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@chloeng.sg
Senior Physiotherapist at Balance Core Physiotherapy Center: SLIPPED DISCS
Honours degree in Bachelor of Science in Physiotherapy
Years of experience on the job: 6
WHAT IS A SLIPPED DISC?
Your spinal column is made up of a series of bones stacked on top of each other. These bones are cushioned by discs that protect the bones by absorbing the shocks from daily activities like walking, lifting and twisting. Each disc consists of two parts: a soft, gel-like, watery inner portion that is surrounded by a tough outer ring. When a disc is no longer able to bear strain it is subject to, the outer ring breaks apart, causing the inner portion to flow out. This is known as a slipped disc. Slipped discs cause radiating pain when the leaked inner portion of the disc presses on the nerve root in the spinal cord.
HOW DO YOU GET A SLIPPED DISC?
There are two common causes of slipped discs: Traumatic causes and degenerative causes. Traumatic slipped discs are sustained during a traumatic event. For instance, when someone lifts something heavy using improper technique such as bending from the waist instead of the knees and hips to pick the object up, or if someone suffers a bad fall that impacts the spine. These traumatic events can put so much stress on a disc that it becomes injured. But not all slipped discs happen like this.
Degenerative slipped discs are caused by prolonged wear and tear. People with degenerative slipped discs may find themselves experiencing back pain doing simple daily activities like bending when brushing their teeth or while taking a shower. This type of wear and tear is usually due to a combination of compressive and shearing forces that the spine is subject to for a prolonged time. These forces are usually due to joint misalignment or muscular imbalances (such as weakness or tightness).
HOW DO YOU IDENTIFY THE ROOT CAUSE OF A DEGENERATIVE SLIPPED DISC?
You need to visit an experienced physiotherapist to help you determine the root cause of a degenerative slipped disc. The physiotherapist will observe, palpate and assess your functional movements to determine the root cause of your degenerative slipped disc. A physiotherapist may observe an individual with acute back pain to be listing (not standing straight, but standing such that their trunk is shifted to the side) in order to avoid feeling pain. On the other hand, an individual with chronic back pain may be observed to be avoiding normal spinal movements in fear that they may cause further injury to their lower back. These behavioral observations can help the physiotherapist understand their patient’s condition better.
Palpation is also a key assessment tool. Palpation is the process of using touch to check and assess the body. An experienced physiotherapist will have sensitive hands and the ability to sense joint mobility, muscular tightness or tension and the overall contour of the body parts. Having gathered information about the patient’s body during the assessment, the physiotherapist will then correlate it to the patient’s present complaints as well as the functional activities that are unique to them. Their movement habits which stress certain parts of the body have to be identified. If these movement habits can be accurately identified and properly corrected, the parts of the body that are subjected to excessive stress will finally be able to fully recover. When the body is moving properly and healthily, there will be minimal chance for future injury.
WHAT SHOULD I DO AFTER GETTING A SLIPPED DISC?
First and foremost, seek help as soon as possible. You can see a doctor or a physiotherapist. You should also seek help if you are experiencing any kind of back pain, no matter how minor. Back issues, or any kind of pain, should not last for more than four to six weeks. If the pain still persists, it’s a sign that something is wrong. If you do not seek help early, you may risk sustaining a more serious injury.
Rest is recommended if the slipped disc is still in the acute stage. The intervertebral discs cannot heal well if they are subjected to constant compressive, torsional or shearing forces. Hence, it is not advisable to spend long hours sitting, walking or standing. Mobility is still encouraged at this stage but within pain limits. Try to avoid sitting, walking or standing for more than 10 to 15 minutes and take breaks in between.
DO SLIPPED DISCS HEAL?
Yes, just like cuts to the skin that ultimately scar and heal, slipped discs heal in a similar way. Scars will form around the outer ring of the slipped discs during the healing process. However, the discs will not go back to the way they were before injury. They may have suffered a loss in height and reduced water content, which makes them more vulnerable to compression, torsional or shearing forces. Hence, it’s important to strengthen muscles that provide stability to the spine to prevent recurrence.
HOW DO I PREVENT SLIPPED DISCS?
The reason many people suffer from back pain that doesn’t recover is because of poor posture in their daily lives. Our increasingly sedentary lifestyles weaken our gluteal muscles and cores, making our backs more vulnerable to injury. Tightness in the hips also contributes greatly to lower back pain. Restoring the balance and mobility of the pelvic and hip region is essential to improving back pain and preventing slipped discs. If you are doing core strengthening exercises (such as planks, crunches, and leg raises) to try to resolve back pain but are experiencing more aggravation instead of relief, it’s important to understand and relearn the concept of core control.
It is also important to practice good posture while standing and sitting. Standing and sitting with incorrect posture can increase muscle tension and joint compression which may contribute to early degenerative changes.
Many people like to stand with their hips swayed forward, which puts a lot of compressive stress on the back. People who stand like this put most of their weight in the front of their feet and toes, which is not ideal because they are not stacking their diaphragm over their pelvic floor muscles. An ideal standing posture levels the diaphragm over the pelvic floor muscles and incorporates the core muscles in daily movements. If the core muscles are not used in daily life, muscular imbalances will occur as other muscles will work harder to compensate and become tighter over time.
The key to good posture is in the position of the spine.
People tend to sit very upright in order to avoid being slouchy, which they think is good posture, but can actually result in back and neck pain because the posterior spine is constantly compressed. It may even result in chest pain because sitting extremely upright elevates your chest, which makes it harder to breathe properly because your diaphragm is not at a good resting position.
Sitting upright should be achieved with the correct positioning of the pelvis. In order to do this, you have to sit with widened buttocks. This allows the pelvis to be in a slight anterior tilt, which, in turn, allows the tailbone to be lifted away from the chair. Most people sit with rounded buttocks, which makes the surface they are sitting on very narrow and makes them feel very unstable. This explains why many people like to cross their legs while sitting because it helps them feel more stable. Once you are sitting with a widened base of support, you can release a sigh to find your most relaxed position. Sitting correctly shouldn’t require much effort; it should always feel comfortable.
HOW TO PROTECT YOUR SPINE
DO
Seek professional help if you are experiencing any kind of back pain, no matter how minor. Any kind of pain should not last for more than four to six weeks.
DO
Bend from the knees and hips when lifting something heavy, not the waist.
DO
Rest if you have a slipped disc that is still in the acute stage. Mobility is still encouraged at this stage, but within pain limits. Don’t sit, walk or stand for more than 10 to 15 minutes at a time and remember to take breaks in between.
DO
Learn to properly engage and control your core if you want to do core exercises, especially if it’s with the intention of relieving back pain. Not engaging your core correctly can aggravate back pain.
DO
Practice good posture while sitting and standing. Poor posture increases muscle tension and joint compression, which may lead to early degeneration.
DON’T
Don't sit down for extended periods of time. Being sedentary weakens the gluteal muscles and the core region, making our backs more vulnerable to injury.
DON’T
Don't stand with your hips swayed forward.
DON’T
Don't stand with your weight in the front of your feet and your toes.
DON’T
Don't sit overly upright as this can result in back, neck and chest pain.
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