7 hours ago
How to avoid getting a slipped disc (and what to do if the worst happens)
Four weeks ago, Tom Hayes, 58, awoke in his hotel bed with his lower back in agony. 'It was pain I've never experienced,' says Tom, a TV producer, who was working in Turkey at the time. 'I've broken my leg and shattered my ankle in 10 places before and that wasn't half as bad. This pain was so much more extreme. I couldn't work out how to get out of bed and had to call a colleague a few doors down to help me.'
Tom went straight to hospital where he learnt that what he was experiencing was a slipped, or 'herniated', disc. 'Knowing that it was just a really common, boring injury took the panic away,' he says. 'Until that point, I think I was in too much pain to be rational and really had no idea what it could be.' A month on, back home and off pain killers, he's feeling only 'mild discomfort' but still wonders how it happened.
He hadn't done anything strenuous in the lead up, though he has suffered 'a slightly dodgy back' and intermittent pain for years. 'I'm not particularly unfit,' he adds. 'I walk and cycle but I don't do weights or yoga, or anything to make my back stronger. Am I culpable in that way?'
What is a slipped disc?
Around 1 to 3 per cent of people in Western industrialised countries will experience a slipped disc – they are twice as common in men than women – and most likely to occur between the age of 30 and 60. Although research teams are looking at stem cell therapy as a means of regenerating disc tissue and preventing degeneration, for now, slipped discs are primarily caused by inevitable age-related change.
'Discs are the spongy spaces between the bones in our back which act as shock absorbers and also enable us to bend,' says Mr Damian Fahy, spinal surgeon at the Fortius Clinic. They are commonly compared to jam doughnuts – with a spongy outside and a hydroscopic gel in the centre. 'After the age of 20, the material that discs are made from starts to change,' explains Fahy. 'It doesn't retain water as effectively and becomes dehydrated – like a stale crispy doughnut – and less flexible. When that happens, it could be that one awkward movement tears the outside of the disc and if it extends right into the core and the gel escapes, you've got a slipped disc. It can cause pain when the gel hits the nerve or because the gel itself contains a lot of chemicals.' In addition to age related decline, added risk factors are:
Genetics: A family history can make this more likely due to genetic variations in the protein that the discs are made from.
Smoking: It reduces blood flow to the discs and weakens the outer layers.
Obesity: The increased load on the spine causes structural weakness.
Being Sedentary: Sitting – especially slumping – for extended periods increases pressure on the discs.
Certain activities: 'Heavy physical work that involves lifting, twisting and bending,' says Fahy. 'Disc injuries from certain gym exercises – like dead lifts and barbell squats – are also hugely common now. Rowing is high risk too because of the way it loads your spine while bending.'
How to avoid a slipped disc
'We can't stop ageing or change our genes, but we can reduce our risk by not smoking and maintaining a healthy weight,' says Fahy. What else can we do?
Avoid sitting for extended periods
'Take a break after 20 minutes,' says Fahy. 'It's not a great idea to stand all day either. If you have the option, a sit stand desk is best.' David Vaux, osteopath, healthy ageing expert and author of Stronger, recommends an ergonomic assessment for a working space if possible. 'Stretch out your glute muscles when you go to stand after being seated for a while and take a brisk walk at lunch time every day,' adds Vaux.
Choose the right activities
'To prevent disc injuries, you want to build a strong core – and that includes the abdominals, the glutes and the back muscles so you have a corset going right around your body,' says Vaux. The multifidus muscle plays a key role here – a short muscle deep in the back that helps stabilise the spine. According to Vaux, the plank, the side plank and glute bridges are good core all-rounders in an exercise routine. If you're selecting an exercise class, Fahy strongly recommends Pilates. 'Pilates involves natural, functional movements that reach the deep muscles in the back,' he says.
General cardiovascular fitness is important too. 'A lot of disc injuries happen when someone overexerts themselves when they're fatigued,' says Vaux. 'That's when you're going to start relying less on your muscles and more on your ligaments, tendons and joints, including the discs.' Build fitness slowly and sensibly. 'Don't sign up to hard classes or push yourself too quickly,' says Vaux. 'Spend three to six months getting generally more active – and if you're doing resistance training, use only your body weight. After you've progressed, you can move to something more challenging.'
'When building fitness, walking is good for the spine and swimming is excellent,' says Fahy. 'It doesn't load your spine and it strengthens the core and back muscles, especially front crawl and back stroke. Cycling is neutral – it doesn't help or harm your back. If you have a damaged back, running is high-risk because of the force when your feet hit the ground.'
Learn to Lift
' We see a lot of disc injuries when people lift too much or use a poor technique,' says Vaux. 'Anyone who doesn't use their legs to lift is putting a lot of pressure on the discs in the lower back. Don't just bend at the hips. If you're gardening for instance, or have heavy shopping – or you're lifting weights – you should bend from both the hips and the knees so you go into a squat position.'
