To begin with slipped disc I want to tell you that a major part of the world population suffers from back pain. But people don’t know why did they get this pain. Sometimes they think it is normal pain that will go away. But they don’t know it may be very severe pain for them in upcoming age. It may be due to many reasons such as lifting of heavy weight, unhealthy lifestyle, wrong sitting position etc. But it may also be due to slipped disc or sciatica that may be asymptomatic in the initial stage. It may show it’s symptoms with ageing. So here we will discuss about everything you should know about slipped disc problem which is very painful and patient likes to die than to live.
Slipped disc ( Sciatica )
Slipped disc ( sciatica ) is also known as prolapsed intervertebral disc in medical terminology. It is also called as herniation of lumbar or cervical disc. But what does it mean ? You know there is a rod shaped straight organ in the back portion of the human body which is known as spinal cord. This spinal cord is protected and surrounded by some short bones which are hollow having a circular shape known as vertebrae. Generally hernia or herniation means enlargement of an organ. So these vertebrae are fixed in one below one pattern having a pillow like material between them. It is known as the disc. This pillow like material have lot of protein based liquid ( paste ) and made up of type-1 and type-2 collagen, proteoglycan and hyaluron long chains that works in shock absorption and support the vertebrae. Disc also supplies nutrition to the vertebral column and performs many other functions too.
Sometimes disc’s internal liquid material ( nucleus pulposus ) leaks out of the vertebrae due to over pressure. When this leaks out it goes to spinal cord and vertebral region and start rupturing the organ. It also start generating pressure to the nerves and other parts of vertebral column. So in a nutshell the slipped disc means coming out the liquid material from the disc to it’s periphery ( herniation ). Always remember slipped disc never means a completely detachment of disc, people don’t know about it so they take it in a wrong way.
Slipped disc is commonly affects those people who bends forward repeatedly and that to with spine. As you know there are two types of forward bending. One in which you bend with the help of your hips and second forward bending with the help of your spine ( back ). Like brooming, lifting something from the floor etc. Those who repeatedly do such forward bending many times a day may develop slipped disc problem. Kindly do remember slipped disc problem doesn’t develop in a single day. It takes times to develop when you repeatedly bend forward for a long time. So if you suddenly get pain in your lower back it would be meaningless to say that it has developed due to slipped disc. But if anybody has got accident and badly injured then it may result in slipped disc. But overall slipped disc develops over the period of time after first symptoms of lower back pain.
Stages of slipped disc
1. First stage – It is the disc degeneration stage. In this stage the water content of the disc goes decrease. The tear annulus of disc gets some tiny holes in it. Due to this the nerves and blood vessels in the periphery of disc get irritated and you feel pain.
2. Second stage – It is the annular tear stage. In this the tear in annular fibrosus occurs. MRI shows HIZ ( high intensity zone ) in white colour. Bulging of disc can be seen in the MRI.
3. Third stage – This is known as the disc protrusion. The accumulation of the material of nucleus pulposus into the annular fibrosus.
4. Fourth stage – Stage of extrusion. In this the falling of disc’s material from the nucleus pulposus into the spinal canal and irritate the nerves. This stage is also referred to as herniation of discs.
5. Fifth stage – It is the stage of disc sequestration. It is the last stage of slipped disc in which the ejected material floats into the spinal canal and pressurizes the associated parts. Results in chronic pain and failure of urine control and bowel movements etc.
Some facts about slipped disc
1. It is more common in males than comparison to female. So males are more prone to develop slipped disc problem.
2. Out of 1000 people with back pain, 5-20 % of them will have back pain due to slipped disc.
3. Generally the chances of developing slipped disc is more in people age between 30-50 years.
4. Evidently it is seen that this problem doesn’t show symptoms in many people for longer time. It means if you find out the diagnosis of this disease in CT Scan or MRI scan you will see it in the report. But the patient doesn’t show any symptoms in the initial stage for a long time. It is because the liquid or paste that has been leaked from the disc doesn’t irritate the nerves. But with time it starts to show symptoms as lower back pain.
5. The most common sites of slipped disc problem are the neck and the back. Out of these two back slipped disc problem is more common.
What are the common sites of slipped disc ?
