No you don't have a slipped disc (and why your disc injury is probably healed and not responsible for your back pain)

​Have you ever been told you have a slipped disc? A "slipped disc" is a term that has been used for years to describe pain and injury in the spinal disc. The term is, however, no longer in use by medical professionals due to the fact that it is misleading and doesn't accurately describe what happens when a disc is damaged. It's also a diagnosis for back pain that may not be at all appropriate - read on to understand what we know about discs!

What is a slipped disc?
The term "slipped disc" suggests that the disc has somehow slipped out of place and is no longer where it should be. In reality, this is not the case. Discs are situated between the vertebrae in the spine, and their main function is to provide cushioning and shock absorption. They have a tough outer layer (the annulus fibrosus) and a soft, gel-like center (the nucleus pulposus).

When a disc is damaged, it is usually due to wear and tear over time, or an injury such as a sudden impact or twisting motion. The damage can cause the nucleus pulposus to bulge or herniate, which means that it pushes outwards from its normal position within the disc while the outer layer of the disc remains in place. This can put pressure on nearby nerves, causing pain and discomfort, but may be completely asymptomatic (read on to find out more).

What do we call them now?
The medical community has therefore moved away from using the term "slipped disc" and now uses more accurate terminology such as "herniated disc," "bulging disc," or "ruptured disc" to describe disc injuries. By using more precise language, medical professionals can better understand and diagnose the specific type of disc injury a patient is experiencing, and provide more effective treatment.

How do we treat disc injuries?
Research on disc injuries and pain has evolved over time. A study published in the New England Journal of Medicine in 1994 found that many people with disc herniations experience spontaneous improvement in symptoms over time, even without treatment. This contradicted the belief at the time that disc herniations always required surgery.

Since then, further research has shown that conservative treatments such as physical therapy and pain management can be just as effective as surgery for many patients with disc injuries. For example, a 2015 study published in the Journal of the American Medical Association found that patients with lumbar disc herniations who underwent physical therapy had similar outcomes to those who underwent surgery.

Another study published in the New England Journal of Medicine in 2006 found that for patients with lumbar spinal stenosis, a narrowing of the spinal canal that can cause nerve compression and pain, surgery was not superior to nonsurgical treatment. The study included 654 patients who were randomly assigned to receive either surgery or nonsurgical treatment. At 2-year follow-up, the researchers found that patients in both groups had similar improvements in pain, function, and quality of life. This suggests that nonsurgical treatments such as physical therapy and pain management can be effective for some patients with spinal stenosis.

Do disc injuries cause pain?
It's important to note that while disc injuries can certainly cause back pain, not all cases of back pain are caused by disc injuries. In fact, many cases of back pain have no clear identifiable cause, which can make treatment challenging. 

Changes to the discs in the spine are a normal part of aging and are not necessarily linked to pain. Discs naturally lose some of their water content as we age, which can cause them to become less flexible and more prone to injury. Additionally, small tears or fissures can develop in the outer layer of the disc, which can also contribute to disc degeneration. However, many people with disc degeneration do not experience any pain or symptoms. A study published in the New England Journal of Medicine in 1994 found that disc degeneration was present in a large percentage of people without any history of back pain. The study included 98 volunteers without back pain who underwent MRI scans of their spines. The researchers found that nearly a third of the volunteers had disc degeneration, and the prevalence of degeneration increased with age. 30% of people in their 30s had disc degeneration without pain, while the incidence steadily increased proportionally to 80% of people in their 80s. The older you are, the more likely you are to have disc injuries regardless of whether you are experiencing pain or not.

So what does this all mean? 
While you might have had imaging in the past that showed disc degeneration, this is most likely healed by now. In general, mild disc injuries can take a few weeks to heal, while more severe injuries may take several months or longer. More importantly, your disc injury may never have been the cause of your pain, and if the pain has continued over several years, investigations into other causes, or experimenting with other treatment types may be appropriate. 

If you've been experiencing long-term back pain there is help available! Our team of physiotherapists are experts in helping with chronic pain and back pain and would love to help.