Do the hard stuff first
'Don't do anything challenging or high risk when you're tired, recovering from a virus, or you've slept badly as you're at much higher risk of a disc injury,' says Vaux. 'If you're low on energy, do some walking or gentle stretching instead. If you're in the garden, don't dig up the big plant or load the wheel barrow at the end of the day. By then, you'll have lost your form and your posture. Do the heavy work first and end with the light weeding.'
What to do if the worst happens?
Most slipped discs heal over four to six weeks with rest, pain relief and gentle exercise. Over time, the slipped disc shrinks and stops putting pressure on the nerve. 'There's are no rigid rules around treatment paths as this has to be led by the patient and pain levels,' says Fahy. 'You can have a really big slipped disc that looks terrible on a scan but doesn't cause much pain and you can have a small slipped disc that's agonising. If you develop numbness or weakness, it means the nerve is being compressed and potentially damaged and that is something to take more seriously and accelerate.' In general terms though, treatment stages are:
Stage 1. Take pain killers – paracetamol and ibuprofen – and rest. If it's pain like you've never experienced before, see a physiotherapist, osteopath or GP. 'Pain causes muscle spasm as a protective mechanism which is very painful so a therapist can break that pain cycle with gentle manipulation and massage,' says Fahy.
Stage 2. If the pain doesn't settle, see your GP for stronger painkillers, and if after six weeks, you are not improving, see a specialist such as a spinal surgeon or pain specialist for an MRI scan.
Stage 3. The first intervention would probably be a guided steroid injection, administered in an operating theatre or radiology suite. 'It doesn't make the disc normal but it takes the heat out of the situation,' says Fahy. 'It reduces the pain caused by the gel and also reduces the swelling and some of the pressure on the nerve. That enables you to do your physiotherapy exercises and manage while nature heals in the background.'
Stage 4. If the injections have failed and the pain is unmanageable or you're developing progressive weakness, surgery is the next step. (The vast majority of slipped discs – 90 per cent – recover without surgery.) 'A microdiscectomy is usually done under a general anaesthetic with a small incision probably 2 or 3cm long,' says Fahy. 'The nerve that's under pressure is released and the escaped gel is removed.'
Recovery depends on general fitness, age and access to rehab. 'My general advice is a half hour walk a couple of times a day for the first two weeks after surgery,' says Fahy. 'Week two to week six, if the skin has healed, you can swim, cycle and drive again and start gentle exercise ideally with a physiotherapist. After that you can start more strenuous exercise, including Pilates, with a full return to unrestricted activity in three months.'
Surgery Risks
Risk of nerve injury leading to weakness, numbness and pain in the lower back or one of the legs – 1 in 100
Risk of incontinence (ranging from partial and temporary to permanent) – 1 in 1000
Risk of infection from surgery – 1 to 3 per cent
The disc can also slip again. The risk of this happening after surgery is 7 per cent. The risk without surgery is 9 per cent.
'If you have back pain, then experience numbness between the legs in the saddle area and difficulty with control going to toilet, that's an absolute emergency and you should go to A&E,' says Fahy.
Very rarely, a slipped disc compresses the nerves that control bladder and bowel function causing Cauda Equina Syndrome. Unless they are released very quickly by a surgeon, they tend not to recover. Unfortunately, in the UK, the signs are often missed and the time from onset to surgery is in the order of weeks. By comparison, in Germany, it's in the order of hours.
Five safe exercise to help you recover from a slipped disc
Participating in movement that does not excessively load the spine can help us recover faster. Our focus should be on strengthening core muscles, improving flexibility, and promoting spinal mobility. Movements should be performed slowly and with control, avoiding any movements that cause excessive pain. Always get a diagnosis of your back pain from a health professional and ensure you check if you are unsure about what movements are right for your body.
Considerations:
Gradual progression: Aim to participate in movements once a week increasing to twice – if your pain does not worsen.
Listen to your body: Some movements won't suit everyone. Avoid any movement that makes your back pain worse and stick to the ones that work for your body.
Seek professional advice: If your symptoms worsen or you are unsure what movement is right for you always check with a health professional.
When a health professional has told you it's ok to get a little more active, consider these movements:
1. Laying knee rolls
Lying on your back with bent knees, gently drop your knees to one side and then the other, keeping your back pressed against the floor. Aiming for 5-10 rolls to each side.
2. Hip Bridge
Lie on your back with bent knees, slowly lift your pelvis and back off the ground by tightening your core and glutes, front of your thighs in line with your tummy. Hold for one second and slowly return to the starting position. Repeat 5-10 times.
3. Cat – Cow
Inhale deeply while curving your lower back and bringing your head up, tilting your pelvis up like a 'cow.' Exhale deeply and bring your abdomen in, arching your spine and bringing your head and pelvis down like a 'cat'. Repeat 5-10 times.
4. Laying Half Extension or Cobra
Laying on your front with your hands facing the floor either side of your shoulders. Slowly push up so that your chest is off the floor, supported by your forearms and hands. Hold for one second and slowly lower to the starting position. Repeat 5-10 times.
5. Standing extension
Standing with feet hip-width apart, knees slightly bent and hands placed on your lower back. Gently lean back, hold for one second and return to the starting position. Repeat 5-10 times.
