Slipped Disc (Disc Herniation): Causes, Symptoms and Recovery

A slipped disc is one of the most common reasons people come to our clinic in Naas with back, neck, arm or leg pain. It is also one of the most misunderstood. The good news: most slipped discs improve well with the right advice and a structured rehabilitation programme, and surgery is rarely needed.

What is a slipped disc?

Your spinal discs sit between the bones of the spine (vertebrae). They act as shock absorbers and allow a small amount of movement between neighbouring bones.

Each disc has two parts:

• a tough, fibrous outer ring (the annulus)
• a soft, jelly-like core (the nucleus)

In a disc herniation, some of the jelly-like core pushes out through the outer fibres and can irritate or compress a nearby nerve as it leaves the spine.

“Slipped disc” is not an accurate term. The disc is firmly attached to the vertebrae above and below, so it cannot slip out of place, and it cannot be “put back in”. If someone tells you their disc was “popped back in” and the pain vanished, the pain was most likely coming from the small spinal joints rather than the disc.

Other names you may hear:

• Disc herniation
• Prolapsed disc
• Protruding or bulging disc

“Sciatica” and “pinched nerve” are often used as well, but they describe symptoms (nerve-related pain) rather than the disc itself. A slipped disc is one possible cause of sciatica.

Where do slipped discs occur?

• Lower back: the vast majority occur at the lowest two levels (L4-L5 and L5-S1).
• Neck: most occur at C5-C6 and C6-C7, the most mobile segments of the neck.

Because the nerves from the lower back travel to the legs and feet, a lumbar disc herniation can cause pain in the buttock and back of the thigh, plus numbness, tingling or pins and needles in the leg or foot. In the neck, the same process causes symptoms in the shoulder, arm and hand.

What causes the symptoms?

Researchers still debate this. Symptoms may come from direct pressure of the disc on the nerve root, from chemical inflammation that irritates the nerve, or from a combination of both. The inflammatory theory helps explain why many people improve significantly as the inflammation settles, even when the disc itself is still visible on a scan.

What causes a slipped disc?

Discs change gradually over years, even though symptoms can start suddenly (a cough, a bend, a lift). Common contributing factors:

• Poor general fitness and deconditioned trunk muscles
• Prolonged sitting
• Lack of regular exercise
• Excess body weight
• Repeated bending and twisting, particularly in physically demanding jobs such as building work
• Age-related changes

A note on scans: disc degeneration is a normal part of ageing, much like grey hair. With age, discs lose water and height. Degeneration on an MRI is very common in people with no pain and is generally nothing to worry about. Nerve pinching from this process is uncommon.

Stages of disc injury

1. Disc bulge: the disc bulges, but the outer fibres are intact and the core has not broken through.
2. Disc herniation: the core pushes through the outer layer and may irritate a nerve root, producing neck or back pain that radiates into the arm or leg.
3. Disc extrusion (prolapse): the outer layer ruptures and part of the core escapes. The nerve is more likely to be compressed, which can cause marked arm or leg symptoms and muscle weakness.

Patients are often surprised when their back or neck pain eases at this stage while leg or arm pain, numbness or weakness takes over. In severe cases, weakness can cause foot drop (difficulty lifting the foot).

Symptoms of a slipped disc

• Dull or sharp pain in the neck or lower back
• Pain that worsens with bending, sneezing or coughing
• Severe muscle spasm in the neck or back
• Cervical radiculopathy: pain, burning, tingling or numbness in the arm
• Sciatica: pain, burning, tingling or numbness in the leg
• Weakness in the muscles supplied by the affected nerve

Lumbar disc: pain in the low back and buttock, sometimes with numbness or tingling down one leg, worse with bending, lifting, sneezing or coughing.

Neck disc: pain in the neck that travels to the shoulder and arm, often worse when looking down, coughing or sneezing.

Muscle weakness can signal a more significant herniation. In the lower back, you might struggle to walk on your toes. In the neck, weakness of the hand can make holding objects difficult.

When to seek urgent medical help

Attend your nearest emergency department or contact your GP immediately if you have a back problem along with any of the following:

• Loss of bladder or bowel control, or difficulty passing urine
• Numbness around the genitals, buttocks or inner thighs (“saddle” numbness)
• Unsteadiness or new difficulty walking
• Rapidly worsening leg weakness

These can be signs of cauda equina syndrome, a rare but serious compression of the nerves at the base of the spine that needs urgent assessment.

How long does it take to recover from a slipped disc?

This is the million-euro question. Disc herniations vary enormously in severity and symptoms, so recovery differs from person to person.

As a guideline, plan on an initial rehabilitation phase of 6 to 12 weeks. This gives a good indication of how well you respond to physiotherapy, and future progress can be predicted with more confidence from there. In the vast majority of cases, symptoms have clearly improved by this point.

Luckily, you can take steps to reduce the odds of reoccurence. This is borne out by research demonstrating a massive reduction in low back re-injury rates in those who undergo specific rehabilitation programmes.
After 12 months re-injury rates were 30% in those who had undergone a rehabilitation programme versus 80% in those who had not.

Do I need surgery?

Rarely. Clinical guidelines generally reserve surgery for people who:

• have progressive neurological deficits (worsening weakness or numbness),
• have changes in bladder or bowel function (an emergency, as above)
• have progressively worsening pain that has not decreased in severity

How is a slipped disc managed?

Treatment is guided by your assessment, but typically includes:

• Education and reassurance about what is (and is not) happening in your spine
• Gentle spinal mobilisations and manual therapy to settle pain
• Activity modification and ergonomic advice
• A graded exercise programme to restore movement and strengthen the trunk
• Guidance on gradually returning to work, sport and daily activity

Reducing the chance of it coming back. Although symptoms can appear suddenly, the underlying changes build up over years. Movement, general health and trunk strength all matter. Research on low back pain shows rehabilitation makes a real difference to recurrence: in one study, re-injury rates at 12 months were 30% in those who completed a specific rehabilitation programme versus 80% in those who did not.

Is there evidence for spinal manipulation in disc herniation?

One of the better-known trials is Santilli et al. (2006), a randomised, double-blind trial of active versus simulated spinal manipulation in 102 patients with acute back pain and sciatica due to disc protrusion (53 received manipulation, 49 received simulated manipulation).

The manipulation group had more pain-free patients:

Mean pain scores (VAS) were also lower in the manipulation group, and no side effects were reported. The authors concluded that it provided Level I evidence that manipulation was more effective than sham for acute (under 10 days) lumbar disc herniation with radiculopathy.

Reference: Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6(2):131-137. https://pubmed.ncbi.nlm.nih.gov/16517383/

Slipped disc treatment in Naas

If you think you have a slipped disc, an early assessment helps you understand what is going on, rule out anything serious and start the right rehabilitation. We see patients from Naas and across Kildare.

Book your appointment with Naas Physio & Chiropractor Clinic: Book Appointment

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