When it comes to “slipped disc”, there’s way too much broscience and marketing fluff going around.
You would have heard people saying that slipped disc occurs when you don’t lift a heavy object with “good” form.
You may have seen a doctor or orthopaedic surgeon who might have told you that you wouldn’t squat again.
Here’s the good news. None of that is true.
What is a slipped disc?
You have round discs in your spine known as the intervertebral discs. These discs act as shock absorbers for your spine to allow you to carry out your daily activities.
For most of us, our discs would change as we age. These changes may lead to the inner portion (nucleus pulposus) of our spinal disc protruding through its outer ring. When this happens, we get disc bulges or disc protusions.
While they may sound scary, these are normal age-related changes. Most of us live with slipped disc without knowing we have them.
You may think of disc hernations as wrinkles or grey hair. As we age, we do get more wrinkles and grey hair. However, these changes do not give us face pain or headaches.
For the minority of us who are affected, a slipped disc may you to feel pain in your arms or legs. This is particularly common in the low back where a lumbar disc may compress on a spinal nerve. The affected nerve may then led to sciatica-like leg pain.
The Flawed “Slipped Disc” Approach To Back Pain No One Is Talking About
You may be wondering how I as a chiropractor can help with your disc herniation.
“Can you put it back in place?”
From a structural, science point of view? No, there is no chance.
Science tells us that it’s imopossible for a chiropractic adjustment to move your vertebrae back into “alignment”. Similarly, you can’t pop your disc back in place. This is the truth.
For perspective, it takes ~740lbs of force (or 335kg) to compress a disc height by 1mm in young adults. For older adults, it will take ~208kg of force!
So if you are thinking your spinal disc is a squishy jam-filled donut, I can assure you it is not.
There are Singapore chiropractors who may say otherwise but current research does not support their claims.
What chiropractors can do for you, however, is to change your symptom experience without the need for drugs or steroid injections.
Video: Chiropractor Jesse and Clinical Exercise Physiologist Michael discuss why you don’t need a MRI for your back pain.
This may seem like a shock to you but your back pain is probably not coming from your disc. (For the purpose of this blog entry, we use the terms slipped disc and disc herniation interchangeably.) Truth is, most of us have herniated disk and do not have pain.
Research has been telling us that herniated discs are more likely a natural progression of ageing – no different from wrinkles and white hair. Will you dye your hair black just because your head hurts? No, you are not likely to.
As a society, we are obsessed with perfection, symmetry, and alignment. Research tells us that this is largely a social-aesthetic construct.
When our magnetic resonance imaging, MRI, scan shows that we have a disc bulge or disc protrusion, we tunnel-vision into looking at how we can get rid of it. Because we expect our physical body to be perfect.
What if that is the wrong way to look at your back pain? Wait, we do know that this is the wrong way to look at back pain. We have hard data to support this.
A massive study from 2015 looking at 3110 individuals without pain or any symptoms found that spinal degeneration progressively increases with age (American Journal of Neuroradiology). What was previously thought of as “wear and tear” is now – by best evidence – archaic, pejorative, and inaccurate (yes, those exact words were used in Rheumatology, 2018).
This is what best evidence says!
You might have a disc herniation from today or ten years ago. So what?
If you want, you can read the specifics to why an entirely structural approach to pain doesn’t work.
The important thing to realise is that spinal degeneration or even “slipped disc” do not cause back pain.
Yes, your MRI may show disc herniation.
Yes, you are experiencing back pain.
However, it doesn’t mean your back pain is caused by your herniated disc. In fact, we know they are unrelated. Like mentioned earlier, they are more likely natural age-associated changes.
Why is no one talking about this? Why healthcare providers consistently lying to patients by telling them their back pain is coming from their disc herniations?
Let’s say disc herniations do cause back pain (it doesn’t). So what?
We know slipped disc resorbs itself over time (Clinical Rehabilitation, 2015). Wow, right? I don’t think it can get any more perfect than this:
1. Slipped disc and pain is poorly correlated (i.e. your back pain is not coming from your vertebral disc)
2. Your herniated disc will go away by itself even if you do nothing to it, quite often within months
MRI To Diagnose Back Pain
MRI referral for back pain is an epidemic. They do not help with recovery most of the time but yet doctors are still referring back pain patients for MRI. You are probably one of them.
Do you know imaging findings have such poor correlation with back pain that medical organisations around the world are frantically pushing for doctors to dramatically reduce MRI studies referrals since as early as 2011 (Annals of Internal Medicine)? Maybe you think this is a financial decision. Less MRI referrals = less insurance payouts and less strain on the public health system right?
No, you are wrong.
A study in 2019 found that patients who had undergone x-ray or MRI spend more money on healthcare. They are also absent from work more than those who did not choose to undergo imaging. We like to think if we can see exactly what is wrong, we will be able to better fix the problem. Unfortunately, in this case, that doesn’t apply.
There are other studies who publish similar findings. Patients with back pain who have had imaging experienced a worse sense of well-being (Radiology, 2005) and were eight times more likely to opt for surgery (Journal of Occupational and Environmental Medicine, 2010).
