Who treats disc prolapses?
I know what you’re thinking – “Why no one?” That just doesn’t make sense. But by the time you’ve finished reading this article I expect you’ll agree with me that these two sentences together make perfect sense – “Who treats dics prolapses? Hopefully no one.”
What is a disc prolapse? Is it a slipped disc?
Disc prolapses are also popularly known as “slipped discs”. But this is a really unhelpful description. I much prefer the medical term “prolpased disc”, or “prolapsed disk” if you’re American. Because you see the disc does NOT “slip” out. It is not like a rubber spacer between the vertebrae. You could think of a disc more like a jam donut. The pastry bit is made up of millions of fibres – the annulus fibrosus. Every one of those fibres attaches the bone below with the bone above. So, it’s one complete unit – bone/disc/bone. You cannot “slip” the disc out form between the bones. You’d have to tear so much of the disc from its boney attachments. It just doesn’t happen like that.
But in the middle of the jam donut is the jam. The jam in the disc is called the “nucleus pulposus”. It’s a thick gel-like substance.
When you prolapse/slip a disc, a significant number of fibres tear in the annulus. Then some of the nucleus (jelly) squirts out through the defect. That’s the prolapsed material. And once it’s out, it’s not going back in. Trying to get it back in is like trying to get toothpaste back in the tube.
That’s what a disc prolapse is – the jam escaping from the damaged donut.
Why shouldn’t you treat disc prolapses?
Because if you treated disc prolapses you would be treating millions of people around the world who have no pain. That’s right. You can have a disc prolapse without any pain or any other symptoms. See the chart below. “Disc protrusion” 4 down in the left-hand column means disc prolapse. You’ll see that at aged 50 more than a third of people have disc prolpases. But, look at the heading. That’s a third of people with no pain!
So, if you treated disc prolapses, you’d be treating more than a third of the population over 40. That’s an awful lot of treatment and expense to go to for people who have no symptoms.
So, why shouldn’t you treat disc prolapses? Because more often than not they don’t cause pain.
Where does that leave us?
It leaves us where we should be. Treating people. As an Edinburgh osteopath specialising in lower back pain and sciatica treatment and author of two books on lower back pain, I don’t treat bodies. I treat people in pain.
I treat many people who I’m convinced have disc injuries, but aren’t a text-book case. In fact only a tiny minority of prolapsed discs present as text-book cases. It’s certainly possible to have an annular strain without prolapsed material. The stage before prolapse is described as “herniation”. This is where the donut bulges outwards, but none of the jam escapes. But there’s a stage before that where the donut is strained, with a few thousand fibres tearing. But there’s no change in the shape of the disc. That’s an annular strain.
It’s vitally important to treat the person and not the diagnosis.
So, whether you’re in Edinburgh or in Timbuktu, the information below is relevant, even though it’s slanted towards Edinburgh.
Who treats people with disc prolapses in Edinburgh?
If you really do have a disc problem and an experienced clinician is pretty certain your symptoms are in large-part coming from that disc problem, then you have a few options…
- Spinal surgeon
- IDD therapy
This article is long enough without diving into these in detail. But here are some links for more reading on these.
Review of IDD therapy in Edinburgh
How should people be treated?
A big topic, but here’s a good article to start with. It does cover similar ground to this one initially, but in the second half I dive into how to get your disc to heal. A very important topic! How can I cure a degenerative lumbar spinal disc?
Coming back to our 2 sentences, I hope you agree – “Who treats disc prolapses? Hopefully no one.”