Slipped disc

A slipped disc can cause very sudden and severe shooting pain. If it occurs in the neck area, the pain might radiate into the arms. If it occurs in the chest area, the pain might spread to the upper back. Slipped discs are most common in the lumbar region of the lower back, though. That is why this article is mainly about this type of slipped disc.

Slipped discs in the lumbar (lower back) region are the main cause of sciatica. The term sciatica is used when pain radiates into the leg. As well as the typical radiating pain, a slipped disc can also lead to pain in the lower back region.

Along with the pain, some people might also experience numbness in the bottom, paralysis in the legs, or bladder and bowel problems (Cauda equina syndrome). These symptoms are signs of a more serious problem, like nerve damage.

But a slipped disc doesn't always lead to noticeable symptoms. This can be seen in studies in which adults who didn't have back pain were examined using magnetic resonance imaging (MRI): Around 30 out of 100 study participants between the ages of 20 and 30 had a herniated disc, but no symptoms. Roughly 40 out of 100 participants aged 50 or over didn't have any symptoms even though they had a herniated disc.

In most people, slipped discs are the result of wear and tear. Over the years, the spinal discs lose their elasticity: Fluid leaks out of them and they become brittle and cracked. These changes are a normal part of the aging process – which varies from person to person, though. Very rarely, an accident or severe injury might also cause damage to a spinal disc and leave it herniated.

Spinal discs act as shock absorbers between the vertebrae in our spine. If a spinal disc is no longer able to bear the strain, it can result in a slipped disc. The associated pain probably arises when part of the spinal disc pushes against a nerve in the spinal cord.

When herniated disc tissue irritates a nerve root in the region of the lumbar spine (lower back), it often causes typical sciatic pain. The nerves that run through the spinal canal connect to the sciatic nerve at the pelvis. The sciatic nerve then runs down the legs. As well as being painful, an irritated sciatic nerve can also cause pins and needles and numbness.

Doctors distinguish between the following types of slipped disc problems:

• Protrusion: The spinal disc is pushing out from between the vertebrae, but its outer layer is still intact.
• Extrusion: The outer layer of the disc is torn and the disc tissue has leaked out, but this tissue is still connected to the disc.
• Sequestration: Disc tissue has entered into the spinal canal and is no longer directly connected to the disc.

Extrusion and sequestration more commonly cause leg symptoms than protrusion. Knowing what type of slipped disc someone has can be important when choosing the treatment and understanding how the condition might develop.

It is estimated that 1 to 3% of all people in western industrialized countries will have back pain caused by a slipped disc at some point in their lives. These symptoms are more common in people over the age of 30. They are about twice as common in men than in women.

Back pain goes away on its own within six weeks in about 90 out of 100 people. It is believed that, over time, the body gets rid of part of the prolapsed tissue or that it shifts position so that the nerves aren't irritated anymore.

A painful slipped disc can go on to develop in very different ways: The pain can start very suddenly, and then disappear again very quickly. Some people have permanent pain that lasts a long time, while others have it again and again.

If the symptoms last longer than six weeks, it is unlikely that they will go away on their own. They are considered to be chronic if they still haven’t gotten better after twelve weeks.

You doctor will ask about your symptoms and do a physical examination to find out what is causing acute back pain. Further testing such as an MRI scan ( magnetic resonance imaging) is only needed if you have

• Numbness or paralysis in one or both legs
• Impaired function of the bladder or bowel
• Unbearable pain despite treatment
• Back pain that doesn't get better after 4 weeks or leg pain that doesn’t get better after 2 weeks, or
• Another condition that is thought to be causing the pain, for example a tumor.

There are often good reasons why doctors don't suggest doing any complex diagnostic tests at first if you have back pain: Imaging techniques may show a supposed cause of back pain that actually has nothing to do with the symptoms. This kind of misdiagnosis can then result in unnecessary treatment that may itself be harmful.

Even severe sciatic pain can go away on its own after a while. Until it does, various pain-relieving treatments can help to cope with the symptoms and stay as active as possible.

What are known as multimodal treatment programs, with treatment from specialists in different therapeutic areas such as medicine, physical therapy, and psychology, can be helpful especially if symptoms last for a long time and become chronic. They help you to stay active, cope with the pain, and perhaps also to learn and practice new behaviors.

Surgery can be an option if severe sciatic pain caused by a slipped disc persists for longer than 6 to 12 weeks despite pain-relief treatment. The aim is to take the pressure off the affected nerve.

Surgery is needed right away if the nerves are so severely affected that you experience paralysis in your legs, or your bladder or bowels no longer function properly. The latter is a sign of what is called Cauda equina syndrome. This is a special emergency, but it is very rare.

The goal of rehabilitation is to improve the symptoms and restrictions resulting from a slipped disc, and strengthen the muscles in the torso to improve the stability of the spine.

Rehabilitation can include things like back training, stretching and relaxation exercises, and weight training. It can also provide motivation to take more regular daily exercise and help to cope with pain.

Rehabilitation programs can be an option for people who can’t work because of their back pain or who are very restricted in their daily life. Follow-up rehabilitation may help after surgery too.

It is important to also regularly exercise the joints and muscles after rehabilitation to maintain the improvements.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.

In Germany there are numerous sources of support for people who have chronic back pain, including support groups and information centers. But there are often regional differences in how these services are organized, and they aren't always easy to find. You can use our list to help you find and make use of local services in Germany.