Slipped disc

The anatomy, briefly

Between each pair of vertebrae sits a disc: a tough fibrous ring (the annulus fibrosus) containing a gel-like core (the nucleus pulposus). The disc is a shock absorber and a spacer it keeps enough height between vertebrae for nerve roots to exit cleanly.

With age, repetitive loading, or a single bad lift, the annulus develops fissures. Nuclear material migrates into them and pushes the wall outward. If that bulge is central, you get back pain. If it presses on an exiting nerve root, you get the radiating pain, numbness and weakness that patients recognise as a "slipped disc."

The grades matter

• Bulge: the annulus is intact but deformed; often incidental and asymptomatic
• Protrusion: nuclear material presses into a weakened annulus; the base remains wide
• Extrusion: material breaches the annulus but remains connected
• Sequestration: a free fragment separates into the canal

Counter-intuitively, larger extrusions often resorb well with conservative care, because the body treats the displaced material as something to clear. A small protrusion sitting in a narrow foramen can be more stubborn than a big one in a roomy canal. This is why we treat patients, not scans.

Symptoms

• Lumbar: low back pain with radiation into buttock, thigh, calf or foot; worse sitting, bending or straining
• Cervical: neck pain radiating into shoulder blade and down the arm; numbness or clumsiness in the hand
• Pins and needles or numbness in a defined strip rather than the whole limb
• Weakness in a specific action, lifting the foot, gripping, pushing off the toes
• Relief on lying down; difficulty finding a comfortable sleeping position

Our assessment

Examination establishes the level and whether there is a genuine neurological deficit: reflexes, power grading, dermatomal sensation, straight leg raise or Spurling's test for the neck. 3D biomechanical mapping quantifies disc height loss, segmental alignment and how load is distributed through the column and pelvis.

Bring every film and report you have, including studies from other hospitals. Recent imaging usually avoids repeat radiation and cost. If your MRI is more than a year old and symptoms have changed materially, we may recommend an updated study.

Treatment at Activa

The mechanical problem is treated first. Acoustic wave therapy releases the deep paraspinal spasm that keeps the segment compressed, letting disc height and foraminal clearance recover so pressure on the root falls. Fully clothed, no injection, no manipulation, 20 to 30 minutes per session.

Where a root stays inflamed despite good structural correction, a transforaminal epidural or selective nerve root block is used, targeted at the confirmed level, day-care, under image guidance.

Rehabilitation then addresses why the disc failed. Most lumbar disc patients load their spine instead of their hips, and brace with superficial muscle instead of the deep stabilisers. DNS retrains that; hip hinge mechanics, gluteal and trunk endurance and sitting tolerance are built progressively over 4 to 12 weeks.

Will it come back?

It can, particularly if the movement pattern is unchanged, the job involves prolonged sitting or heavy lifting, and the home programme is abandoned once pain settles. The rehabilitation phase exists precisely to reduce that risk, which is why we review formally at 30, 60 and 90 days rather than discharging you the week the pain stops.