Slipped disc? How to proceed correctly

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A slipped disc can be extremely painful, but also completely painless. What is important in the treatment, why surgery is seldom necessary and what to do to prevent it.

How a herniated disc arises

In a slipped disc, also called a herniated disc, the soft core of the disc emerges through a tear in the harder outer fibrous ring. If the disc tissue presses on a nerve, the result can be severe pain.

However, there are many incidents of slipped discs in which the nerves remain untouched and the patient doesn’t feel any pain.
Oliver Nic Hausmann, specialist in neurosurgery at the Neurological and Spinal Surgery Centre Central Switzerland

Causes of a slipped disc

The discs between the vertebrae act as shock absorbers. They make the spine mobile and cushion any shocks. Various factors can lead to the discs losing their elasticity and becoming damaged, which raises the risk of a slipped disc. Factors include:

  • Incorrect load distribution
  • Hard physical work
  • Insufficient exercise
  • Incorrect posture, weak back muscles
  • Excess weight
  • Age: Slipped discs often occur between the ages of 30 and 50
  • Gender: Men are twice as likely to be affected as women

Slipped disc in the cervical spine

Slipped discs are most common in the lumbar spine, but the cervical spine or thoracic spine can also be affected.

Which pains are typical of a slipped disc

  • Pain is typically felt in the corresponding section of the spine.
  • The pain can also spread to other regions of the body. If the slipped disc has occurred in the lumbar spine, the pain can sometimes be felt in the buttocks or leg. If the cervical spine is affected, the patient may feel pain in the neck or arm.
  • It can also lead to sensory disturbances such as tingling or numbness.

How to recognise a slipped disc

A slipped disc can be diagnosed from the typical symptoms. Any medical consultation will also involve neurological tests. Imaging procedures such as magnetic resonance imaging (MRI) or computed tomography (CT) help to locate the slipped disc and estimate the extent of the problem.

When a slipped disc should be treated

Sometimes a slipped disc is discovered by chance. If the nerves are unharmed and patients have neither pain, paralysis nor muscle dysfunction, treatment isn't absolutely necessary. It's enough to wait for spontaneous regression.

Often the leaked disc material loses water and dissipates with time.
Oliver Nic Hausmann

When an operation is necessary

If you're in pain, it is best to discuss with your doctor and therapist which approach is the most appropriate. As a rule, a step-by-step approach is followed:

  • If the pain is bearable and no paralysis or muscle dysfunction is evident, conservative methods are the first choice. Physiotherapy or chiropractic treatment can be used to try to correct the posture, stretch the joints and strengthen the pelvic and back muscles. This treatment can be supplemented by painkillers. Treatment generally takes six to eight weeks. It is estimated that a good 80 percent of slipped discs can be treated conservatively, i.e. without surgery.
  • Only if the pain doesn't improve is the next step taken: interventional pain therapy. This is interdisciplinary and may include, for example, injections at nerve roots.
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  • An operation is only discussed if no improvement is seen.
  • An operation is necessary if the pressure on the nerve roots is too strong, as this can cause permanent damage. This can be the case if nerves are affected which control the emptying function of the bladder and bowels, for example.
  • The bulging disc material is usually removed using minimally invasive procedures (keyhole technique).

Which everyday exercises are useful

New findings show that hereditary factors play a role with slipped discs. Nonetheless, by taking good care of your back, prevention is possible. The important thing is to regularly train the back, pelvic and abdominal muscles. It's also worth noting the following:

  • Design your working space ergonomically.
  • Ensure an upright, relaxed working position even at home.
  • When working in a seated position, take regular breaks, get up and walk around.
  • Don't lift loads in a stooped position.
  • Watch your body weight.

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