The difference is REAL.
Unnecessary MRI will increase your health care costs, worsen your symptoms, delay your recovery, and give you a poorer quality of life.
There is no nice way to say this, but this is an all-round loser.
MRI is powerful and sensitive
Don’t get me wrong. MRI is an amazing imaging technique. With magnetic field and radiowaves, MRI allows doctors to visualise any part of your body from any angle. If you want to look at the spinal canal to see how the spinal cord looks in it, MRI is perfect for that.
Yes, MRI studies are perfect when diagnosing life-threatening conditions such as cauda equina syndrome. You can read more about when you may need a lumbar MRI here.
How do I know my disc herniation is a problem?
While disc herniations poorly correlate with back pain, they might cause leg pain or “sciatica”. This happens when the disc is pushing against a spinal nerve against part of your spinal bones called vertebrae. The symptoms to this may include pain, numbness, or weakness in your lower limb. These symptoms result from a compression of the spinal nerve or nerve roots coming out of your lumbar spine.
While the most obvious treatment may be surgery, there are also conservative treatment options available. Neurodynamic mobilisation is a type of herniated disc exercises that can help. There are treatments for herniated disc without surgery.
If you start to changes in your bladder or bowel movements or significantly muscle weakness, seek medical advice immediately. It is possible that there is pressure on your spine that is causing parts of your spinal cord to be compressed.
p.s. true sciatica happens with the impingement of the sciatic nerve. This typically occurs in the buttock muscle known as the piriformis. True sciatica doesn’t originate from the lumbar spine.
What causes lower back pain?
There are many reasons why your back may be hurting. It could be from the soft tissues in your low back, a muscle spasm, nerve pain, or other conditions such as ankylosing spondylitis. As such, there are different types of lower back pain.
Do not try diagnosing back pain symptoms yourself.
The best thing you can do to find out where your pain is coming from is to seek professional advice. A good chiropractor will go through your medical history and perform a thorough examination. After which, they work with you to get to the root of your back pain to provide treatment to relieve pain.
Slipped Disc Treatment
Now that you know your back pain is unlikely to be coming from your disc, allow me to take you through on how your recovery may look like.
First, do not think of me as your pain terminator.
Think of me as someone who works with you to increase your body’s capacity and your body’s tolerance for the activities you love enough so that you don’t get pain. Even if all you want to do is “just” read on your ottoman pain-free, I want to help.
The difference between a good chiropractor and a mediocre one is his or her intention to help you live your life the way you want it. It is what you deserve and we want to work with you to achieve just that.
Research has been telling us exercise is the best approach to treating back pain. Most Singapore chiropractic clinics, however, still offer only chiropractic adjustments. Even physical therapists or physiotherapists in Singapore are slow to pick up exercise as a primary modality – physical therapy, IASTM, dry needling are still common treatments offered in Singapore even though all of them are at best adjunctive therapy.
I know exercise rehabilitation is probably not what you are after. You must think I am crazy to suggest you exercise even though you are in pain. Remember, back pain exercise is what works best.
Even if you have a pinched nerve in your lower back, we have exercises that can help with just that.
Research has also shown painful rehab-exercises have better outcomes than non-painful ones. Of course we will work within your limits to help you achieve full recovery. Don’t worry, we are good at what we do.
The worst thing you can do for yourself is avoid physical activity.
While muscle relaxants and anti inflammatories may be good for short-term relief, they are extremely unlikely to be your long term pain solution.
The Chiropractor-Patient Dialogue
At Square One, we treat you (clients and clients patients alike) holistically.
We put your values and preferences with our clinical expertise and the best research evidence to help you achieve your recovery goals.
In the rush and hurry of living in the 21st century, healthcare providers stopped listening to what you desire (as a patient). This is unacceptable. It caused misconceptions and misunderstanding of what your symptoms are and your can do about it. When was the last time a health professional you offered you advice AND the research papers to support their recommendations?
To illustrate the severity of the problem, do you know the average doctor interrupts you just after 23 seconds (Journal of American Medical Association, 1999)? The amount of time it will take for you to complete your opening statement is only 32 seconds. Yet most health professionals can’t let you speak for 32 seconds uninterrupted.
You First, Always
Research guides us as healthcare providers to administer best-evidence care. This not limited to just the best techniques and modalities. It also includes the relationship we build with you, and how we can – in intangible ways – help you get more than pain relief.
Don’t settle for less. Let us help you with what really matters to you.
Today, we want you to know that MRIs are not good for your back pain. In fact, MRI itself is a risk factor for chronic back pain!
If you already had your MRI done and found that you have a couple of disc bulges/protrusion, don’t worry. Research tells us it’s okay. Just breathe, relax, and find yourself a good chiropractor who will help with your back pain treatment.
You came to this page because you were looking for advice regarding herniated discs.
The good news? You don’t have to worry about them any more! Let us help you achieve pain-free living with the best evidence care. Book now via our online booking form below.
Looking to visit us? We are two minutes away from Outram Park MRT (Dorsett Hotel exit). If you are coming from Tanjong Pagar, we are a five minute walk from 100 AM Mall.