Slipped disc

The vertebrae in your spine are separated by discs, which contain soft, cushioning tissues. Each disc has a hard outer shell and a soft tissue centre, and they help to keep the spine flexible. If there’s a weakness in a disc’s outer shell, tissues can bulge out, pushing against a spinal nerve. There may also be inflammation and swelling which can put pressure on a spinal nerve. This can trigger severe back pain, often lower back pain.

A slipped disc can happen in any part of your back. They most often occur in the lumbar spine which is the lower part of your back. The size of a slipped disc can also vary but generally the larger the bulge, the more severe your symptoms will be.

Usually, the painful symptoms of a slipped disc will gradually improve over a few weeks with rest, gentle exercise and some painkillers. However, if the pain continues and is affecting your daily life, your GP may recommend treatment.

Although back pain is a common issue, less than one in 20 cases are caused by a slipped disc. A slipped disc is more likely if you’re 30–50 years old, with men twice as likely to be affected. Factors which increase the risk of a slipped disc include:

• Occupations involving lots of lifting or sitting
• Weight-bearing sports such as weightlifting
• Smoking
• Being overweight
• Being inactive
• Over-exercising
• Driving or operating heavy machinery

However, if you already have a weakness in one of your discs, even something as simple as a sneeze or awkward movement can cause a slipped disc.

If you have a slipped disc, the first sign is often sudden, severe back pain. You may find that the pain can be eased by lying still, or made worse if you move your back, cough or sneeze. Spinal stenosis can also be an indication of a slipped disc.

Other symptoms include:

• Tingling and/or numbness in your shoulders, back, arms and hands
• Neck pain
• Back pain
• Sciatica – pain, tingling and/or numbness in your buttocks, hips, legs and feet resulting from pressure on the nerve in your spine
• Loss of muscle strength
• Problems bending or keeping your back straight

In some cases, a slipped disc won’t cause any symptoms and you may not know that you have one.

Sciatica occurs when the slipped disc puts pressure on the sciatic nerve. The sciatic nerve is made up of lots of smaller nerves that travel from the lower back, into the buttocks and down the back of each leg. This is why you may feel pain from the lower back through to the feet.

Your pain may be the result of another injury such as a strain or sprain, although there’s often no obvious reason. Back pain is rarely caused by anything serious.

There’s a rare nerve condition which affects the base of the spinal cord called cauda equina syndrome. Contact your doctor immediately if you have increasing back and leg pain accompanied by any of the following symptoms:

• Bowel or bladder problems
• Numbness around the bottom of your spine
• Weak leg muscles

Slipped disc symptoms usually improve over a few weeks as the tissues that have spilled against the nerve start to shrink. Around three quarters of cases improve after four weeks. After a month, if you still have severe back pain or sciatica, make an appointment to see your GP.

During your appointment, your GP may ask you to raise your arms or perform some leg exercises to help pinpoint the location of the slipped disc. Following the examination, your GP may prescribe muscle relaxants, anti-inflammatory painkillers or a steroid injection. They may also suggest spine-strengthening exercises, physiotherapy or spinal manipulation.

If your symptoms are very severe, your GP may send you for an X-ray or MRI scan. This will reveal the location and severity of your slipped disc and will help rule out degenerative disc disease.

Initially, you can help relieve the severe back pain caused by a slipped disc by:

• Continuing as normal – don’t stop doing your usual activities unless it’s painful. You may find it helpful to set yourself daily goals and sleep in the most naturally comfortable position
• Taking over-the-counter painkillers and anti-inflammatories – such as aspirin, ibuprofen, paracetamol and low-dose codeine. Muscle relaxants and medication for neuropathic pain may also be helpful
• Alternating between applying ice packs and heated pads to your back
• Gradually increasing your daily activity levels – exercise can help to reduce pain and speed up recovery by strengthening the supporting muscles of the spine. Keeping active in the long term can also reduce the chance of a slipped disc recurring

If your symptoms continue for a month, contact your GP. You should also contact your GP if you have back pain and:

• Painkillers are not helping
• A very high temperature or feel hot and shivery
• Unexplained weight loss
• Swelling in your back
• The pain is worse at night

Your GP may recommend treatment or refer you to a consultant. Your consultant will discuss your options, including surgery, although this is usually only recommended for severe back pain and muscle weakness or numbness.

During back pain surgery, the portion of the disc that has prolapsed will be cut out and this will release the pressure on the spinal nerves. The procedure will carry some risks and this will be explained to you in more detail.

Your GP may suggest osteopathy as an alternative treatment for your back pain. Osteopaths use physical manipulation, stretching and massage to relieve the pain. Your GP may also recommend an epidural injection into your back, which contains a local anaesthetic and an anti-inflammatory steroid. The injection acts as a long-term painkiller.

One way to prevent a disc slipping is adopting a healthy lifestyle by keeping active and exercising regularly. If you smoke cigarettes, it’s a good idea to stop because nicotine weakens the disc tissue. You should also be sensible when using your back. If you have to lift a heavy object you should use a safe lifting technique or ask somebody to help you.

What does a slipped disc feel like?

A slipped disc often feels like sudden, severe pain in the lower back. It may be worse when you move your back, cough or sneeze. In some cases, you may not feel any pain at all.

Other symptoms include:

• Tingling or numbness in your shoulders, back, arms and hands
• Neck pain
• Pain, tingling and/or numbness in your buttocks, hips, legs and feet resulting from pressure on the nerve in your spine
• Loss of muscle strength
• Problems bending or keeping your back straight

How long does it take for a slipped disc to heal?

In most cases, the disc will start to heal and the pain will improve over a few weeks. Around 50% of people with a slipped disc find that the condition starts to improve within 10 days, and 75% after four weeks. If you still have pain after a month you should contact your GP.

Can you still work with a slipped disc?

You may still be able to perform some tasks with your back pain but if you have a job that requires manual labour then it may be difficult. If you have any concerns about how your back pain is affecting your work, you should speak to your employer and GP.

What should you avoid if you have a slipped disc?

If you have back pain, you shouldn’t rest in bed because this can make your back stiff and weak. Instead, you should continue with your usual activities as far as possible to build up muscle strength and flexibility. You should also sit in chairs that give you the correct amount of support and you may need a cushion to support your lower back – although you should avoid long periods of sitting. You’ll probably be able to continue with a number of your day-to-day activities, but you should always stop if something causes pain.

How should you sleep with a slipped disc?

You should try and sleep in the position that’s most naturally comfortable for you and doesn’t cause any pain. There isn’t one best position.