Back PainMore commonly (and misleadingly) known as a ‘slipped disc’, a prolapsed orherniated disc occurs when the spinal disc becomes less elastic and can rupture. When the disc ruptures, a portion of the spinal disc pushes outside its normal boundary, this is called a herniated disc. When a herniated disc bulges out from between the vertebrae, the spinal nerves and spinal cord can become pinched. There is normally a little extra space around the spinal cord and spinal nerves, but if enough of the herniated disc is pushed out of place, then these structures may be compressed.

Symptoms

Back pain
The pain is often severe, and usually comes on suddenly. The pain is usually eased by lying down flat, and is often made worse if you move your back, cough, or sneeze.

Many different symptoms can be experienced in this region and comprehensive assessment by one of our Physiotherapists will enable your problem to be  managed in the most effective way.

Nerve root pain (usually ’sciatica’)
Nerve root pain is pain that occurs because a nerve coming from the spinal cord is pressed on (’trapped’) by a prolapsed disc, or is irritated by the inflammation caused by the prolapsed disc. Although the problem is in the back, you feel pain along the course of the nerve in addition to back pain. Therefore, you may feel pain down a leg to the calf or foot. Nerve root pain can range from mild to severe, but it is often worse than the back pain. With a prolapsed disc, the sciatic nerve is the most commonly affected nerve. (The term ’sciatica’ means nerve root pain of the sciatic nerve.) The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back. It travels deep inside the buttock and down the back of the leg. There is a sciatic nerve for each leg.

Other nerve root symptoms
The irritation or pressure on the nerve next to the spine may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. The exact site and type of symptoms depends in which nerve is affected.

Cauda equina syndrome – rare, but an emergency
Cauda equina syndrome is a particularly serious type of nerve root problem that can be caused by a prolapsed disc. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the ’saddle’ area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. See a doctor immediately if you develop these symptoms.

Some people do not have symptoms
Research studies where routine back scans have been done on a large number of people have shown that some people have a prolapsed disc without any obvious symptoms. It is thought that symptoms mainly occur if the prolapse causes pressure or irritation of a nerve. This does not happen in all cases. Some prolapses may be small, or occur away from the nerves and cause minor, or no symptoms. You may even have one now reading this page!

Treatment
Recovery from a herniated disc normally takes between 4-6 weeks. To recover from a herniated disc treatment will often involve some gentle exercise, manual therapy, massage and a prescription of painkiller medication. In the majority of cases, a disc that bulges, or protrudes out from in between your vertebrae (bones of the spine), will eventually shrink back to it’s normal location. Pain will usually ease as the disc stops pressing on the affected nerve.

Keeping active
If you have been diagnosed with a herniated disc it is very important that you keep active. It might be difficult to move around immediately after a herniated  disc and if the pain you are experiencing is severe, you may need to have complete rest for the first couple of days. However, after this period, it is best if you can start moving around as soon as possible as it will help to keep you mobile and will speed up your recovery.

It is very important that you make sure that any exercise you do is gentle and has a low impact on your back. Swimming, for example, puts very little strain on your joints as the water supports your weight. Movement and exercise will also help to strengthen any muscles that have become weak. Avoid any activities that could aggravate your condition, such as reaching, lifting, or sitting for a prolonged period of time. Full consultation with a Physiotherapist will help you develop strategies to improve and manage your symptoms.

Physiotherapy
Physiotherapy can be very beneficial in treating acute herniated discs. Our physiotherapists will use manual techniques to reduce the herniation and to also reduce the pain. This normally involves spinal mobilisations, soft tissue techniquesand specific exercises and may even involve mechanical traction. The initial treatment aims to reduce the symptoms, and to get the patient moving better. Your Physiotherapist is experienced at treating back problems of all kinds of severity and treatment is tailored to you and your specific problem.

After a time, and when appropriate, your physiotherapist will work with you to build on strengthening the core muscles of the back and abdomen to ensure the chance of further prolapsed discs are reduced significantly. Our in-clinic Physio-Gymprovides the perfect environment and equipment for this to take place. 

Medication

There are several different types of medicines that you may be given to aid the symptoms of a prolapsed disc. These include:

  • Analgesics (painkillers) – such as paracetamol.
  • Non-steroidal anti inflammatory drugs (NSAIDs) – such as ibuprofen, diclofenac and naproxen. These can help to relieve pain and reduce any inflammation caused by the protruding disc and aggravated nerve. However, they may not be suitable for people with high blood pressure, asthma, heart failure or kidney failure. Ask you GP if you are unsure.
  • Codeine - this medicine is a much stronger type of analgesic, and is often taken in combination with paracetamol. It is usually only taken when other analgesics and NSAIDs fail to work. The most common side effect of codeine is constipation.
  • Muscle relaxants - such as diazepam. You may be prescribed a muscle relaxant if your back or leg muscles are very tense. Your GP will usually only recommend that you take this type of medicine for a few days.

Surgery

Approximately 1 in 10 cases of a slipped disc will require surgery. Surgery for a slipped disc is usually performed as a last resort, unless you are suffering from very severe symptoms, such as those associated with cauda equina syndrome (see ’symptoms’ section). You may also require surgery if your symptoms fail to improve to the desired level.

The aim of surgery is to cut away the piece of the disc which protrudes out. For most people, surgery like this will help to ease your symptoms, and you will usually be able to return to work after two to six weeks (dependent on your occupation). However, this surgery does not work for everyone and you may require further operations and treatment if the initial surgery does not work. Specific rehabilitation programmes following your operation will ensure you recover in the best way possible.

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