Disc schmisk - Have you slipped one? What does it mean? Can I help?

I'm going to get it out there.  I can't help your slipped disc!  A slipped, or herniated, disc is a protrusion of the soft inner matter of the intervertebral disc, through the outer fibrous layer and no amount of osteopathy (or anything else) is going to poke it back in.  That doesn't mean I can't reduce your pain or increase your function as you deal with a slipped disc.

Slipped discs 101
As I mentioned above, the slipped disc occurs when the outer fibrous part of the intervertebral disc, the annulus fibrosis, breaks down and the fibres fray and part, allowing the inner liquid, nucleous pulposus, to create a bulge in the wall of the disc and sometimes to extrude.  As the bulge occurs and some of the matter from the centre of the disc is displaced outwards the disc loses height and the ligaments muscles etc acting over the joint are all now too long to provide full stability, the body can respond to this perceived instability by tightening up all of the muscular tissue around the joint to protect it and make it immobile, this can be painful and can impair function.  The loss of disc height and tightening of muscles can also bring into contact other structures which are meant to sit in close proximity but not touch, and they can become irritated and inflamed, as a result.  The most common pain that suggests a possible slipped disc is pain down the leg...so called sciatica...I say, 'so called' because a true slipped disc will cause irritation to a nerve root instead of to the peripheral nerve (sciatic or otherwise) and the pattern will be slightly different but that's nerd stuff.

I have had patients tell me that their problem is due to a slipped disc...it must be...I had an MRI and the report says I have a slipped disc at L1-L2, the trouble is, their symptoms are consistent with S1 nerve root irritation...nerd stuff again...basically the slipped disc is far too high to give them the symptoms they are experiencing.  27% of over 40s without symptoms have herniated discs, maybe in multiple, so this tells us that many herniated discs don't cause pain.

Back pain, even back pain that mimics a 'slipped disc', can be caused by many different dysfunctions, either singly or in multiple.

What does this tell us?  That there is a lot of uncertainty in diagnosis and even more in prognosis.  So why bother to try and work out whether an injury is discal in origin?

The first is an issue of safety.  Disc prolapses are usually painful rather than dangerous but sometimes they compress the nerves in the spinal canal (another nerdy fact, the spinal; cord ends before the low back and here the nerves in the spinal canal are called the cauda equina as they run separately like the hairs in a horses tail).  If there is a likely disc prolapse it is useful to make the patient aware of the symptoms to look out for if rare but dangerous cauda equina syndrome is occurring.  Secondly, I would modify my techniques where I suspected a disc prolapse.  The chances of an osteopathic technique exacerbating a disc issue are slim but let's reduce that chance even further by selecting techniques that minimise the risk.  Finally, the patient needs to know the possible prognoses (plural), a disc herniation can take a long while to heal and may not respond to osteopathic treatment, the chance of a complete cessation of symptoms in the short term is lower than for some other types of back ache, that doesn't mean it can't happen but it is important that the patient has realistic expectations of treatment.

Overall I have been pleasantly surprised how well many patients who have had classic slipped-disc symptoms and signs have responded to treatment despite the fact I can't 'pop the disc back in'