The intervertebral disks act as “shock absorbers” between the vertebral bodies and are responsible for flexibility of the spine. Each consists of a pulpy nucleus contained in an outer fibro cartilaginous ring. The disk cannot “slip” but the soft nucleus may herniate through the outer ring, producing a bulge forward or sideways into the spinal canal. Usually this is due to trauma (80 percent of cases) associated with changes in the fibrous consistency of the disk’s outer wall. Typically, the disk “slips” while the person is lifting a heavy weight with the body bent. (The risk of a disk injury can be reduced by keeping the back straight while lifting.) This condition, known technically as herniated disk, ruptured disk or prolapsed disk, occurs most often in persons in their 30s and 40s.

Protrusions of the lumbar disks (in the lower part of the back) are approximately fifteen times more common than cervical protrusions (in the neck); thoracic disks (in the chest region) rarely are affected. Protrusion backward may impinge on the spinal cord or the nerves leading from it, causing pain (sciatica), weakness, and numbness, especially in a leg.

X-ray examination of the spinal area usually will show loss of disk space between particular vertebral bodies; it will not show the disk itself. Injection of a radiopaque dye (a myelogram) is required to define the precise extent of a disk’s backward protrusion. Treatment depends largely on the severity of the symptoms and the nature of the injury.

The first treatment for slipped disk is for the person to rest in bed, lying on a firm mattress supported on a wooden base. Complete rest often leads to relief of symptoms within a few days and to healing within a few weeks. If the rest alone is ineffective, then the bones of the spine may be stretched apart by traction, under medical supervision.

Persons who have experienced a slipped disk are at higher risk for developing more, either in the same spot or elsewhere. Treatment is aimed at controlling pain and enabling the person to continue to work, but it is not a cure. If these measures fail, or if the symptoms recur on several occasions, then surgical treatment may be necessary to remove the protruded section of disk.

Self Help - damage limitation

When a disc prolapses the muscles surounding the area go into spasm - this not only hurts but also further compresses the damaged disc, squeezing the bulge still further. If the compression on the disc reaches critical level it may burst and cause the jelly from the centre of the disc to leak into the surrounding tissues where it causes further inflammation and eventually may crystalise around the nerves resulting in permanent injury and pain.

Bed rest and immobility can actually be detrimental to long term recovery from a prolapsed disc. It is essential to begin to gently move the spine as soon as possible (and as soon as pain allows).

Step one - reduce pain

Before you can do anything, it is important to reduce pain and inflammation. This does mean lying on a firm bed, or on the floor, and taking anti-inflammatory pain killers such as aspirin or ibruprofen. Also alternate hot and cold compresses are an excellent idea. For this you need a hot water bottle, wheat bag or hot, wet towels (and a willing and able body to supply them!) and an ice pack, very cold wet towels or a package of frozen peas. Every couple of hours apply the hot compress followed by the cold - about 3 repetitions of each for a couple of minutes at a time. This gets the blood moving through the damged region and helps reduce the inflammation which is contributing to the pain. The large muscles supporting the spine should then be able to relax a little and allow you to proceed with the next step.

Step two - move those aching bones

Obviously what you dont want to do is to make the condition worse, so avoid bending, lifting or straining in any way. The movements you do should hopefully lessen the pain by stretching the spine and reducing pressure on the damaged disc - if the pain stays the same, don't worry, but if it hurts more STOP!

The types of exercise depend on where in the spine the injury is. The most common site for a prolapse is the lumbar region - the lower back, where the curvature of the spine (lordosis) is greatest. Exercises such as pelvic tilts, which flatten the curve, are usually beneficial, as is raising and holding one knee (carefully) to the chest or just sliding alternate legs into a flexed position. If you can comfortably lie on your stomach (with or without a pillow under your body - whatever is most comfortable) try moving your hips away from the side with the pain - this reduces the pressure on the disc. Lying in the foetal position, with a rolled towel supporting your waist, can be very relaxing and helpful, so long as it lessens the pain.

Step three - seek professional advice

If you can afford it, or if your health service has the facilities, seek the help of a specialist such as a chiropracter, osteopath or physiotherapist. To find a McKenzie practitioner in your area try http://www.mckenziemdt.org. A good therapist will be able to loosen the rigid muscles by massage and then manipulate your spine to unlock the vertebrae thus relieving the pressure on the disc - sometimes the results can be instantaneous, but usually you may need half a dozen or more sessions.

More importantly they will be able to give you a series of exercises which will strengthen the individual muscles to correct the weakness that caused the prolapse in the first place. Follow this regime (for the rest of your life!), improve your posture, and with any luck you will never suffer from a slipped disc again.


http://www.spine-inc.com/exercise/exerpage7.html
Treat your Own Back - by Robin McKenzie

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