Slipped disc (prolapsed disc)

A slipped disc, also known as a prolapsed or herniated disc, is where one of the discs in the spine ruptures and the gel inside leaks out.

Information written and reviewed by Certified Doctors.

Contents

Key Information

What should I do?

If you think you have this condition you should see a doctor within 2 weeks.

How is it diagnosed?

Your doctor can diagnose an intervertebral disc prolapse by asking you about your symptoms and examining your back and legs. However, your doctor might also recommend an MRI scan (magnetic resonance imaging) of your back to confirm the diagnosis.

What is the treatment?

If you are diagnosed with intervertebral disc prolapse, the treatment will depend on the severity of symptoms.

  • Initial treatment consists of a combination of exercise, massage, and painkillers
  • Surgery may be necessary if these do not control your symptoms well enough.

When to worry?

If you develop any of the following symptoms, you should see a doctor immediately:

  • numbness around the anal and genital region
  • weakness or paralysis of leg
  • inability to control bowel movements
  • unintentional passing of urine
  • unable to walk
  • pain which is worsening rather than improving.

Introduction

A slipped disc, also known as a prolapsed or herniated disc, is where one of the discs in the spine ruptures and the gel inside leaks out.

This can cause back pain as well as pain in other areas of the body.

The sciatic nerve is often affected in cases of slipped disc. It is the longest nerve in the body and runs from the back of the pelvis, through the buttocks, down both legs to the feet.

If pressure is placed on the sciatic nerve it can cause:

  • a lasting, aching pain
  • numbness
  • a tingling sensation in one or both legs

Read more about the symptoms of a slipped disc

The spine

The spine consists of 24 individual bones called vertebrae which are stacked on top of each other.

In between each vertebra there are protective, circular pads of cartilage (connective tissue) called discs. They have a tough, fibrous case that contains a softer, gel-like substance. The discs help to cushion the vertebrae when you move around.

The spinal cord is highly sensitive and passes through the middle of the vertebral column. It contains nerve cells and bundles of nerve fibres that connect all parts of the body to the brain.

What causes a slipped disc?

A slipped disc occurs when the outer case of the disc ruptures (splits), resulting in the gel inside bulging and protruding out of the disc.

The damaged disc can put pressure on the whole spinal cord or on a single nerve root. This means that a slipped disc can cause pain both in the area of the protruding disc and in the area of the body that is controlled by the nerve that the disc is pressing on.

It is not always clear what causes a disc to break down, although age is a common factor in many cases. As you get older, your spinal discs start to lose their water content, making them less flexible and more likely to rupture.

Read more about what causes a slipped disc

Diagnosing a slipped disc

Your doctor will usually be able to diagnose a slipped disc from your symptoms and medical history. They may also carry out a physical examination to test:

  • reflexes
  • muscle strength
  • walking ability
  • sensation in your limbs

Read more about how a slipped disc is diagnosed.

Treating a slipped disc

It can take about four to six weeks to recover from a slipped disc. Treatment usually involves a combination of physical therapy, such as massage and exercise, and medication to relieve the pain.

Surgery to release the compressed nerve and remove part of the disc may be considered in severe cases, or if the pain continues for longer than six weeks.

In many cases, a slipped disc will eventually shrink back away from the nerve, and the pain will ease as the disc stops pressing on the affected nerve.

If you have a slipped disc, it is very important to keep active. Initially, moving may be difficult but after resting for a few days you should start to move around. This will help keep your back mobile and speed up your recovery.

Any exercise you do should be gentle and not put a strain on your back. Swimming is ideal because the water supports your weight and little strain is placed on your joints.

Read more about treating a slipped disc.

Preventing a slipped disc

Taking a few sensible precautions, such as leading a healthy lifestyle, can help prevent back pain and lower your risk of getting a slipped disc. For example, you should:

  • take regular exercise
  • use a safe technique when lifting heavy objects
  • always maintain a good posture when sitting and standing

Read more about preventing a slipped disc.

Symptoms

Most people who have a slipped disc experience pain which usually begins in the lower back before sometimes spreading to other parts of the body.

However, some people with a slipped disc do not have any obvious symptoms. This is usually because the part of the disc that bulges out is small or does not press on nerves or spinal cord.

Sciatica

In most cases of slipped disc, pain is caused when part of the disc begins to press on one of the nerves that run along the spine. Parts of the sciatic nerve are most commonly affected.

The sciatic nerve is the longest nerve in the body and is made up of several smaller nerves. It runs from the back of the pelvis, through the buttocks and down the legs to the feet.

Pressure placed on the sciatic nerve can cause:

  • a lasting, aching pain
  • numbness
  • a tingling sensation in one or both legs

These symptoms often start in the lower back and travel down the buttocks, into either of the legs.

Read more about sciatica.

Other nerves

If the slipped disc presses on any of the other nerves that run down your spinal cord, your symptoms may include:

Muscle spasms and paralysis tend to occur in your arms, legs and buttocks. The pain you experience when a disc presses on a nerve is often worse when you put pressure on the nerve. This can happen when you cough, sneeze or sit down.

