Both back pain and neck pain are relatively common conditions that we as physiotherapists treat almost every single day. Any injury to the back or neck, whether it be big or small, generally evokes quiet a lot of anxiety and worry for most people. So, it’s completely understandable that when you hear the words “slipped disc”, that you immediately feel concern. However, there are a lot of misconceptions when it comes to back pain, particularly when the pathology is disc related. For this reason, we thought it would be a good idea to debunk some of the most common myths and hopefully ease some of the fear that often surrounds back pain and disc injuries.
First let’s take a look at the anatomy of the spine
The spinal column is comprised of 33 bones that are stacked on top of one another called vertebrae, together forming a canal for the spinal cord to travel through. These vertebrae are separated by 23 intervertebral discs, which are fibrocartilaginous cylinders that act as shock absorbers for the spine. Each vertebral disc is made up of two parts: the nucleus pulposus which is a soft jelly-like centre and the annulus fibrosis which is a tough but flexible outer ring, as pictured below.
The spinal column is made up of 4 different regions:
- Cervical region (neck): 7 vertebrae
- Thoracic region (chest/upper back): 12 vertebrae
- Lumbar region (lower back): 5 vertebrae
- Sacral and Coccyx region (pelvic region): fused vertebrae
These regions create our healthy “S” shaped spinal curve, which further allows the spine to adequately absorb force. In addition to the vertebrae and intervertebral discs, the spine is also comprised of facet joints, muscles, ligaments and nerves all of which play their part in providing support, protection and promoting movement.
Common Myths Related to Disc Herniation
Now that we know a little bit more about how the spine works, we are in a better position to debunk some of the most common myths associated with disc pathologies.
Myth 1: Discs can “slip” out of place
Despite that it is commonly referred to as a “slipped” disc, it is almost impossible for a disc to “slip” out of place as discs are attached firmly by two thick ligaments, rather the more correct term is herniation. Herniation occurs when the thick outer layer (annulus fibrosis) splits and allows the gel like interior (nucleus pulposus) to spill out, which can occasionally push against the nerves in the back.
There are four stages of disc herniation:
1. Degeneration – the gel-like substance moves from the centre to the edges of the disc
2. Protrusion – the outer layer forms a bulge that sometimes presses against the nerves
3. Extrusion – some of the inner gel layer leaks out but most stays within the disc
4. Sequestration – majority of the inner gel spills out
Myth 2: Surgery is the best and only option
The thought of having surgery can be very daunting, so you will be pleased to know that surgery is certainly not the best or only option when it comes to managing back pain, in fact it is usually considered the last resort. Recent literature indicates that spontaneous regression of disc injuries can occur and completely resolve with conservative treatment. Spontaneous regression occurs in 96% of disc sequestrations, 70% of disc extrusions, 41% of protrusions and 13% of disc bulges. Furthermore, complete resolution occurs in 43% of sequestered discs and 15% of extruded discs. Although disc herniations are able to resolve on their own with time, we as physiotherapists can offer a range of treatment techniques to help reduce pain and accelerate recovery.
Myth 3: MRI and Imaging will show the cause of my back pain
Believe it or not, when it comes to back pain, what we see on an MRI rarely correlates to the symptoms experienced. In a recent study involving 1211 healthy and pain free adults aged 20 to 80 years, the prevalence of disc degeneration on MRI increased from 37% in the people 20 years of age to 96% in 80-year-old individuals. Similar astounding results were found for the prevalence of disc bulges, where 30% of those 20 years of age up to 84% of those 80 years of age had at least one disc bulge on MRI. Now, it is important to remember that all of these people who had evidence of disc herniation on MRI were completely asymptomatic, indicating that MRI results really aren’t great for identifying the cause of back pain or predicting symptoms.
Myth 4: Movement is “bad” for my disc injury
While rest may provide you with some temporary relief, prolonged rest can worsen your symptoms and it is actually exercise and movement that can aid in your recovery. Remaining engaged in regular physical activity is exceptionally important to strengthen the muscles in your back and core, to help support your back and relive your pain. At Breathe Physio and Pilates we can provide hands on care, education, movement retraining and personalised exercises to help you fully recover and address some of the potential causes of disc irritation.
If you have any further questions or would like an individualised assessment and treatment for your back pain, please give us a call on 3061 7128.
Blog and videos by Physiotherapy Student undertaking clinical placement from the University of Queensland, Australia, supervised by Principal Physiotherapist, Winnie Lu.
Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical rehabilitation, 29(2), 184–195. https://doi.org/10.1177/0269215514540919
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
Teach Me Anatomy. (2021). The Vertebral Column. Retrieved 7 September 2021, from https://teachmeanatomy.info/back/bones/vertebral-column/
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