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Is my back in bad health? | 5 min reading time

Slipped disc? No need to panic.

Written by Theresia Lechner
Bandscheibenvorfall an Hand der Wirbelsäule mit Nerven gezeichnet

Unfortunately, when it comes to discussion around slipped discs, you hear the wildest stories and convictions. Disseminated via the Internet and by well-meaning relations and “wannabe” doctors. Only in the rarest of cases are these “insights” based on the latest scientific evidence. For example, did you know that a very large number of slipped disc cases are not linked to back pain? No? Then get ready for some evidence-based and surprising information.

Slipped discs – the most common cause for back pain?

When talking to colleagues, relatives and friends, you often get the impression that slipped discs are the number 1 cause of back pain. In actual fact, 70% of back pain cases are non-specific. That means that no one really knows where the pain actually comes from [10].

In total, just 4% of back pain instances in the lower back are actually caused by a slipped disc [10]. 

Before we delve any further into the topic of pain and slipped discs, here is a brief explanation of what exactly a slipped disc is.

The intervertebral disc doesn’t actually slip anywhere

If your intervertebral disc has just been a vague notion for you so far, then why not read this article about the function of the intervertebral disc, before reading any further on this page. That might make reading this article a bit easier. 

From a physiological perspective, the term slipped disc isn’t quite right, as your intervertebral disc as a whole stays where it is. In other words, it doesn’t just slip out or to the front. It is more a case of the outer ring of the intervertebral disc becoming brittle and getting small tears, due to increasing age and strain. So it is no longer able to maintain the required tension as well as before. The gel-like core of the intervertebral disc then presses into the tears [1,2].

Your intervertebral disc may swell a bit when this happens, which increases its diameter in the direction of the nerves and spinal cord. When this happens, it is know as a disc protrusion. If this continues, the gel-like inside of the intervertebral disc may “leak” through the tears and then “flow” towards the spinal cord/spinal nerve [1,2].

And voilà: you have a slipped disc or a prolapsed disc [1,2].

Bandscheibenvorfall von cranial gezeichnet
Slipped disc (viewed from above) to the right hand outer side (blue), which irritates the spinal nerve (yellow).

How does a slipped disc manifest itself?

As a general rule, one can say that for up to 20% of people under 50, an intervertebral disc protrusion will show up on an MRI scan. However, these people will not show any symptoms at all. No back pain. No numbness. No muscular atrophy [3-9].

If you are over 75, the probability of you having a disc protrusion that doesn’t actually cause any problems even increases to up to 75% [9].

Even in the case of a slipped disc, at least 3 in 100 people don’t notice anything at all [3-9]. And as already mentioned above, only 4% of all back-related symptoms, such as pain, can be traced back to a slipped disc [10].

Therefore, the probability that your back pain stems from a slipped disc or disc protrusion is very low.

But what if I belong to the 4%?

Depending on where the slipped disc is, all sorts of problems can then arise. And depending on which nerves are being irritated by the protruding intervertebral disc material, there are certain muscles that might be weaker. Or even skin parts that feel numb or funny. A further symptom is radiating pain in your arms or legs/bottom. To assess this more closely, you need to have a detailed conversation with your GP and undergo a physical and neurological examination [11].

But what you almost never need is an MRI or an X-ray [15]. You are even advised against having one of these, as it has been established that an image can have a negative effect on your attitude towards your back pain [10].  It is important to know that even back pain that comes with neurological symptoms (i.e. discomfort, weakened muscles or radiating pain) usually improves all by itself within the first 4 weeks [12,13]. It is important that you remain activemove around within your capacity, and go back to work [11].

The woman with the slipped disc but no back pain whatsoever

To make it even more clear that even a slipped disc with symptoms doesn’t mean unbearable back pain, I would like to tell you a short story encountered in physiotherapy practice. I once had a young patient who, whilst shaving her legs, had noticed a small numb patch on her lower legNothing else. No pain. Nowhere. After conducting an MRI scan of her back, it turned out that she had slipped a disc in her lumbar spine. So you see, a slipped disc in no way has to signify the start of a life of pain.

Beinrasur gezeichnet mit zwei Beinen und einer Hand im Bild
Sometimes you don't notice the slipped disc until you shave your legs

Don’t you have to have an operation with a slipped disc?

It is now known that in the case of patients who are operated on at an early stage (within the first 48 hours), the pain and neurological symptoms return much more quickly than in the case of patients who are operated on later or not at all. However, after a year, there is no longer any significant difference between patients who have been operated on and those who haven’t [11].

