Each disc is very securely welded to the bone above and below it. The idea that a disc can "slip" is therefore incorrect.
What Happens When a Disc is Compromised
There are a few different ways a disc can change. Each disc has a soft centre and fibrous outside. If the fibrous layer develops a weak spot, the soft centre can push against it. This might cause a bulge, in which the disc remains intact but a lump develops in the fibrous layer. Sometimes the soft centre pushes through, causing a protrusion. This is much less common than a bulge, and both can heal themselves over time, and we can help to provide an ideal environment for this to happen.
As we age, we notice ourselves getting shorter. One factor in this is lost disc height. This is a normal part of ageing, as discs become dehydrated over time. It means that the joints of the bones above and below get closer together which may cause some discomfort, but it does make the disc less able to bulge. So although back pain doesn't necessarily improve with age, incidence of bulging discs does.
Discs and Sciatica
Not all disc bulges result in sciatica, and not all sciatica is caused by a disc. Not every disc problem is even symptomatic. If a disc bulge presses on a nerve that joins with others to become the sciatic nerve, it might cause the pain, tingling, or weakness associated with sciatica. Similarly, if another nerve, such as the femoral nerve is affected, the same symptoms may affect another part of the leg.
Your osteopath will use clinical tests and your descriptions of the problem to work out if there is associated nerve irritation. We will also work to identify problems that share some features, such as referred pain. Once the diagnosis is confirmed, we can devise your treatment plan.
Management Strategies
Osteopaths are qualified to help with simple lower back pain like this. Contrary to common belief, clicking a joint does not click a disc back in, it simply improves movement in the joint. It might be most appropriate to improve movement above or below the problematic area. This approach aims to address the root of the problem: did the disc bulge because the area was overworked? If so, is there another area that's underperforming?
Local work can be appropriate to relax the muscles that restrict local movement once things have started to calm down. Encouraging movement to return to normal is a part of the plan that goes hand in hand with improving stiffness elsewhere. Your osteopath will develop this plan, including exercises you can do to help, depending on how your symptoms change over time.
Patients often ask if they should look into imaging for their back pain when a disc problem is mentioned. For straight-forward lower back pain, or simple sciatica, the NHS does not recommend routine imaging. One reason for this is that imaging is notorious for false positives in back pain. By the age of 40, roughly 50% of people would be diagnosed with a disc bulge if you scanned a random section of the population. but 50% of 40 year olds are not suffering the symptoms of a disc bulge.
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