Slipped disc (herniated disc)
Between the vertebrae sit the discs, springy pads that absorb the load with every step. When the tough outer ring of a disc tears, the soft core bulges…
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Medicines commonly prescribed for Slipped disc (herniated disc)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 200 mgActive substance: ibuprofenManufacturer: Hc Clover Productos Y Servicios S.L.Prescription requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 200 mgActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription required
Between the vertebrae sit the discs, springy pads that absorb the load with every step. When the tough outer ring of a disc tears, the soft core bulges outwards and can press against a nerve root. That is what a slipped disc is. The phrase sounds like a life sentence, but the real picture is rather reassuring: in most people the bulge shrinks by itself over weeks and months, the pain settles without surgery, and what a person does during those weeks affects the timescale more than any procedure does. This page also deals separately with the signs you must not wait on, and gives an honest account of what a scan can and cannot tell you.
What actually happens to the disc
Everyday phrases such as "a disc has slipped out" or "a vertebra has shifted" paint a false picture, as though something has come loose inside and just needs putting back. The disc does not slip out of anywhere: it is firmly bonded to the vertebral bodies. Some of the inner material squeezes through a crack in the outer ring, rather like jam through a cut in a doughnut, and sits outside as a small bulge.
What happens next is rarely mentioned: the body dismantles that bulge. Disc material is foreign to the tissues once it is outside its casing, so blood vessels and scavenging cells move in, the bulge loses water and gradually shrinks. In some people a repeat scan a year later simply cannot find it. And the larger the bulge was to begin with, the more often it shrinks noticeably.
Hence a point worth keeping: the pain goes not because the disc has "gone back in", but because the bulge has got smaller and the inflammation around the nerve root has settled. Manipulation with a click puts nothing back, even though it does give many people short-lived relief.
How it shows itself
A herniated disc feels different depending on the level of the spine involved and on whether it touches a nerve at all.
- In the lower back. The commonest site. The pain may stay in the back, or it may travel down the leg past the knee with tingling and numbness. Pain running along the sciatic nerve is called sciatica, and it has its own page on this site.
- In the neck. Neck pain radiating into the shoulder blade, shoulder, arm and fingers, sometimes with numbness or weakness in the hand. It typically worsens on turning or tilting the head and eases if you rest a hand on top of your head.
- Shared features. Pain that flares on coughing, sneezing and straining; difficulty sitting for long or bending forwards; difficulty straightening up after sitting.
An important corrective to the general alarm: a bulge on a scan is by no means always the cause of the pain. Enormous numbers of people live with disc bulges and never find out, because no nerve is touched and nothing hurts. More on that in the section about scans.
A herniated disc rarely comes from a single unlucky movement: discs lose water and springiness with age, and then whatever happens to come along does the rest — lifting a weight while bent and twisting, hours of sitting, a jerk in the gym, excess weight, smoking.
Why rest is not treatment
The folk logic is straightforward: your back hurts, so lie down until it mends. With a herniated disc that is one of the costliest mistakes going.
Bed rest does not speed recovery up, it slows it down. Within a few days of lying still the muscles that support the spine weaken, joints stiffen, movement becomes harder, fear of pain grows and the person moves even less. The circle closes. Moving with a herniated disc hurts, but it does no damage: you cannot break the disc further by walking.
As a rough guide to timing: the sharp pain usually settles within days or a couple of weeks, clear improvement comes for most people at six to eight weeks, and full recovery takes anywhere from several weeks to several months. Surgery is needed by a minority.
What to do in the first weeks
- Carry on with ordinary life as far as you can. If the pain is severe you may need to take the first day or two quietly, but then return to movement without waiting for the pain to disappear entirely.
- Walk. Several short walks a day are tolerated better than one long outing. If you work sitting down, get up every twenty to thirty minutes.
- Pitch the effort by the rule "uncomfortable but bearable, and no worse tomorrow". Walking, swimming and simple exercises for the back and abdominal muscles all suit; heavy lifting, jumping and sharp twisting do not, at least in the acute phase.
- Pain relief is there so you can move, not so you can tolerate lying still. Anti-inflammatory painkillers are the usual starting point, since paracetamol does less for this kind of pain. Anti-inflammatories do not suit everyone: with stomach, kidney or heart disease, with high blood pressure and in pregnancy they are taken only with a doctor's agreement. A short course works better than taking them "until it goes".
- Heat over the sore area — a hot water bottle, a warm shower — helps many people; others prefer cold. The right choice is whichever eases things for you.
- For sleeping, most people are more comfortable on their side with a pillow between the knees, or on their back with a cushion under the knees; a special mattress is not necessary. A support belt can rescue a bad day, but it is not worn for weeks on end, because the muscles get out of the habit of working.
Stopping smoking and shedding excess weight are both worth doing: they affect the state of the discs and whether the episode returns.
