spinal cord, your symptoms may include:

  • muscle weakness
  • numbness and tingling

Muscle weakness or numbness and tingling may occur in your arm or leg depending on where the slipped disc is.

Cauda equina syndrome

Cauda equina syndrome is a serious condition where the nerves at the very bottom of the spinal cord become compressed.

Symptoms include:

Seek immediate medical assistance if you develop these symptoms. Visit your GP or your nearest accident and emergency (A&E) department.

If cauda equina syndrome isn't treated quickly, the nerves to your bladder and bowel can be permanently damaged.


Diagnosis

Your GP will usually be able to diagnose a slipped disc from your symptoms and medical history.

You'll also have a physical examination, where your GP may test your:

  • posture
  • reflexes
  • muscle strength
  • walking ability
  • sensation in your arms and legs

Leg-raising test

While you're lying flat or sitting, your GP will slowly raise your legs one at a time to see if it causes any pain or discomfort in your legs.

The test stretches the nerves in your spine. If a disc is pressing on a nerve, this stretching can cause pain, numbness or tingling.

Pressure on a nerve

Your GP may test whether there's any pressure on a nerve in your neck by asking you to bend your head forward and to the sides while applying some pressure to the top of your head.

If this causes any pain or numbness to increase, it's likely that a slipped disc is putting pressure on a nerve in your neck.

Further tests

In most cases, further tests aren't needed because the symptoms of a slipped disc usually settle down within one to three months.

But if your symptoms don't ease after three months, further tests may be recommended to help pinpoint the exact location of the slipped disc and assess how well the nerves are functioning.

Some of the tests you may have are described below.

Nerve conduction test

In cases where there's uncertainty, a nerve conduction test may be used to help diagnose a slipped disc. It can also be used to measure how well the electrical signals are being transmitted through your nerves.

During the test, small metal discs called electrodes are placed on your skin. They release small electric shocks that stimulate your nerves, allowing the speed and strength of the nerve signal to be measured.

Magnetic resonance imaging (MRI) scan

A magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to produce detailed images of the inside of your body.

MRI scans are effective at showing the position and size of a slipped disc. They can also pinpoint the affected nerves.

Computerised tomography (CT) scan

A computerised tomography (CT) scan uses a series of X-rays to scan parts of your body. A computer is used to build up detailed images of your body.

This produces cross-sectional images of your spinal column and the structures surrounding it. Like an MRI scan, a CT scan can pinpoint a slipped disc, although it's often not as effective.

X-rays

Normal X-rays aren't usually used to investigate slipped discs because they only detect bone and don't give a view of the nerves and spinal cord.


Treatment

In most cases, a slipped disc will slowly improve with rest, gentle exercise and medication. Recovery can take between one and three months.

Keeping active

It's very important to keep active if you have a slipped disc.

Initially, it may be difficult to move around. If you're in severe pain, you may need to rest completely for the first couple of days.

However, after this period, you should start to move around as soon as you can. This will keep your back mobile and speed up your recovery.

Make sure any exercise you do is gentle and doesn't put a strain on your back. Swimming is an ideal form of exercise because the water supports your weight and it puts very little strain on your joints.

Movement and exercise will also help strengthen any muscles that have become weak. Avoid any activities that could aggravate your condition, such as those that involve:

  • reaching
  • lifting
  • sitting for a prolonged period of time

You may find your pain increases at first when you start moving around.

This is normal and doesn't mean you're causing more damage to your spine or the slipped disc. The pain should settle down quite quickly, allowing you to gradually increase the amount of exercise you're doing.

Physiotherapy

You may be referred to a physiotherapist as part of your treatment programme.

Physiotherapists are qualified healthcare professionals who use a range of techniques, including massage and manipulation, to restore movement and function.

A physiotherapist will be able to draw up an individually tailored exercise plan for you. This will keep you active, minimise pain, and help prevent any further damage to your back.

Read more about physiotherapy.

Osteopathy and chiropractic

Some people choose to try osteopathy or see a chiropractor. Both types of therapy are used to treat back pain.

Osteopathy and chiropractic aren't widely available on the NHS, and you'll usually have to pay for treatment privately.

Medication

You may be prescribed a number of different medicines to help ease any painful symptoms of a slipped disc. These are outlined below.

Painkillers

Simple painkillers, such as paracetamol, are available over the counter from pharmacies or on prescription.

Some people worry that taking painkillers may mask something more serious going on with their back.

This isn't true - regularly taking painkillers can ease your pain and help you to begin moving around, which will speed up your recovery.

However, always read the manufacturer's instructions before using them.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen, can help relieve pain and reduce any inflammation.

NSAIDs may not be suitable for people with high blood pressure (hypertension), asthma, heart failure or kidney failure. Again, you should always read the manufacturer's instructions before use.

Codeine

Codeine is a stronger painkiller that's often taken in combination with paracetamol.