The only case in which an operation is actually urgent is when a patient has cauda equina syndrome. This is when the protruding intervertebral material presses directly onto the spinal cord. But there is no need to panic, as this syndrome occurs in only 0.04% of people with back pain [10]. If you become aware of the following symptoms in your own body, you should see a doctor as soon as possible [11]:

  • Bladder-rectal disturbances (suddenimpotence, flaccid paralysis and the unintentional loss of stool and/or urine)
  • Saddle anaesthesia (change in sensation in the inner buttocks area or thigh area, such as tingling, sensitivity to cold or heat and numbness)
Reithosenanästhesie gezeichnet
Saddle anaesthesia – you notice sensation changes in the blue area when you have cauda equina syndrome

What you have learnt about slipped discs

You now know that a slipped disc does not necessarily go hand in hand with back pain and that it occurs rather infrequently. You have also learnt that your intervertebral disc cannot really “fall out” and that most instances of back pain (even in conjunction with neurological symptoms) get better by themselves after 4 weeks, and therefore do not necessitate an operation. Regardless of whether you have a slipped disc or not, it is important to stay active.

Back up your knowledge

Regular jogging (20-40 km per week) or long-distance running are associated with an improvement in the state of your intervertebral discs. The supply of both fluids and nutrients, and the thickness of the intervertebral disc benefit from regular running. The ideal speed for your intervertebral discs is between 5.5 km/h and 9 km/h [14].

Important to note:
This article contains general recommendations only and must not be used for self-diagnosing or self-treatment. It is not a replacement for visiting your GP.

[1] Frost, B.; Camarero-Espinosa, S.; Foster, E. (2019): Materials for the Spine: Anatomy, Problems, Solutions. In: materials(Basel). 12(2): 253. 

[2] Krämer, R.; Matussek, J.; Theodoridis, T. (2013): Bandscheibenbedingte Erkrankungen. Ursachen, Diagnose, Behandlung, Vorbeugung, Begutachtung. 6. Auflage. Stuttgart: Georg Thieme Verlag.

[3] Brinjikji, W.; Diehn, F.; Jarvik, J.; Carr, C.; Kallmes, D.; Murad, M.; Luetmer,P. (2015): MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta- Analysis.

[4] Matsumoto, M.; Okada, E.; Toyama, Y. (2013): Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects. Eur Spine J. 22:708–13.

[5] Al-Saeed, O.; Al-Jarallah, K.; Raeess, M. (2012): Magnetic resonance imaging of the lumbar spine in young Arabs with low back pain. Asian Spine J. 6:249–56

[6] Bennett, D.; Nassar, L.; DeLano, M. (2006): Lumbar spine MRI in the elite-level female gymnast with low back pain. Skeletal Radiol. 35:503–09.

[7] Boos, N. ; Rieder, R.; Schade, V. (1995): 1995 Volvo Award in clinical sciences: the diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine Phila Pa. 20: 2613–25.

[8] Takatalo, J.; Karppinen, J.; Niinimäki, J.(2012): Association of Modic changes, Schmorl’s nodes, spondylolytic defects, high-intensity zone lesions, disc herniations, and radial tears with low back symptom severity among young Finnish adults. Spine Phila. 37:1231–39.

Und noch mehr Quellen

[9] Boden, S. ; McCowin, P. ; Davis, D. (1990): Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects: a prospective investigation. J Bone Joint Surg Am. 72:1178–84.

[10] Wáng, Y., Wu, A. M., Ruiz Santiago, F., Nogueira-Barbosa, M. H. (2018). Informed appropriate imaging for low back pain management: A narrative review. Journal of orthopaedic translation15, 21–34.

[11] Glocker F. et al, Lumbale Radikulopathie, S2k-Leitlinie, 2018; in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien (abgerufen am 24.04.MM.2019) .

[12] Pengel, L.; Herbert, R; Maher, C.; Refshauge, K. (2003): Acute low back pain: systematic review of its prognosis. BMJ.327:323.

[13] Vroomen, P.; de Krom, M.; Knottnerus, J. (2002): Predicting the outcome of sciatica at short-term follow-up. Br J Gen Pract. 52:119–123.

[14] Belavy, D.; Quittner, M.; Ridgers, N.; Ling, Y.; Connell, D.; Rantalainen, T. (2017): Running exercise strengthens the intervertebral disc. Sci Rep.7:45975.

[15] Glocker, F. (2018): Lumbale Radikulopathie: Klinik steht vor Bildgebung. Dtsch Arztebl. 115(37): [22].