Cauda equina syndrome

Cauda equina syndrome is a serious condition where the nerves at the very bottom of the spinal cord become compressed. Symptoms include:

  • lower back pain
  • numbness in your groin
  • paralysis of one or both legs
  • rectal pain
  • bowel disturbance
  • inability to pass urine or incontinence
  • pain in the inside of your thighs

You should seek medical assistance immediately if you develop these symptoms. Visit your doctor or the accident and emergency (A&E) department of your nearest hospital.

If cauda equina syndrome is not promptly treated, the nerves to your bladder and bowel can become permanently damaged.

Causes

A slipped disc occurs when the circle of connective tissue surrounding the disc breaks down. This allows the soft, gel-like part of the disc to swell and protrude out.

It is not always clear what causes the connective tissue to break down. However, slipped discs are often the result of increasing age.

As you get older, your spinal discs start to lose their water content. This makes them less flexible and more likely to rupture (split).

There are a number of other factors that can put increased pressure and strain on your spine. These include:

  • bending awkwardly
  • jobs that involve heavy or awkward lifting
  • jobs that involve lots of sitting, particularly driving
  • smoking
  • being overweight
  • weight-bearing sports, such as weight lifting
  • a traumatic injury to your back, such as a fall or car accident

Situations such as these can weaken the disc tissue and can sometimes lead to a slipped disc.

Connective tissues help provide support and structure to other tissue and organs.

Diagnosis

Your doctor will usually be able to diagnose a slipped disc from your symptoms and medical history.

You will also have a physical examination, during which your doctor will test your:

  • reflexes
  • muscle strength
  • walking ability
  • sensation in your limbs

Straight leg-raising test

While you are lying flat, your doctor will slowly raise each of your legs, one at a time, to see if it causes any pain or discomfort in your legs or back. This is known as the straight leg raising test.

Most people with a slipped disc will not be able to raise their leg more than two thirds of the way up without feeling tingling, numbness and pain.

Further tests

Further tests are not usually required because in most cases the symptoms of a slipped disc settle down within a few weeks.

However, if your symptoms do not ease after four to six weeks, further tests may be required to rule out other conditions and investigate the size and position of the slipped disc.

Some of the tests that you may have are described below.

Magnetic resonance imaging scan

A magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to produce detailed images of the inside of your body.

MRI scans are effective at showing the position and size of a slipped disc. They can also pinpoint the affected nerves.

Read more about MRI scans.

Computerised tomography scan

A computerised tomography (CT) scan uses a series of X-rays to scan parts of your body. A computer is then used to build up detailed images of your body.

This produces cross-sectional images of your spinal column and the structures that surround it. Like an MRI scan, a CT scan can pinpoint a slipped disc, although it is often not as effective.

Read more about CT scans.

Discography

A discography is a test where a special dye is injected into the disc in your spine.

An X-ray will then be taken to show how the dye has spread around your back. The image will reveal any tears or leaks from your disc.

Other causes

The tests listed above can be used to check that your back pain is not being caused by another health condition such as:

  • a tumour (growth)
  • an infection
  • arthritis – a painful condition that affects the joints and bones

Treatment

In most cases, a slipped disc will eventually shrink back spontaneously. Any pain will usually ease as the disc stops pressing on the affected nerve.

It usually takes four to six weeks to recover from a slipped disc. Most people will need to do some gentle exercises and may need to take painkilling medication.

Keeping active

It is very important that you keep active if you have a slipped disc.

Initially, it may be difficult to move around and if you are in severe pain, you may need to rest completely for the first couple of days.

However, after this period, you should start to move around as soon as you can. This will keep your back mobile and speed up your recovery.

You should ensure that any exercise you do is gentle and does not put a strain on your back. Swimming is an ideal form of exercise because the water supports your weight and it puts very little strain on your joints.

Movement and exercise will also help to strengthen any muscles that have become weak. Avoid any activities that could aggravate your condition such as those that involve:

  • reaching
  • lifting
  • sitting for a prolonged period of time

Physiotherapy

As part of your treatment programme, you may be referred to a physiotherapist. Physiotherapists are healthcare professionals who use physical methods, such as massage and manipulation.

A physiotherapist will be able to draw up an individually tailored exercise plan for you. This will keep you active, minimise pain and help prevent any further damage to your back.

Read more about physiotherapy.

Osteopathy and chiropractic

Some people choose to try osteopathy or to see a chiropractor. Both types of therapy are used to treat back pain. y.

Read more about osteopathy and chiropractic.

Medication

You may be prescribed a number of different medicines to help ease any painful symptoms of a slipped disc. These are outlined below.

Analgesics

Analgesics are painkillers, such as paracetamol. They are available over-the-counter from pharmacies, or on prescription.

Always read the manufacturer’s instructions before using analgesics.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen can help relieve pain and reduce any inflammation.

NSAIDs may not be suitable for people with hypertension (high blood perssure), asthma, heart failure, or kidney failure. Again, you should always read the manufacturer’s instructions before use.

