The Great 'Slipped Disc' Myth: Let’s set the record straight!

You know that moment, the moment when you bend down to do that trivial thing and you get that feeling.

Yes THAT feeling…

THAT feeling that something is about to go.

But THAT something is your back and in that moment multiple thoughts flying through your mind: 

Can I get out of this position before it goes?

If I could just move like a Transformer, maybe I can stop it from slipping?

To the “oh no, it is too late! My back is slipping!  There is no hope for me, may as well leave me behind and save yourselves”.

And then BAM!

You felt it, you heard it (you are sure at least one other person around you heard it) and you know, deep within your soul, your disc has slipped. Like a penguin on a banana peel on ice, your disc has slipped. It has relocated from its existing post code to another; unfortunately the new post code doesn’t want a new neighbour and starts mailing the council in protest. That is your slipped disc ramming itself straight into its neighbouring nerve, sending every kind of lightening and electrical pain down your back and into your leg. 

And then you think, “who am I you going to call???”

Does this sound familiar? Have you slipped a disc? Have you ever been told that you have slipped a disc? Have you heard someone tell you their experience of slipping their disc? The one problem with this is that

DISCS DON’T SLIP!

The idea that a disc can slip has most likely come from someone trying to explain a complicated structure in the simplest terms possible, or simply because that is the way it can feel. 

But thankfully, discs are not that fragile!  Discs are actually incredibly strong structures. They may bulge, herniate, extrude or sequestrate, but they definitely don’t slip!

So here’s a bit of anatomy for the nerd in all of us: 

The intervertebral disc, AKA ‘the disc’, is situated between two bony vertebral bodies. There are 23 discs in your spine, and each disc has 3 components namely: 

·         THE NUCLEUS (The gelatinous stuff in the middle of the disc) 

·         THE ANNULUS (The strong connective tissue that wraps around the disc)

·         CARTILAGE ENDPLATES (These plates form a very strong attachment from the disc to the vertebra above and below)

Imagine your disc is like a yummy jam doughnut; a tougher outer shell that surrounds a jam centre. The discs however, are way more complex (and robust) than a doughnut! But just bear with us. The jam on the inside of our discs is called the nucleus pulposus and it is made up of proteins that love to hold onto water. In fact, the nucleus is made up of nearly 80% water!

The denser outside layer of the disc is called the annulus and is made up of multiple overlapping layers of collagen fibres. Think of an onion with rings, but that each layer is oriented in a slightly different direction which allows the disc to resist forces from all directions as well as compressive forces from gravity and the weight of the spine and body pressing down on it. The most outside layer of the disc, cartilage endplate, is attached to the vertebrae above it and below it which prevents the disc from moving forward, backward, or side to side. These endplates are very important as they allow for the flow nutrients to the disc as well.

Then to add another layer of protection to the disc to the front and back aspects we also have the anterior and posterior longitudinal ligaments which run the entire length of the spine and provide even more stability to the disc. 

There we have it, a yummy slightly oniony flavoured jam doughnut! 

So, what does happen to the disc and why does it feel like it slips?

Sometimes we may have a sudden trauma which can overcome the resistant structures of the disc and cause the nucleus (jam) to shift through the annulus which results in injury and compression onto the nerve. But most often, it is the slow and repetitive daily movements along with poor posture, poor spinal stability and poor nutrition/hydration that will cause the annular rings to develop weak zones. Because the nucleus can shift, it may start moving into those weak zones and start to deform the outer layers of the annulus resulting in a disc bulge.

These bulges can be normal and are often found on MRIs in people with no pain whatsoever. However, with poor nutrition, poor spinal stability, and chronic poor posture, the disc will continue to degenerate and the bulge will continue to get bigger. With time, more of the inner annular fibres will start to tear, the nucleus can now push further into the outer annulus, but it hasn’t shifted completely out yet. We now have a disc herniation/protrusion. It is at this point you may start to experience intermittent episodes of pain or tingling sensation along the distribution of the nerve that the disc is approximating.

The disc is weaker now and it takes less force to result in the disc progressing even further and eventually pushing past the final layers of the annulus resulting in a disc extrusion.  This is most likely the point where most people think they have ‘slipped a disc’ because the outer layer of the disc has a nerve supply, it is very painful as it tears. The nucleus is no longer fully contained and may now shift outwards into the spinal spaces. If a piece shifts completely away from its original disc that is called a disc sequestration. This is the more serious condition and may require surgery.

Okay, now for some good news. 

As Chiropractors, when we look at imaging studies, there are about 5-10% of all the people with back pain that will have structural issues that can be related back to their back pain and only a small percentage of these will be due to issues with the discs. We often see disc bulges and protrusions in lumbar discs in people who don’t have any back pain at all and in fact these changes seem to be a normal occurrence as we get older. So remember: You are not an imaging study, don't let people scare you with findings on imaging!

We also know that depending on which direction disc bulges and protrusions are pushing out, your body’s immune system has the ability to remodel the disc by eating away any excess material pushing out which can reduce and remove the bulge or protrusion over time naturally.

We do know however that shearing and twisting movements are much more likely to injure discs, just as spraining your ankle. This is why it is not a good idea to lift heavy items off of the ground by twisting and bending your back or staying in those awkward twisted postures.

So how do we prevent this from happening in the first place?

1.      Good nutrition and hydration are key to maintaining proper tissue health and flexibility. 

2.      Using correct lifting and loading techniques while exercising or performing normal daily activities will decrease the amount of stress placed on a disc. Avoid beding to far back when carrying heavy objects or squatting and don’t only twist and bend to pick up something.

3.      Maintaining proper spinal stability and mobility is vital to prevent overcompensation of muscles and to keep the disc well hydrated.

4.      Your back and its discs are incredibly strong. You don’t need to fear movement!

So now I ask, who are you going to call???

Us! At CoreHealth Chiropactic we want to keep your spine in the best possible condition to prevent injuries and damage caused by poor posture, lack of nutrition and lack of mobility. So give us a call and we will strive to help you prevent and also manage any oniony-jammy issues that might be going on under the surface!

‘til next time,

Brenda x