It's usually only prescribed when other painkillers and NSAIDs can't be used or tolerated or haven't worked.

Codeine can cause a number of side effects, including feeling or being sick, constipation, dizziness and a dry mouth.

Corticosteroids

Corticosteroids, often known as steroids, are an anti-inflammatory medicine. They may be injected into your lower spine to help reduce inflammation.

Muscle relaxants

You may be prescribed a muscle relaxant, such as diazepam, to take for a few days if your back or leg muscles are very tense.

Surgery

Surgery is required in about 1 in 10 cases of a slipped disc.

It may be considered if:

  • there's evidence of severe nerve compression
  • your symptoms haven't improved using other treatments
  • you're having difficulty standing or walking
  • you have very severe symptoms, such as progressive muscle weakness or altered bladder function

The aim of surgery is to cut away the piece of the disc that bulges out to release the pressure on your spinal nerves. This is known as a discectomy and can be carried out in several ways.

Some of these procedures are explained in more detail below.

Open discectomy

An open discectomy is a procedure to remove part of the slipped disc. It's carried out under general anaesthetic, which means you'll be unconscious during the operation.

The surgeon will make a cut (incision) over the affected area of your spine down to the lamina, the bony arch of your vertebra.

They'll gently pull the nerve away to expose the prolapsed or bulging disc, and remove just enough to prevent pressure on the nerves.

To complete the operation, the surgeon will close the incision with stitches or surgical staples.

Endoscopic laser discectomy

During endoscopic laser surgery, a small incision is made to gain access to the spine. A long, thin, flexible tube with a light and camera at one end (endoscope) is used to examine the disc.

The procedure is carried out under either local anaesthetic or general anaesthetic, depending on where in your spine your slipped disc is.

After the affected disc has been identified, the compressed nerve causing you pain will be released and part of the disc will be removed with a laser.

A study found 67% of people could move around more easily six months after having endoscopic laser surgery, and around 30% needed less pain-relieving medication. Around 2-4% of people needed another operation.

Another study reported that, on average, people were able to return to work seven weeks after having endoscopic laser surgery.

Endoscopic laser surgery is still a relatively new procedure, so it's often only performed with special arrangements - for example, as part of a clinical trial.

Read the National Institute for Health and Care Excellence (NICE) guidance about endoscopic laser lumbar discectomy.

Recovery

For most people with a slipped disc, back surgery helps ease their symptoms.

Depending on the procedure you've had and the type of work you do, you'll be able to return to work after two to eight weeks.

However, the surgery doesn't work for everyone, and you may need to have further operations and treatment if the initial surgery isn't effective.

Possible complications resulting from surgery may include:

  • infection
  • nerve injury and paralysis
  • severe bleeding (haemorrhage)
  • temporary impaired sense (dysaesthesia) - for example, losing the sense of touch

Before deciding to have surgery, ask your surgeon about their experience doing the surgery, and their success and complication rates.

They'll tell you whether you're at risk of developing complications and how long it will take to recover. You may be given a rehabilitation programme to follow.

Read more about the risks of lumbar decompressive surgery and recovering from lumbar decompressive surgery.


Prevention

To avoid back pain and help prevent a slipped disc, you should keep mobile, exercise regularly, maintain good posture and lift heavy objects correctly.

Read more about preventing back pain.

Exercise

Regular exercise can slow down the age-related deterioration of the discs in your back. It can also help keep your supporting back muscles strong and supple.

Make sure you warm up and cool down properly before and after a workout or sports activity. If you're recovering from a slipped disc, avoid high-impact activities, such as running and aerobics.

Read more about warming up before exercising and stretching after exercising.

Healthy weight

Being overweight can put extra strain and pressure on your back, so maintaining a healthy weight will help ease the pressure.

You can use the healthy weight calculator to find out whether you're a healthy weight for your height.

Read more about obesity and how to lose weight.

Lifting

It's very important that you use the correct technique when lifting.

When lifting heavy objects:

  • think before you lift and make sure you can manage the weight
  • slightly bend your back, hips and knees at the start of the lift
  • keep the load close to your waist
  • avoid twisting your back or leaning sideways
  • keep your head up and look ahead as you carry the load

Read more about how to lift safely.

Sitting

When sitting or driving for long periods, make sure your seat is comfortable and supportive. If possible, take regular breaks to stretch and walk around.

If your job involves using a computer, take regular breaks away from the computer screen. Make sure the computer screen is at eye level and directly in front of you so you don't have to twist or bend to see it.

Sit in a comfortable position with enough space to move around, and don't stay in the same position for too long.

Your employer should provide you with information and training about working with computers, including advice about the best way to sit and position your equipment.

Read more about how to sit correctly.

Posture

Always try to keep a good posture. Walk or stand with your head and shoulders slightly back.

When sitting at a desk, make sure your chair is the correct height for the desk. Your feet should be able to rest flat on the floor with your knees bent at 90 degrees.

Read more about back pain at work and workplace health.


 
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