Read more about NSAIDs.

Codeine

Codeine is a stronger painkiller that is often taken in combination with paracetamol. It is usually only prescribed when other painkillers and NSAIDs have not worked.

Codeine can cause side effects, such as constipation (an inability to empty your bowels).

Corticosteroids

Corticosteroids are a type of medication that contain hormones (powerful chemicals that have a wide range of effects on your body). They may be injected into your lower spine to help reduce inflammation.

Read more about corticosteroids.

Muscle relaxants

You may be prescribed a muscle relaxant, such as diazepam, to take for a few days if your back or leg muscles are very tense.

Surgery

Surgery is required in about 1 in 10 cases of a slipped disc. It may be considered if:

  • there is evidence of severe nerve compression
  • your symptoms have not improved using other treatments
  • you are having difficulty standing or walking
  • you have very severe symptoms, such as progressive muscle weakness or altered bladder function

The aim of surgery is to cut away the piece of the disc that bulges out. This is known as a discectomy and it can be done in several ways.

Some of these procedures are explained in more detail below.

Open discectomy

An open discectomy is a procedure to remove part or all of the slipped disc. It will be carried out under anaesthetic (painkilling medication).

An incision is made in your spine and the disc is removed. For more information about this type of surgery, see the lumbar decompressive surgery topic.

Prosthetic intervertebral disc replacement

Prosthetic intervertebral disc replacement involves having a prosthetic (artificial) disc inserted into your back to replace the slipped disc.

An incision is made in your spine and the damaged disc is either partially or completely removed. A replacement disc is then inserted into the space.

One study found that 87% of people felt their quality of life had improved three months after having a prosthetic intervertebral disc replacement. However, as the procedure is still quite new, long-term results are not yet available.

Endoscopic laser discectomy

During endoscopic laser surgery, a small incision will be made to gain access to the spine and an endoscope will be used to view the disc. An endoscope is a long, thin, flexible tube with a light and camera at one end.

The procedure is performed under either local anaesthetic or general anaesthetic, depending on where in your spine your slipped disc is.

After the incision has been made, the compressed nerve that is causing you pain will be released and part of your disc will be removed with a laser.

A study has found that 67% of people could move around more easily six months after having endoscopic laser surgery, and around 30% needed less pain relieving medication. Around 2-4% of people needed another operation.

Another study reported that after having endoscopic laser surgery, on average, people returned to work after seven weeks.

As endoscopic laser surgery is still a relatively new procedure, it is often only performed with special arrangements – for example, as part of a clinical trial (a type of medical research that tests one type of treatment against another).

Recovery

For most people with severe symptoms of a slipped disc, back surgery helps to ease their symptoms.

You will usually be able to return to work after two to six weeks. However, the surgery does not work for everyone, and you may need to have further operations and treatment if the initial surgery is not effective.

Possible complications resulting from surgery may include:

  • infection
  • nerve injury
  • haemorrhage (severe bleeding)
  • temporary dysaesthesia (impaired sense – for example, losing the sense of touch)

Before having surgery, you should ask your surgeon whether you are at risk of developing complications and how long it will take to recover. You may be given a rehabilitation programme to follow.

One review of a number of studies found that exercise programmes which started four to six weeks after surgery on the lumbar spine (lower back), helped to decrease pain and improve a person's ability to function

Read more about the risks of lumbar decompressive surgery and recovering from lumbar decompressive surgery.

Prevention

To avoid back pain and help prevent getting a slipped disc, you should keep mobile, exercise regularly, maintain good posture and lift heavy objects correctly.

Read more about preventing back pain.

Exercise

Regular exercise can slow down the age-related deterioration of the discs in your back. It can also help keep your supporting back muscles strong and supple.

Before and after any workout or sports activity, you should warm up and cool down properly. Your warm up and cool down should incorporate stretching exercises.

If you are recovering from a slipped disc, avoid high impact activities, such as running and aerobics.

Lifting

It is very important when lifting that you use the correct technique. When lifting heavy objects you should:

  • think before you lift and make sure you can manage the weight
  • slightly bend your back, hips and knees at the start of the lift
  • keep the load close to your waist
  • avoid twisting your back or leaning sideways
  • keep your head up and look ahead as you carry the load

Sitting

When sitting or driving for long periods make sure that your seat is comfortable and supportive. If possible, take regular breaks to stretch and walk around.

If your job involves using a computer, take regular breaks away from the computer screen. Make sure that the computer screen is at eye level and directly in front of you so that you do not have to twist or bend to see it.

Sit in a comfortable position with enough space to move around, and do not stay in the same position for too long.

Your employer should give you information about working with computers and provide advice about the best way to sit and position your equipment.

Posture

Always try to keep good posture. Walk or stand with your head and shoulders slightly back.

When sitting at a desk, make sure that your chair is the correct height for the desk. Your feet should be able to rest flat on the floor with your knees bent at 90 degrees.

Content supplied by NHS Choices