You know our body has a vertebral column ( series of spinal bones ) which is divided into 4 parts like cervical ( from cranium to neck ), thoracic ( upper back ), lumber ( the actual region of slipped disc ) and sacral ( tail ). There are 23 spinal discs in our vertebral column, cervical spine-6 discs, thoracic spine-12 discs and lumber spine-5 discs. Basically the problem of slipped disc is majorly associated with lumbar region ( between L4 and L5 ). The disc between L4 and L5 is mostly affected and more common. Further the chances of developing this problem between L5 and S1 is also common after previous one in lumbar region. Almost 95% of patients have impact on L4-L5 and L5-S1. For cervical region C5-C6 and C6-C7 is most common site ( 0.15% to 4.0% of cases )
- Back pain – The first sign of identification. But some patients have no back pain but found with tingling numbness in the feet.
- Pain radiating to legs – Patient feels sensation as electric shock in the legs.
- Weakness in legs
- Some people may have all symptoms along with back pain.
- Difficulty in walking – patient feels tiredness even at short distance.
Generally the diagnosis of slipped disc can be done visiting a orthopaedic surgeon. He will physically examine the patient. Then the doctor will take history of patient. He will gently pull the areas where you feel the pain. He will do the provocative test ( a test in which patient pain is examined where the patient is feeling the pain ). Then doctor will understand which nerve has the problem. Along with all these he may also suggest you to go with testing like X-rays, CT Scan, MRI, EMG etc.
Pathology of slipped disc prolapse
- Excess stress applied to spine
- Stress injures the disc annulus ( ring structure )
- Hernia forms and bursts
- Disc material ejected through tear in annulus
- Additional irritation caused by ejected disc material
Conditions that shouldn’t be taken similar to slipped disc
Some diseases are there that give you the exact symptoms similar to slipped disc. A wise doctor shouldn’t get confuse while treating a SDD patient. These conditions should be addressed clearly distinct from SDD ( slipped disc disease ). These conditions are as follows :
1. Lumber Spondylitis
It develops due to ageing. As the age of the person increases the gap between two vertebrae increases due to degeneration of spinal cells.
2. Ankylosing Spondylitis
As you know it is an autoimmune disorder in which spinal cord becomes so hard like a bamboo stick. As a result the patient feels back pain.
3. Cuada Equina Syndrome
It is an autoimmune disorder that usually occurs in a person by birth. Cuada equina is the end part of the spinal cord where a bunch of many nerves accumulated. Sometimes it gets pressure and sometimes it has deformities. But it is mostly associated with neurological science because it results in loss of urine control, gall bladder secretion control etc.
4. Mechanical Low Back Pain
Sometimes muscles of the back get strain or pull, hence patient feels severe back pain. Now patient thinks that he has got slipped disc which is not true.
5. Mechanical and Arthritis
Sometimes patient has already arthritis and severe mechanical back pain due to pulling of muscles. Now patient complains he has severe pain in back and legs which will make a doctor confuse diagnosing wheather it is slipped disc or other.
6. Myofacial Pain
As the name suggests myo means myosin ( protein in the muscle ) and facial means the starting point. So myofacial pain is the pain due to development of nodules in the nerves that supply the muscles. It will also result in back pain.
On the basis of modern medical science the treatment of slipped disc may be divided into three parts :
1. Medical management
It includes usually medicines such as anti-inflammatory ( NSAIDS, steroids ), pain inhibitors ( Analgesics ), Epidural block ( injection given to the nerve to block it to minimize pain sensation ). All these come under conservative management. Result is seen within treatment of 6 weeks.
2. Surgical management
If none of the treatment is beneficial and giving effect to the patient, the surgery is the last option. If patient is feeling very severe back pain, unable to walk, facing issues in urine control etc. Then a patient may have to go with surgery. This is an endoscopic surgery which is also known as key hole surgery. A minor incision is given to the patient’s back. It takes only 2 hours to complete the surgical procedure. The patient gets immediate relief from the pain.
This treatment has been proved to be a boon for sciatica pain ( slipped disc problem ). By giving physiotherapy treatment to the patient we can cure it permanently. So whenever a patient visits to a physiotherapist with the sciatica pain the doctor gives pain reliever therapies to the patient like electrical modalities, thermotherapy, mobilization and manipulation technique, dry needleing, cupping therapy etc.
Apart from machines next is positioning of patient which includes how to walk, how to sit, which exercise should be avoided which shouldn’t be, what activities should do which shouldn’t. It includes ergonomic modification and counselling, increase muscle flexibility etc
- Don’t wake up or sit with a jerk.
- Avoid lifting heavy weight.
- Ignore sudden to sting bending movement.
- Whenever you sleep or wake up. always do this with the help of rolling.
- Step up or step down carefully and stay away from pushes.
- Don’t do forward bending repeatedly.
- Avoid travelling.
- Don’t sit in same position for long time.
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