When people think of severe back pain, they often refer to it as a slipped disc. Many cases of back and leg pain are given this label both by the patient and by their family physician. This is a misleading term and leads to confusion, since a disc is very firmly attached to the vertebrae above and below it and cannot slip.
The disc is a shock absorber between the bones of the spine. These cushions are found between all the vertebrae in the spine with the exception of the first and second vertebrae in the neck. The disc is elastic and is composed of fibrous tissue with a central capsule consisting of a gel-like material. The disc receives its nutrition from surrounding fluids when it is compressed and relaxed during normal weight-bearing.
If the spinal joints are blocked and do not allow movement to occur between the spinal segments, nutrition to the disk is decreased. It can become brittle and subject to small tears in the fibers. This eventually may allow the gel-like central part of the nucleus to bulge or protrude through the tear. This is a herniated disc, often mislabeled a "slipped disc".
If the herniation or bulge is at the side or the back of the disc, it can put pressure on the spinal nerves or spinal cord causing severe pain in the back and one or both legs as well as other symptoms. A major disc herniation may require surgery to relieve pressure on the nerve. In many cases, however, conservative therapy can be successful in resolving the problem without the need for surgery.
A great deal of confusion arises when various types of back pain are mistakenly diagnosed as disc problems. The majority of low back pain, leg pain and sciatica are not due to disc herniation. Rather, they stem from abnormal joint function in the vertebrae or the sacroiliac joints.
Even a myelogram which shows a disc protrusion may lead to unnecessary surgery. Studies show that in many cases a disc herniation found on a myelogram is not the cause of the patient’s pain and disability. Some herniations are not symptomatic. With time the protrusion corrects itself with a loss in disc height and absorption of the gel or nucleus of the disc.
Recent research has shown that the body doesn’t recognize the central disc material as its own tissue, so after a tear occurs, the body’s defense mechanisms attack the gel-like part and dissolve it. Once this occurs, there is seldom a protrusion remaining. For these reasons Dr. Kirkaldy-Willis, a well-known Canadian orthopedic surgeon, recommends conservative therapy, including spinal manipulative therapy by a qualified chiropractor, for most low back problems before considering surgery.
If you have back or leg pain, don’t assume that the symptoms are due to a "slipped disc". The majority of such problems can be successfully treated with spinal manipulation. Your doctor of chiropractic is a professional who is qualified to determine whether your case should be referred for surgery or whether a course of therapy may resolve it.