Osteopathically, we tend to describe three types of acute disc injuries. Some consider hernia and prolapse to be the same injury, but most osteopaths make the differentiation based on whether the disc bulge is reversible or not.

Disc tissue is cartilaginous and, consequently, has a relatively poor nerve and blood supply. This is why some chronic disc problems can develop over time and why all disc injuries (acute and chronic) take longer to repair than other tissues, such as muscle or bone.

Here is a brief summary of three types of acute disc injuries:

The least severe of the three, an annular strain occurs when the outer ring of the disc (annulus fibrosus) is over-stretched and swells, causing localised pain. With treatment, the acute pain settles in 3-5 days and after 10-14 days, there could still be a minor stiffness present.

The outer ring of the disc is still intact, but disc material (nucleus pulposus) is breaking through the inner rings and causing a bulge to appear. The bulge is usually in the rear left or right quadrants of the disc as, centrally, there is one ligament which gives support and the pressure causes the bulge to go to one side of it. As the outer ring is intact, the bulge can reduce, but there is still vulnerability in the future if backache (or neckache) persists.

Pain comes on after an incident, usually involving forward bending, and is again localised to the back (or the neck). Within a few hours, the pain can become more diffuse and radiate across the back (or neck) into the buttock (or shoulder) area as the body tries to move away from the bulge and compensations take effect. A scoliosis away from the affected side is common as the bulge swells and the body attempts to remove the compression from this affected area.

Treatment is usually 7-14 days to decrease the diffuse pain and to ensure that the patient has a reduced scoliosis. The localised stiffness and ache can take anything between two to six weeks to settle depending on the severity of the hernia and the patient's lifestyle.

This is often referred to as a "slipped disc", which is a misnomer as the disc itself remains firmly implanted between the vertebrae and does not move anywhere.

With a prolapse, the disc material is now outside of the outer ring (annulus) and consequently the disc height now drops. There is usually less pain in the spine itself as the disc is no longer being strained. However, the space where the nerve passes through is smaller due to a thinner disc and a piece of disc material now occupies the same area, which presses on the nerve and causes greater limb (arm or leg) pain.

Treatment is longer term with the main principle being to create a larger space for the nerve to pass through. Although direct mechanical compression to the nerve causes pain, there is also a chemical swelling of the nerve which makes the space even smaller and consequently a vicious circle of "small space -> swollen nerve compression -> more swelling within the small space -> more pain etc " continues.

Treatment is initially geared to making the pain more bearable and stable by decreasing the compression. As well as the nerve pain, a lot of pain develops from the compensations of the body trying to avoid the painful area and the stiffness from over-protection. Over-treating these compensations can make the original injury persist so a balance of treatment is perhaps more important rather than aiming for a quick miracle cure.

Depending on the size or location of the prolapse, relief is at best two to three weeks, but is not uncommon to take three months or longer. If the prolapse is severe and manual treatment has not been sufficient, surgery may be the only option.

Typically, surgery gives immediate relief of the pain, so if the pain is no different afterwards, more manual treatment may be needed to ensure that the rehabilitative process is successful.

Warning Signs

It is not normal to feel a low grade (or stronger) neck or backache for more than a week or two without treatment. One of the most common scenarios described to me is of a persistent neck or backache which became worse with a simple movement (turning the head or when bending to pick up something as light as a tissue). This is usually a vulnerable disc that is herniating.

A neck or backache that reduces after a cough, sneeze or sudden movement and is then followed with severe leg (or arm) pain within 24 hours is likely to be a disc prolapse.

When the hernia or prolapse occurs, it is usually associated with spinal compensations reaching their limit of adaptability. Osteopathically, we try to fine tune the body's adaptive processes so that it can continue to function without breaking down, but for all of us there eventually comes a point when the body can no longer compensate for its own problems and injury develops.

Taking care of long-term minor aches and pains in the early stages is easier to deal with. We will all get older and we will all get stiffer whether we wish to or not, so a small amount of attention now can delay or decrease the changes to come.

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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards