A herniated disc (slipped disc) is when part of a disc between two vertebrae pushes out of place and can press on a nerve. The symptoms of a herniated disc depend on where it is: with a herniated disc in the lower back, the pain often runs down the leg, and with one in the neck, down the arm. It is most common between the ages of 30 and 50. A milder form, where the disc only bulges, is called a disc bulge (protrusion).
Symptoms
- Pain in the lower back or neck that gets worse when you sit, bend, cough or sneeze.
- Pain down the leg (with a herniated disc in the lower back) or down the arm (with one in the neck).
- Numbness, pins and needles or burning in the foot, the toes or the arm.
- Stiffness and difficulty standing up straight after sitting.
- Sometimes weakness: your foot drags or you drop things.
With a herniated disc in the lower back, the pain is usually in one leg and goes below the knee. With one in the neck, you feel it in the shoulder, arm and fingers. Not every herniated disc hurts. MRI scans often show disc bulges in people who have no symptoms at all. That is why Kaloyan looks first at how you feel and how you move, and uses the scan to support the examination.
Why it happens
A disc is like a cushion between the vertebrae, with a soft centre and a tougher outer layer. Over the years the outer layer weakens and cracks appear in it (degenerative disc disease). A herniated disc happens when part of the centre pushes out through them. The risk is higher with:
- sitting for long periods and working hunched forward;
- lifting heavy things with a bent back and twisting;
- wear of the disc with age;
- being overweight and not moving much;
- a family history of herniated discs.
How we treat it
Bring your MRI or CT scan and any discharge summaries from the hospital, if you have them. Kaloyan starts with a conversation, looks through your scans and test results, and checks the strength, reflexes and sensation in your legs or arms. This shows how irritated the nerve is and which movements ease the pain. The core of the treatment is kinesitherapy for a herniated disc (exercise and manual therapy): positions and movements that reduce the pressure on the nerve, manual therapy, and exercises for the deep muscles of the abdomen and back.
When the pain is strong at the start, Kaloyan adds electrotherapy, which calms the pain for a few hours and makes the exercises easier to bear. Dry needling eases pain in the tight muscles around the spine. TECAR therapy warms the muscles around the spine and helps them relax. The course is usually about 5 sessions, 2–3 a week. Many people feel less pain after just the first 2 sessions; the rest are for maintenance and strengthening. The pain often retreats first from the leg to the lower back, which is a good sign. At the end, Kaloyan teaches you how to sit, bend and lift so that you put less strain on the disc. If there is no progress after 6–8 weeks, or weakness appears, he will send you back to a doctor.
What you can do yourself
- Change position often. Sitting for long strains the disc more than standing and walking.
- Take short walks if the pain allows.
- Sleep on your side with your knees bent and a pillow between them, or on your back with a pillow under your knees.
- Don’t do exercises from the internet that make the leg pain worse. Kaloyan will show you the exercises that suit you.
When to see a doctor first
- Numbness in the groin, around the anus or on the inner thighs.
- Difficulty urinating or leaking urine. You need an urgent examination by a neurologist and imaging (MRI, CT scan or X-ray).
- Weakness that is getting worse: your foot drags, or you can’t stand on your toes or heels.
- Severe pain after a fall or a blow.
- A fever or unexplained weight loss together with the back pain.
With either of the first two, see a doctor on the same day.
