What causes a slipped disc?

It is not clear why some people develop a 'slipped' (prolapsed) disc and not others, even when they do the same job or lift the same sort of objects. It seems that some people may have a weakness in the outer part of the affected disc. Various things may trigger the inner softer part of the disc to squeeze out through the weakened outer part of the disc. For example, sneezing, awkward bending, or heavy lifting in an awkward position may cause some extra pressure on the disc. In people with a weakness in a disc, this may be sufficient to cause a prolapse. Factors that may increase the risk of developing a prolapsed disc include:

• A job involving lots of lifting.
• A job involving lots of sitting (especially driving).
• Weight-bearing sports (weightlifting, etc).
• Smoking.
• Increasing age (a disc is more likely to develop a weakness as we become older).

What are the treatments for a slipped disc?

If you have a 'slipped' (prolapsed) disc, you should carry on as normal as far as possible. This may not be possible at first if the pain is very bad. However, move around as soon as possible and get back into normal activities as soon as you are able. As a rule, don't do anything that causes a lot of pain. However, you will have to accept some discomfort when you are trying to keep active, but this is not harmful. Setting a new goal each day may be a good idea - for example, walking around the house on one day, a walk to the shops the next, etc.

In the past, advice had been to rest until the pain eases. It is now known that this was wrong. You are likely to recover more quickly and are less likely to develop persistent (chronic) back pain if you keep active when you have back pain rather than rest a lot. Also, sleep in the most naturally comfortable position on whatever is the most comfortable surface. (Advice given in the past used to be to sleep on a firm mattress. However, there is no evidence to say t

Exercise

General exercise is very important if you have a prolapsed disc. It can help lessen the pain by strengthening the muscles that support your spine. Although it is not known if specific spinal exercises are better than generally keeping fit, a physiotherapist can advise you on what exercise you could do in your situation.

Exercise not only reduces the pain of a prolapsed disc but may also reduce the chance of it happening again.

Physical treatments

Some people visit a chiropractor or osteopath for manipulation and/or other physical treatments. It is debatable whether such physical treatments help all people with a prolapsed disc but they may provide some short-term comfort. They should be accompanied by regular exercise.

Surgery

Surgery may be an option in some cases. As a rule, surgery may be considered if the symptoms are very severe and have not settled after at least six weeks or so. This is the minority of cases as, in about 9 out of every 10 people with a prolapsed disc, the symptoms have eased off completely or are not bad enough to warrant surgery by this time.

The aim of surgery is to cut out the prolapsed part of the disc and release the pressure on the nerves. This often eases symptoms. However, it does not work in every case. Also, as with all operations, there is a risk from surgery. A specialist will advise on the pros and cons of surgery and on the different techniques that are available.

It is not known whether it is better to have surgery or better to wait and see. Recent research suggests that surgery is better in the short term but makes no difference in the long term. For example, people who had an operation had less pain six weeks later than those who hadn't. However, it made no difference to the amount of pain someone had or the effect on their lives, after three months.