WHAT IS IT DOC? SLIPPED DISC? PINCHED NERVE?
by Dr. Brian S. Seaman, DC, FRCCSS(C), FICC
When back pain persists for more than a couple of days, is quite severe, or getting worse, you should schedule an appointment with your health care professional.
A common question I often hear from patients is "What is it Doc? A pinched nerve? A slipped disc?"
The first thing your health care professional will do is review with you a number of issues or characteristics of your particular problem. These questions would include such things as:
There are many questions that can be asked, depending upon your response to these initial questions. These will assist your health care professional in identifying the potential sources of the pain and what would be the best approach to further investigations. The examination will help to confirm the suspicions of your health care professional and provide additional information from a clinical perspective.
For instance, a slipped disc --- which does not really slip--- can cause considerable pain. A slipped disc may or may not cause lower back pain but can cause pain in the gluteals or buttocks and extend down the leg to the ankle or foot. Your health care professional will likely ask what part of the leg the pain travels down and into what part of the foot (or toes). This is very important information as this can determine what nerve may be involved and in turn, help to determine clinically, which disc is the most likely culprit. The most common level of disc herniation is the last one in your lower back (referred to as L5-S1). The next most common is the disc right above it (referred to as L4-L5).
Do x-rays show a slipped disc?
To confirm a diagnosis of a slipped disc, your health care professional may recommend a CT scan or an MRI. He/she will review the radiology report (or x-ray report) to determine if the CT or MRI results correlate clinically, to your examination findings and pain pattern. Many people can actually have a disc bulge, or herniation demonstrated on a CT or an MRI, but will have no actual symptoms.
Disc injuries can involve only the outer fibres of the disc (referred to as a bulge of the annular fibres), herniation of the gel in the center of the disc (this is the nuclear pulposis and is often referred to as the slipped disc), or can have part of the disc break off (referred to as a disc fragment) and lodge against the nerve. Your examination findings, as well as the effect on your daily activity level, will have a bearing as to whether surgery would be a consideration.
Obviously, you should pursue all conservative approaches to treating a slipped disc first. This could include chiropractic care, physiotherapy, acupuncture, medication, ice therapy and modification of your activity levels.
"What if it isnt a slipped disc"?
What is the most common cause of lower back pain?
In addition to spinal manipulation/spinal adjustments, chiropractors will consider other aspects of you lower back difficulties including potential causes (and how to prevent a recurrence and chronicity), ergonomics (how you job may affect your lower back and how top prevent further strain), and design an appropriate exercise program to correct the imbalances and weaknesses of muscles that may have been contributing factors.
What should I do if I injure my back?
If the pain is severe or limiting your activity level, be sure to consult with your health care professional as to what would be the appropriate treatment, if any other investigations are needed and to see how you can prevent a recurrence.
The recurrence of back problems is a significant problem not only in Canada but in most societies. Approximately 64% of Canadians experienced an episode of back pain in the past year and 15% of these people lost time from work! Almost half of these individuals were off work for more than a month (Source: Environics).
So the survey says
Conservative approaches to back problems benefit the majority of individuals. So consult with your health care professional and ask about how to approach your back problems from a conservative point of view and prevent recurrent problems.
Reprinted with permission of