Slipped Disc

What is a slipped disc?

A slipped disc, more accurately termed a herniated disc, refers to the condition where the nucleus pulposus (the soft, jelly-like centre of the disc) protrudes through a tear in the annulus fibrosus (the tougher outer layer of the disc). This terminology—”slipped disc”—though technically a misnomer, has become popularly used to describe this condition because it vividly captures the essence of what occurs. Despite the name, the disc does not actually “slip” out of place; instead, part of the inner material bulges or herniates through a tear in the disc’s exterior. 

This can lead to the disc pressing against or irritating nearby spinal nerves, causing symptoms like pain, numbness, or weakness, primarily on one side of the body. When the herniation places pressure on the sciatic nerve, it results in sciatica, manifesting as pain that radiates down the leg, occasionally extending to the foot​.

slipped disc singapore
Slipped disc refers to the condition where the nucleus pulposus protrudes through a tear in the annulus fibrosus.

What causes a slipped disc?

The causes of a slipped disc are multifactorial, often involving:

  • Degenerative changes: for most individuals, slipped or herniated discs occur due to age-related wear and tear on spinal discs. Over time, discs lose hydration and elasticity, making them more susceptible to tearing, even with minor stress or movement.
  • Mechanical stress: incorrect lifting techniques (lifting with the back instead of a combination of the legs and core), sudden twisting, or severe physical strain can directly cause or contribute to disc herniation.
  • Traumatic injury: direct impact from accidents or falls can abruptly displace or damage discs, leading to herniation.

 

What are the symptoms of a slipped disc?

Symptoms of a slipped disc are primarily influenced by the disc’s location and whether the herniation compresses spinal nerves. Slipped disc symptoms include:

  • Localised and radiating pain: the most common symptom of a herniated or slipped disc is pain, which may be localised or radiating. If the pain radiates, the slipped disc is compressing or irritating a nearby spinal nerve, reflecting the path of the affected nerve.
  • Numbness and tingling: these sensations typically spread along the nerve route, indicating nerve irritation or compression. Numbness and tingling may occur in the buttocks, legs, feet (in the case of lumbar disc herniation), arms, or hands (in the case of cervical disc herniation).
  • Muscular weakness: the affected nerves may lead to weakness in muscles served by those nerves, impacting motor functions​.
  • Changes in sensation: compression of spinal nerves can also cause changes in sensation in the affected area, such as reduced sensitivity to touch, temperature, or pressure. Individuals with a slipped disc may experience heightened sensitivity (hyperesthesia) or altered perception of pain (dysesthesia) in the affected area.

 

Is a slipped disc painful?

A slipped disc can range from being mildly irritating to severely painful, based on the extent of nerve involvement. The presence and severity of pain also depend on the disc’s location and the degree of nerve compression. While some individuals may experience acute pain, others might notice more pronounced numbness or muscle weakness without significant pain​.

slipped disc pain
Slipped disc can range from being mildly irritating to severely painful.

Who is at risk of developing a slipped disc in Singapore?

 

While slipped discs can occur in individuals of any age, certain factors may predispose some individuals to experience this condition more than others. Common risk factors for developing a slipped disc include:

 

  • Age: as we age, our intervertebral discs, which comprise 66-88% of water, lose some of their water content, making them less flexible and more at risk of herniation. Therefore, middle-aged and elderly individuals are more likely to experience disc degeneration.
  • Genetics: a family history of slipped or herniated disc increases the individual’s risk of the condition.
  • Gender: men are two times more likely to experience a slipped disc than women.
  • Occupation: jobs requiring heavy lifting or prolonged sitting, particularly those involving repetitive bending or twisting, can cause disc degeneration and an increased risk of slipped disc.
  • Lifestyle: a sedentary lifestyle, obesity, and smoking can all contribute to the risk of a slipped disc due to their impact on spinal health and disc integrity​.
  • Trauma and injury: trauma from accidents, falls, or hard impacts to the spine can increase the risk of a slipped disc.
  • Degenerative conditions: certain degenerative conditions, such as degenerative disc disease, can weaken the intervertebral discs, making them more prone to herniation.

 

How is a slipped disc diagnosed?

 

A slipped or herniated disc is diagnosed using the following: 

 

  • Medical history and physical examination:  your pain specialist (link to service page) will inquire about your symptoms and what activities worsen or improve them. Additionally, a physical exam will be conducted to assess your range of motion, sensation, muscle strength, and reflexes. 
  • Imaging tests: imaging tests such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans are effective in visualising soft tissues, including discs and nerves, to confirm the presence and extent of herniation.

Diagnostic injections: diagnostic injections such as provocative discography and epidural steroid injections may be used to identify the source of pain and to rule out other spinal disorders.

spinal injection
Epidural steroid injections can help to identify the source of pain in slipped discs.

What are the treatment options for slipped discs in Singapore?

Treatment strategies can vary, ranging from conservative measures to surgical intervention, based on the severity of symptoms. Treatment for slipped discs includes:

  • Medications: nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and, in some cases, steroids may be prescribed for pain management and to reduce inflammation.
  • Physical therapy: physical therapy for slipped discs involves tailored exercises to strengthen the back and alleviate pain.
  • Epidural steroid injections: epidural steroid injections deliver a potent anti-inflammatory medication directly into the epidural space surrounding the affected spinal nerves, providing targeted pain relief and reducing inflammation associated with a slipped disc. These injections may be considered for individuals with persistent or severe pain that does not respond to conservative treatments.
  • Facet joint injections: facet joint injections  may be used to alleviate pain originating from the facet joints of the spine, which can contribute to symptoms associated with a slipped disc. These injections deliver a local anaesthetic and corticosteroid medication directly into the facet joints to reduce pain and inflammation.
  • Disc decompression: annuloplasty (biacuplasty) or nucleoplasty may be viable options to manage this condition.
neck xray
An X-ray of the neck allows for visualisation of any abnormalities contributing to neck pain.

Frequently asked questions

Fixing a slipped disc often involves a combination of rest, physical therapy, medication, and sometimes injections or surgery, depending on the severity of the symptoms. Initial treatments usually focus on relieving pain and inflammation, with options including over-the-counter pain relievers like ibuprofen or acetaminophen, as well as heat or ice application to the affected area. 

For more severe cases, a healthcare provider may prescribe muscle relaxers, neuropathic drugs such as gabapentin or pregabalin, or even cortisone injections to reduce inflammation around the spinal nerves. Physical therapy can also be beneficial, as it teaches exercises that minimise pain and improve mobility. 

If these conservative treatments fail to provide relief after several weeks, surgery may be considered, particularly if there’s significant nerve compression causing muscle weakness or loss of bladder or bowel control​. 

Many slipped discs can improve on their own over time, with about 90% of cases resolving without surgery. The healing process can vary, with some people experiencing significant improvement within a few days to weeks, although the typical recovery timeline is about four to six weeks. The key factor in healing is often simply time, allowing the body to repair the herniation naturally​.

Knowing if you’ve slipped a disc usually involves recognising specific symptoms, including pain and numbness, often on one side of the body and extending to your arms or legs. Pain might worsen at night or with certain movements. Severe cases can lead to muscle weakness, affecting your ability to carry out daily activities.

While a slipped disc can be a serious problem, especially if it leads to significant pain or functional impairment, it’s not always the case. Many people with a slipped disc experience mild symptoms that improve with time and conservative treatments. However, if the disc herniation compresses nerve roots or the spinal cord, it can lead to more severe conditions like radiculopathy or myelopathy, necessitating more urgent intervention​.

Being proactive in treatment and consulting with healthcare professionals can effectively manage the condition, preventing it from becoming more serious.