We hear the terms “slipped disc”, “ruptured disc”, “herniated disc” and “prolapsed disc” but what do these terms really mean? Perhaps you may have come across someone who has told you that they visited an osteopath who “cracked their disc back in”….. this is not strictly accurate but we will address this later! Let's first look at the anatomy.

What is Sciatica?

The correct term is an intervertebral disc and as it’s name suggests the disc is a structure located between the spinal bones (vertebrae).

The disc is made up of two parts: a tough fibrous outer ring (called the anulus fibrosus) and the gel-like centre (the nucleus pulposus).

Functions

The intervertebral disc has many functions. It separates the vertebrae and acts like a shock absorber between the bones. It helps give the spine its curves and also joins the vertebrae together. There are 23 discs in our spinal column.

The disc and back pain.

Problems with the discs in the spine are a common cause of back pain. Most of us are familiar with the fact that disc problems can cause low back ache, however as the discs are between each vertebrae in the spine it is possible to have pain as a result of a disc problem anywhere throughout the spine e.g. in the neck or between the shoulder blades. What does a disc problem mean?

Disc protrusion and prolapse?

The disc, like any shock absorber, can start to wear with time. Over the years the disc loses a little fluid (this can be picked up on an MRI scan ) and  small cracks begin to appear in the outer walls. If the disc is placed under undue strain the nucleus pulposus (nucleus) can begin to push the anulus fibrosus (anulus) out of shape. This is called a protrusion. The bulge may push out so much  that it strains the anulus and eventually a small part of the nucleus escapes through the anulus fibrosus  and becomes separated. This is called a disc prolapse.

The anulus is pain sensitive so any problem with the disc can cause pain. A prolapse can exude and compress the nerves of the spine as they exit through small foramen (tunnels) to supply the arms, legs and body. This can cause symptoms of nerve root compression such as pain, numbness, tingling or power loss. In severe cases the disc can prolapse backwards into the spinal canal causing signs of spinal cord compression. Osteopaths are trained to recognize these signs which are termed “red flag signs” and necessitate an urgent medical/surgical referral.

In cases from mild to severe, a protrusion/prolapse can be painful and can make sitting, standing, walking, lifting, moving, urinating, defaecating or sneezing difficult.

Slipped disc

The term “slipped disc” is really a misnomer as the disc by virtue of its anatomy cannot slip as it is attached to the vertebrae both above and below. The terms ‘disc prolapse’ and ‘disc protrusion’ are much more accurate. As such, the old tale of a patient having their “disc cracked back into place” by an osteopath is really a myth. Osteopaths sometimes manipulate the facet joints in the spine which, when gapped, can cause an audible sound due to a suction pop as the joint surface separate.  This technique is used to help alleviate some of the mechanical strain which is being placed on the disc and is not actually the disc “being put back in”.

The Osteopathic approach.

Having a disc problem, whether it is a protrusion, a prolapse or a minor strain of the annulus, indicates that the disc has sustained some physical damage. Bearing this in mind, disc problems take time to resolve as there is a certain amount of repairing which has to take place. Osteopathy can be used to try and speed this process up and to ensure that the spine is in the right condition to allow the healing process to happen.


The osteopathic approach is to examine the spine and see if it is possible to establish the reason why that particular disc has become symptomatic. It may be that the disc has sustained trauma, it may be degenerative, it may be that a quirk in that particular individual’s anatomy or posture has placed undue strain onto one particular disc.

In the acute phase osteopathic treatment can help ease the protective spasm around a symptomatic disc and improve the mechanical function of the spine. Help and advice on the management is invaluable. Painkillers and anti inflammatory tablets can be extremely useful. In the long run understanding how the problem developed in the first place is key to knowing how to treat the condition and how to prevent it from reoccurring in the future.