Acute or sudden onset back pain is very common with over 80% of us experiencing back pain at some point in our lives. The symptoms can be severe and can extend into the lower body causing many people to blame a slipped disc for their pain. However only 1 in 20 episodes of sudden back pain are caused by discs, so what’s actually going on?
Backs are complex structures formed around the central focus on the spinal column. This is made up of 33 vertebrae, blocky shaped bones that fit together like a jigsaw and extend from the head to the pelvis. In between most of the vertebrae are discs which act like little shock absorbers to cushion the bones and help with movement. The bones and discs are supported and held in place by muscles, ligaments and fascia, the main connective tissue in the body which forms an integral part of maintaining the balance and connection of the back.
One of the main functions of the spine is to protect the spinal cord, the nerve bundle that extends from the brain and then splits into smaller nerves that exit the spinal cord through gaps between the vertebrae. In the same way electrical wiring travels from a junction box to deliver a current to all points in a house, nerves travel out from the spinal cord to enervate every area of the body.
What are slipped discs?
The term ‘slipped disc’ is a misnomer as discs do not ‘slip’. Instead they can bulge and then sometimes prolapse or herniate. Discs are made of strong rubbery tissue on the outside with a softer core, similar to a jam doughnut.
If there are uneven pressures on a disc, for example more pressure on one side than the other, this can cause the disc to start to bulge. Too much pressure, and the disc can herniate as part of the soft core protrudes out.
Because all discs are near to the gaps where nerves exit the spinal cord, the herniated section may press on a nerve causing pain and other symptoms. Most discs bulges and herniations happen in the lumbar or lower back because this is the weight bearing area and under more pressure.
What are typical symptoms?
The most interesting fact about herniated discs is that many of them cause no symptoms at all. Research studies where routine back scans have been done on a large range of people show that many people have a herniation but no symptoms.
When symptoms do occur, they typically include:
- Lower back pain
- Sciatica – where the herniation is pressing on the sciatic nerve and causing pain in the buttocks, hips, legs or feet
- Numbness or tingling
- Muscle weakness
- Problems bending or straightening your back
Depending on which part of the back the herniation has occurred in, these symptoms may be felt more in the upper body and affect the arms and shoulders (a herniated cervical disc in your neck) or in the lower body and affect the hips and legs (a herniated lumbar disc). Herniations can also occur in the mid back but are less common as this area has extra stability from the attachment of the ribcage to the spine.
What causes discs to bulge or herniate?
Sometimes people can pinpoint a specific activity such as picking up a heavy or awkward load, or an accident, but for most people the causes are less clear. For most people the causes are a combination of factors including work and lifestyle that gradually cause the body to lose its normal balance.
Too much heavy lifting, sitting or driving are common factors, as are strenuous sports such as weight lifting, rugby or running, as well as general life factors such as being overweight or ageing.
All of these create imbalance in the body, which cause it to compensate by changing muscle activation, posture and movement. Eventually the body can’t compensate anymore and something has to give, which is usually a disc. The most mundane activities can be the tipping point, often something that you have done many hundreds of times before, and can be even something as simple as trying on a pair of flip-flops.
What can I do to help my back pain?
Generally 90% of herniated discs settle within 6-12 weeks. For the small minority of people whose pain does not subside surgery may be an option, although recent research suggests that surgery makes little difference in the long term.
However, bearing in mind even acute back pain is most likely to be due to muscle strain rather than a disc, the things you can do to help apply to any episode, no matter the actual cause:
- There will be an initial painful period of inflammation and swelling around the injured area which can last a few days. Even so it is better to keep moving as much as possible to prevent restrictions forming in the tissues that may cause a chronic problem later. Gentle regular movement such as walking would be advisable, or anything that doesn’t aggravate your pain.
- During this period it may be helpful to use medication such as anti-inflammatory painkillers that you know you can tolerate. If intense pain lasts for longer, then it would be advisable to contact your GP for a course of stronger prescription medication.
- Sleep in whatever position is comfortable for you. This could be on your back with a pillow under your knees to flatten your lower back, or sidelying with a pillow between your knees to keep your hips level and avoid too much pressure on your lower back.
- As the pain eases a return to exercise can be very beneficial for back pain. Regular cardiovascular exercise such as walking, swimming or cycling can help to maintain movement and fitness. Specific movement exercise such as yoga, pilates or tai chi can help to build flexibility and strength. High impact exercise such as running or weight lifting may have an adverse effect so are probably better avoided until you are pain free.
- Supplement your exercise programme with daily myofascial release exercises. These gentle exercises help to release fascial restrictions that may be part of the underlying problem and encourage freer movement and better body balance. Watch our video of myofascial exercises for lower back pain: