A prolapsed disc (also called a slipped disc) is a common condition that can be painful and debilitating. The term “prolapse” means a slipping forward or down of a body part or organ. A “prolapsed disc,” then, occurs when the soft disc material that separates the vertebrae of the spine bulges out.
A prolapsed disc often causes sudden, severe lower back pain. The most common age to develop a prolapsed disc is between 30 and 50, with men twice as likely to be affected as women. However, back pain is very common and can have different causes. Less than 1 in 20 cases of sudden-onset (acute) back pain is due to a prolapsed disc. Most cases of low back pain are the result of a muscle, ligament, or other structural problem in the back.
A prolapsed disc occurs when a part of the inner, softer portion of the disc (nucleus pulposes) bulges out through a weakness in the tougher, outer portion of the disc. The bulging disc material may press on a nearby nerve coming from the spinal cord, resulting in pain. Furthermore, inflammation may also develop around the prolapsed part of the disc, which can irritate a nerve and cause swelling, resulting in pain.
Any disc in the spine can prolapse. However, most prolapsed discs occur in the lower back (the lumbar spine), which is constantly absorbing the impact of bearing the weight of the upper body. The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be.
What Causes a Prolapsed Disc?
As we age, spinal discs lose some of their fluid content. This reduction in fluid weakens the discs and makes them less supple and more prone to splitting. Furthermore, the disc is also weakened as a result of normal wear and tear over time and by repeated movement, a part of the normal aging process.
In addition to the aging of the spine, various triggers can cause the inner portion of the disc to bulge. Some risk factors include repeated heavy lifting or bending.
It is not entirely clear why some people develop a prolapsed disc compared with others who do not experience the condition. Doctors believe that some people may be predisposed to having a weakness in the outer part of the affected disc. Furthermore, a poor diet and strenuous exercise can also weaken the structures within the body, rendering them more susceptible to disc problems.
Some of the factors that may increase the risk of developing a prolapsed disc include:
Overweight (obesity). Extra weight puts additional stress on the lower back.
Driving long periods of time. A combination of being seated for long periods and the vibrations and movements of the car can damage the discs and spinal structure.
Genetics. A person might inherit a predisposition for prolapsed discs.
Back injury. A previous back injury may weaken a disc causing it to be more likely to bulge.
Occupation. Individuals with physically demanding jobs or pastimes that involve pushing, pulling, or twisting are more prone to getting prolapsed discs. Any repetitive activities that strain the spine can result in a prolapsed disc.
Older age. A disc is more likely to develop weakness as we become older.
Poor nutrition. Poor eating habits including overeating or under-eating, and not consuming enough healthy food.
Sedentary lifestyle. Extended periods of sitting and a lack of exercise can lead to a prolapsed disc.
Smoking. This can reduce the oxygen supply to the discs and help speed up the wearing down of the tissue.
Unsafe lifting technique. Incorrect lifting can lead to a prolapsed disc. You should always lift heavy objects using the legs, not the back.
Weight-bearing sports. Repeated activities like weightlifting, high-impact aerobics, and excessive jogging can weaken the spinal discs.
Prolapsed discs can occur at any age, but they are most common in men between 30-50 years of age.
What are the Symptoms of a Prolapsed Disc?
The most obvious symptom associated with a prolapsed disc is the sudden onset of severe back pain. The exact symptoms depend on where in the spine the prolapsed disc occurs and whether nerve tissues are being irritated. It is possible that there are no symptoms; however, when the disc causes inflammation, pain can occur in several parts of the body, not just the back.
The pain associated with a prolapsed disc often feels like a mild to severe burning sensation and can be associated with numbness, weakness, and tingling. A shooting pain often occurs on one side of the body and can affect either the legs or arms.
For a lower back prolapsed disc, the pain often becomes worse upon standing and lessens when lying down. This type of pain is commonly referred to as a “pinched nerve.” In severe cases, there can be muscle weakness of the lower extremities and even incontinence of the bowel and bladder (cauda equina syndrome). If the prolapsed disc is higher (in the cervical spine), the pain may shoot down one arm, and cause a stiff neck or muscle spasms in the neck.
The primary types of pain occurring from a prolapsed disc include:
Back pain. The pain is often severe and typically comes on suddenly. The pain is usually eased by lying still and is often made worse if moving the back only slightly, coughing, laughing, or sneezing.
Nerve root pain. Nerve root pain is any pain that occurs when a nerve branching from the spinal cord is pressed upon or irritated by the inflammation caused by a prolapsed disc. Although the problem is in the back, pain may be felt anywhere along the course of the nerve in addition to the back. With a prolapsed disc, the sciatic nerve is the most commonly affected nerve. It travels deep inside the buttock and down the back of the leg. This type of pain is called sciatica.
Other nerve root symptoms. The irritation or pressure on the nerve next to the spine may also cause pins and needles, numbness, or weakness in part of the buttock, a leg, or a foot. The exact location and type of symptoms depend on which nerve is affected.
A prolapsed disc can cause cauda equina syndrome (CES), a particularly serious type of nerve root problem. It is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. In addition to low back pain, this syndrome can cause:
Problems with bowel and bladder function (usually inability to pass urine).
Weakness in one or both legs.
Cauda equina syndrome requires urgent treatment to prevent permanent damage to the nerves of the bladder and bowel.
In most cases, the symptoms of a prolapsed disc tend to improve over a few weeks for most patients. About 50 out of every 100 patients improve within 10 days, and 75 out of a hundred after four weeks. Only about 2 out of every hundred people with a prolapsed disc remain in pain after 12 weeks.
If the doctor suspects a prolapsed disc, a neurologic examination can reveal abnormal reflexes that might indicate a prolapsed disc. Additional tests that can be performed include:
Blood tests to determine if there are signs of inflammation or infection.