When it is a matter of hours
There is one complication that makes this whole page worth reading. At the very bottom of the spinal canal the nerve roots run in a bundle known as the cauda equina, the horse's tail. If a large herniation squeezes the whole bundle, the bladder, the bowel and both legs are affected at once. This is an emergency: if the pressure is not relieved within hours, the loss of bladder control, sensation and sexual function becomes permanent.
Call an ambulance at once or go straight to the emergency department if even one of the following appears:
- numbness in the perineum, around the anus and genitals, and on the inner surface of the thighs — the area that touches a bicycle saddle;
- being unable to pass urine, or feeling a full bladder with no urge; or, conversely, urine leaking without you noticing;
- losing control of the bowels, or losing the urge to open them;
- increasing weakness or numbness in both legs at once, unsteadiness on your feet;
- pain that was in one leg and has spread to both.
Do not wait for the morning and do not test whether it settles by the evening. Do not drive in that state — ask someone to take you or call an ambulance, in European countries on the single number 112. Take the list of medicines you are on. And say it plainly: numbness in the perineum, trouble passing urine. Those words decide how quickly you are seen.
Other reasons not to wait
Besides the cauda equina there are signs that need a doctor the same day or the next, not after a month of watching and waiting.
- Increasing weakness in the foot or the hand. The toes catch on the floor, the foot slaps down as you walk, the knee has to be lifted higher; objects drop out of the hand and a cup cannot be held. This is loss of function in the nerve root, and the sooner it is freed, the better the chance the strength returns fully.
- Fever together with back pain, particularly with chills and night sweats, in someone with a weakened immune system, recent spinal surgery or recent injections. That is how infection of a vertebra or an abscess next to the spinal cord shows itself.
- Pain that started after a fall, a blow or a road accident, or after a minor injury in someone with osteoporosis or on long-term steroid treatment.
- Night pain that prevents sleep and does not depend on position, along with weight loss, loss of appetite or a past history of cancer.
- Neck pain with loss of balance and an altered gait, clumsiness in both hands, difficulty doing up buttons — a sign that the spinal cord itself is being compressed in the neck.
And the ordinary, unhurried reason to book an appointment: the pain has not begun to ease within six to eight weeks, it is getting in the way of work and sleep, or it keeps coming back.
About scans: why an early MRI usually changes nothing
"Just send me for a scan" comes up at almost every appointment, and a refusal looks like penny-pinching. The reason is different, and worth knowing.
Disc changes turn up in vast numbers of people who have no pain at all. Scan the lower backs of people with not a single complaint and disc bulges appear in around a third of those in their thirties and in most of those over sixty. This is an age-related finding, much like grey hair. A herniation on a scan therefore does not by itself prove it is the source of the pain: to link picture to symptom, the doctor needs what is on the image to match exactly where the pain and numbness are.
Second: in the first weeks a scan does not change the plan. Herniation or no herniation, the treatment is the same — movement, pain relief as needed, time. A scan earns its place when a decision depends on it: red flags from the sections above, a neurological deficit, or surgery under discussion.
Third, and less obvious: an early scan sometimes does harm. Someone who reads "protrusion, degenerative change, deforming spondylosis" in a report starts guarding the back, moves less and takes longer to recover. Report language sounds far worse than what it describes.
A plain X-ray shows neither discs nor nerves — it answers only the question of whether a bone is broken.
If the pain drags on for months
When several weeks of home measures have not worked, a doctor will usually suggest the following.
- Work with a physiotherapist. Not passive treatments, but a tailored exercise programme and a look at how you move, sit and lift. This is the best-supported part of the treatment.
- Reviewing pain relief. A short course of something else is sometimes added. Strong painkillers are not prescribed long term for home use, and muscle relaxants are given for a few days only.
- A steroid injection near the nerve root. It does not help everyone and its effect lasts a limited time, but it can buy a breathing space and break the pain-stiffness-pain cycle. A sensible step before any conversation about surgery.
- Surgery. The part of the disc pressing on the root is removed. It is discussed for severe persistent pain that has resisted everything for months, for progressive weakness, and urgently for cauda equina syndrome. It relieves leg or arm pain faster, but after a year or two the results of those operated on and those treated without surgery largely level out: in an ordinary course there is no reason to rush, whereas with a neurological deficit the opposite is true.
Online consultation
A remote appointment settles the main questions of the first few days: whether this fits a herniated disc, whether any red flags are hiding among your symptoms, and what to do today. The doctor will go through where exactly the pain radiates and ask about strength in the foot and hand, about passing urine and about numbness in the perineum — in other words, will check precisely what separates an ordinary episode from an emergency. Online is also a good place to tailor pain relief around your other conditions, get a clear movement plan for the coming weeks, and work out whether a scan is needed or would change nothing. Another common request is to have an existing MRI report explained: the wording almost always sounds worse than the situation is. The signs in the cauda equina section are not assessed remotely — with those, go straight to the emergency services.
This material is for information only and does not replace medical advice.
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