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Prolapsed Disc (Slipped Disc)
While the terminology is misleading, a disc does not slip. In reality, a part of the inner gel-like part of the disc between two vertebrae bulges outwards through a weak spot in the outer part of the disc. To note, the prolapsed part of the disc can put pressure on a nerve nearby. As a result, one of the disc prolapse symptoms is a sudden onset of acute lower back pain.
In fact, a prolapsed disc is sometimes also referred to as a herniated disc. The bulging disc may occasionally put pressure on other nerves or nearby structures. Additionally, inflammation is likely to develop around the prolapsed portion of the disc. Also, inflammation may lead to irritated nerves and also bring about some swelling, which may, as a result, put pressure on a nerve.
Generally, a slipped disc condition happens in the lower lumbar spine. Thus, the pain may extend down a leg. The size and severity of the prolapse could vary from person to person. As a general rule, the larger the prolapse, the more severe the symptoms are likely to be.
Structure of the back
The lumbosacral area is the lower back area between the top of the legs and the bottom of the ribs.
- Muscles in the lower back attach to and surround the spine.
- Vertebrae are the bones that make up the spine.
- They are somewhat circular and are separated by discs.
- The discs have a strong fibrous outer layer. They also have a soft, gel-like center.
- They perform the function of shock absorbers.
- Additionally, in order to give extra support and strength to the spine, strong ligaments also attach to adjacent vertebrae.
- The various muscles attached to the spine enables the spine to bend and move in different ways.
- The spinal cord contains the nerve pathways to and from the brain.
- It is protected by the spine on the outside.
- Nerves from the spinal cord exit between the vertebrae to send and receive messages to various parts of the body.
Who can get a slipped disc?
Most cases of prolapsed discs occur in people between 30 and 50 years of age. In fact, two times as many men are affected by this condition as women. This condition is rare in anyone below 20 years of age. Also, less than 1 among 20 cases of sudden and acute back pain are due to a prolapsed disc.
Indeed, it is speculated that some people may have a weakness in the outer part of the affected disc. Thus, making them more prone to this condition. Different factors may trigger the inner softer gel-like part of the disc to squeeze out through the weakened outer harder component of the disc:
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Disc Prolapse Symptoms
To start, one of the disc prolapse symptoms is back pain. The pain is often acute and usually comes on suddenly and progresses quickly. In fact, the pain is worse if you move your back too much, sneeze or cough.
Nerve root pain (usually sciatica)
When a nerve coming out from the spinal cord – or the root of the nerve – is irritated, inflamed or pressed upon, you may experience nerve root pain or sciatica. Also, it can be called a trapped nerve. Additionally, it occurs in less than 1 out of every 20 people who complain of acute low back pain.
- There is pain along the length of the nerve.
- Typically pain extends down a leg, sometimes as far as the calf or the foot.
- Pain in the lower back is often not as bad as the pain down the leg or foot.
- You may experience pins and needles, weakness or numbness in part of a buttock, leg or foot.
- Depending on which nerve is affected, weakness could appear in different parts of the body
Cauda equina syndrome – rare, but an emergency
Cauda equina syndrome is a very rare disorder where the nerves at the very bottom of the spinal cord are pressed upon. This disorder can cause:
- Lower back pain
- Problems relating to bowel
- Problems relating to bladder function (usually being unable to urinate)
- Numbness in the saddle area (the groin, buttocks, and upper thighs) around the anus
- Weakness in either or both legs
In fact, this syndrome must be treated as an emergency. It requires urgent medical treatment so that the bladder and bowel do not become permanently damaged.
Therefore, it is important to note that some people do not have disc prolapse symptoms as prolapsed discs can sometimes be dormant and asymptomatic. Also, this condition does not require medical intervention as long as the prolapse does not put pressure on any nerve. Some prolapses may be small, cause minor insignificant or no symptoms or occur away from the nerves.
How does a slipped disc progress?
- In many cases, the symptoms reduce over a few weeks.
- Also, studies of repeated MRI scans have revealed that the bulging prolapsed portion of the disc tends to shrink or regress as time progresses.
- Additionally, the symptoms may go away completely.
- About 50 out of every 100 people improve within 10 days of the onset of pain, and almost 75 out of 100 people report a marked improvement after four weeks.
- Only a very small number of people, about 2 out of every 100 people with a ‘slipped’ disc, are still in severe pain even after 12 weeks and may need surgery.
Do I need any tests?
- Try to continue with normal activities as much as possible. This may not be possible in the beginning if the pain is terrible.
- Also, move around within the home as soon as you can.
- Most importantly, do nothing that causes or increases existing pain.
- Remember to sleep in the most comfortable position on whatever surface is the most comfortable, it does not matter if it is hard or soft.
- Some people reported that a small firm pillow tucked between the knees when sleeping on the side helps relieve pain.
- Some exercises designed by physiotherapists to work on at home may aid a speedy recovery.
- Additionally, they may help strengthen lower back muscles in the long run and reduce the chances of recurrence or severity of the pain when it does come again.
- Taking complete bed rest is not the best way to go about managing back pain.
- Anti-inflammatory painkillers include ibuprofen, diclofenac or naproxen which may require a prescription from a doctor.
- Also, some people may not be able to take anti-inflammatory drugs. For example, those who suffer from asthma, high blood pressure, kidney failure, or heart failure.
- If anti-inflammatories do not work well, consider codeine as an option. Take codeine as co-codamol. Accordingly, it is codeine with paracetamol. It acts as a stronger painkiller. Constipation is a common side-effect of codeine. Therefore, this may aggravate back pain if you need to strain to go to the toilet. To avoid this problem, be sure to have lots of fluids and drink water and eat foods rich in fiber.
- Prescription of a muscle relaxer such as diazepam is rare. But, it can be given, usually for a few days, if the back muscles become very tense making the pain unbearable. Diazepam can be habit forming. It provides quick and significant relief from pain. Therefore, it should be taken for a brief period.
- Additionally, although rare, physicians may prescribe antidepressants or medicines for neuropathic pain. Specifically, if the pain has not subsided or reduced for a long period of time. Examples include: amitriptyline, duloxetine, gabapentin or pregabalin.
- If you take painkillers, it is best to take them regularly. This is better than taking them only when the pain is very bad. Taking them regularly ensures pain relief for longer periods of time. This allows you to exercise better and keep more active.
Some people see a chiropractor or osteopath for manipulation and/or other physical treatments. Yet, it is still unclear if they provide relief in the long term. It may indeed only provide short-term comfort. Physicians recommend one do manipulation treatments with regular exercise.
An epidural is an injection in the back around the area where the sciatic nerve comes out of the spine. Additionally, only a specialist can administer an epidural. The injection contains a special combination of local anesthetic and steroids. Thus, it is a very strong anti-inflammatory concoction. Essentially, it is a long-term painkiller. It can give you enough pain relief that you can start or continue to exercise and go back to your normal routine activities faster.
In rare cases, your physician may consider surgery. Specifically, if symptoms are very severe and the pain is excruciating. To add, they may also consider surgery if symptoms have not gone down even after medical intervention- over six weeks. The surgery aims to cut out the prolapsed part of the disc and release the pressure on the nerves. Thus, you will experience a reduction in symptoms. Recent studies reveal that while surgery may be a better option in the short term, it makes no difference in the long term. The effects of the surgery seem to wear off after the first few months.
Can I prevent further incidents?
Research suggests that the best way to prevent future spells of low back pain is simply to be as active as possible and to exercise regularly.