X-rays can indicate “wear and tear” (degeneration) of the spine. They do not show the status of the discs. An X-ray can also help rule out other conditions which exhibit similar symptoms.
An MRI scan or CT scan can help determine the location of the disc and the affected nerves, or whether a disc is actually prolapsed.
A CT myelogram can help further define the structures affected by a prolapsed disc. A CT myelogram is a CT that uses contrast dye for better visualization of the discs.
An electromyogram (EMG) is a nerve test using electrical impulses that can pinpoint which nerves are being irritated by a prolapsed disc.
A discogram involves injecting dye into the soft center of one or more discs to help pinpoint cracks in individual discs.
A myelogram is the process of injecting dye into the spinal fluid and then taking an X-ray image. A discogram can show whether a prolapsed disc is exerting any pressure on the spinal cord and nerves.
How is a Prolapsed Disc Treated?
Previously, patients were instructed to rest in order to ease the pain. We now know that was wrong. Patients are likely to recover more quickly and are less likely to develop persistent (chronic) back pain by remaining active. Doctors also once told patients to sleep on a firm mattress. There is no evidence that a firm mattress is better than any other type of bed for people with back pain. Doctors now tell patients to sleep in the most natural and comfortable position, on whatever surface feels the most comfortable.
Today, doctors recommend that patients diagnosed with a prolapsed disc carry on as normal a life as possible. Patients are encouraged to move around as soon as possible. Getting back into normal activities helps the back heal. Doctors do not want patients to do anything that causes a lot of pain; however, it is important to know that some discomfort while remaining active is not harmful. Movement can begin with something as simple as walking around the house.
Strenuous exercising is not advisable during and around the time of experiencing symptoms of a prolapsed disc. However, building and maintaining strength in the back muscles and abdominal muscles are essential to prevent and treat chronic back problems. Exercises such as walking, simple stretching, physical therapy, and yoga have been proven to be very beneficial in treating chronic back pain.
Conservative treatment while following a planned exercise and pain medication regimen, while avoiding painful positions, helps relieve symptoms in most patients within a few days or weeks. Other treatment options for a prolapsed disc include treatments such as medication and physical therapy.
Typical medications used to treat the pain of a prolapsed disc include:
Over-the-counter (OTC) pain medications. If the pain is mild to moderate, an over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others) can help reduce the pain.
Cortisone injections. Inflammation-suppressing corticosteroid medication that quickly fights inflammation is given as an injection. By reducing inflammation, steroids help relieve pain. Occasionally, oral steroids may be used to reduce swelling and inflammation.
Muscle relaxers. Prescription muscle relaxants can be helpful in relieving muscle spasms.
Nerve pain medications. These medications for treating nerve pain can be prescribed if the pain has lasted for more than a few days. Gabapentin, pregabalin, duloxetine, and amitriptyline are commonly prescribed for nerve pain.
Anticonvulsants. Drugs initially designed to control seizures are often helpful in treating radiating nerve pain associated with a prolapsed disc.
If the pain has not resolved within a few weeks, physical therapy may help relieve the pain. The physical therapists can help the patient find positions and exercises that minimize the pain of a prolapsed disc. Exercise not only reduces the pain of a prolapsed disc by strengthening the muscles that support the spine, but it may also help reduce the chance of it happening again.
A therapist may also recommend:
Heat and ice treatments. Heat relaxes the muscles while cold helps reduce inflammation and pain.
Ultrasound stimulates blood flow with the use of sound waves to stimulate the affected area.
Traction helps alleviate pressure on the affected nerve.
Braces used for the short term can help support the neck or lower back. Extended use is not recommended as it weakens muscles.
Electrotherapy using electric impulses can help some patients reduce pain.
Other treatments that may help ease chronic back pain include:
Acupuncture. Although the results are usually modest, acupuncture appears to ease chronic back and neck pain reasonably well in some patients.
Chiropractic. Spinal manipulation can be moderately effective for low back pain that has lasted for at least a month.
Lumbar Discectomy. A minimally invasive procedure to remove a portion of a damaged disc to help ease the pressure on the spinal cord and/or nerve.
Massage. This hands-on therapy can provide short-term relief to people dealing with chronic low-back pain.
Spinal Cord Stimulation (SCS). A neurostimulator delivers mild electrical impulses to the epidural space near the source of chronic pain that interfere with pain signals to the brain. This treatment does not correct the problem but helps lessen the pain.
Yoga. A combination of physical activity, breathing exercises, and meditation, yoga can improve function and relieve chronic back pain in some people.
Activity modification is also important, which includes avoidance of activities that aggravate pain and may worsen the nerve impingement. Bed rest and complete inactivity are unnecessary; they hinder recovery and are not advised.
A very small number of patients will need surgery. When conservative treatments fail to improve symptoms of a prolapsed disc, surgery may be the only alternative. This is especially true if the patient continues to experience:
Numbness or weakness.
Difficulty standing or walking.
Loss of bladder or bowel control.
There are several different surgical approaches to treating a prolapsed disc. Each is customized to each patient’s needs and will depend on the condition of the spine around the affected disc. The goal is to cut out the prolapsed part of the disc and relieve pressure on the nerves. The surgery often eases symptoms but does not work in every case.
Is It Possible to Prevent a Prolapsed Disc?
Evidence suggests that the best way to prevent bouts of back pain and a prolapsed disc is to keep active and to exercise regularly. The best way to prevent a prolapsed disc is by avoiding injury to the spine. Some simple steps for doing this include:
Lose weight, if necessary, by eating healthy and exercising.
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating the pain caused by a prolapsed disc. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.