Slipped disk

Intervertebral foramen.

Slipped disk is common and, if treated early before swelling and inflammation sets in, usually responds magnificently to chiropractic help. However, once it starts going down the leg, then it's another matter. Take it seriously in the beginning so that these other disabling and painful symptoms begin.

The intervertebral space is filled with material that lies between each adjacent pair of bones in the spinal column; it can bulge and herniate quite commonly. Few of us escape occasional episodes. Mostly pain in the low back only, with the possibility of radiating down the leg, very rarely in the midback, but also quite commonly in the lower neck, with the possibility of pain and tingling in the arm.

The spinal column is made up of 26 vertebrae that are strongly joined together with ligaments to permit forward and backward bending, side bending, and rotation of the spine.

The facet joint, situated immediately behind the nerve root, helps to control and limit these movements.

Each disc is composed of two parts: a gelatinous material not unlike egg white called the nucleus pulposus, surrounded by rings of a fibrous tissue called the annulus fibrosus.

That gel can bulge and herniate through the surrounding rings. The further it progresses, the more the pain in the leg.

Normal disc.
4 stages of slipped disk
Foraminal herniated disc.
Disc extrusion.
Disc sequestration.

This is typically how it may begin, particularly if you twist and lift, or sneeze at the same time.

A worker bending over.

Recognise the artist? You should! Look for a V hidden in the bottom left corner.

From the Coal Face

'I don't need to ask what's wrong with you, Mr Jones. But tell me how it happened, and when.'

The tall angular man looked like the leaning tower of Pisa. He stood with an acute angled posture, yet declined to sit. Instead he perched on the edge of the desk.

'Six months ago, and gave a hard tug on the sheet on my boat, and felt a sharp stab of pain in my back.'

'And then?'

'My doctor said I had sprained my sacroiliac joint. I had some pills, some physiotherapy, and then after a sneeze it started down my leg.'

We eventually won with Mr Jones' back, but I won't pretend it was easy. It wasn't. It all starts with the right diagnosis. His doctor I'm sure would be streets ahead of most chiropractors in diagnosing pain in the abdomen, but in the back he was out of his depth.

Pain with coughing, sneezing, or straining on the toilet is a sure sign that you need to be careful. It could be a slipped disk in the making.

Slipped Disk

The prolapsed nucleus pulposis is readily seen below.

Herniated disc.

In the neck a slipped disk causes a deap-seated ache in the arm. It can be the most dreadful pain, often worse at night, and the only escape may be putting your hand on your head. Read more about arm pain …

In a slipped disk the inner bubble of gel, the nucleus pulposus, herniates or slips through the surrounding annulus fibrosus towards the spinal canal. Initially it causes no frank pressure on the nerve root, but it releases noxious chemicals that may inflame the nerve.

Sudden wrong movements, sneezes, heavy lifting, or just prolonged sitting may cause further bulging, placing pressure on a spinal nerve; with the begin of ominous tingling and or pain in the leg or arm. Further pressure causes more severe pain in the limb and ultimately damage to the nerve.

First the limb becomes more sensitive to pinprick, and thereafter numb. Then weakness in the leg may start to develop.

Feeling the pinch? Not in your back, but your back pocket? Don't feel all alone. Research proves that low back pain costs the public, insurance companies and the governments billions of dollars.

Strong research by workman's compensation proves that chiropractic help is more effective, far cheaper, and gets patients back to work much sooner. Read more at lower back pain.

Cervical and Lumbar spine

Slipped disk most commonly affects the low back and neck. Prolonged exposure to a bent-forward work posture is correlated with an increased incidence of disc herniation.

This condition is also commonly called a

  • herniated nucleus pulposus
  • protruded disc LUMBAR DISC PROTRUSION ...
  • prolapsed disc
  • ruptured intervertebral disc,
  • bulging or, simply, slipped disc

A sequestrated disc has burst completely beyond the confines of the outer fibres, characterised by severe leg pain, and little back pain. Surprisingly, it too may respond to chiropractic, but if it affects your bladder, you must see a surgeon immediately. IMMEDIATELY. If you cannot void your bladder, it can cause serious harm.

Disc herniation sequence.

Atherosclerosis symptoms low back pain

What are the affect of smoking and cholesterol on your lower back pain? You probably think it's very difficult to quit or change your diet, but current research shows that smoking and raised serum cholesterol are highly related to low back pain. Why? They both contribute to inflammation of the arteries supplying the lumbar spine.


  • Grade I: A protrusion may occur where a slipped disc bulges without rupturing the annulus fibrosis. Classically there is only low back pain which could be mild or very severe.

  • Grade II: The disc may prolapse where the nucleus pulposus migrates to the outermost fibres of the annulus fibrosis. Pain or tingling, or a numb feeling will be felt in the leg..

  • Grade III: There may be a disc extrusion, which is the case if the annulus fibrosis perforates and material of the nucleus moves into the epidural space. The pain in the leg becomes worse, and weakness and numbness in the leg develops. The lower discs affect the Sciatic nerve, the higher lumbar discs the Femoral nerve.

  • Grade IV: The sequestrated slipped disc may occur as fragments from the annulus fibrosis and nucleus pulposus are found outside the disc proper. The pain in the back lessens, but the leg becomes a consuming fire. Disturbance of bladder control should be reported immediately. Sciatica without back pain is not uncommon. 

  • For some interesting cases of low back pain (and other) from the Chiropractic Coalface, click here. CHIROPRACTIC COALFACE ...


    Grade 2-4 disc herniations cause pain (or possibly only tingling) that radiates below the knee. The pain is usually aggravated by

    • Sitting
    • Standing and slow walking (Faster walking may be less painful, though this is not necessarily the case.)
    • A positive valsalva manoever.
    • Coughing, sneezing and straining on the toilet (the so-called Dejeurine's triad)
    • Forward bending
    • Side bending, more often towards the side of pain, though this is dependent of the type of herniation.
    • The sign of Pisa . You can't stand up straight! Pain, tingling or simply a tight feeling may begin in the leg... sciatica and occasionally it can affect the Femoral nerve too. HELP FOR SCIATICA ...

    Antalgia = Ant-algia = away/ towards the pain

    A man with a slipped disc and antalgia.

    The word "antalgia" means leaning to the side to relieve the pain. It is a reflex action that you cannot control, a temporary posture that the body takes to relieve the pressure on the nerve root. It's a very serious sign, often the prelude to a nasty sciatica if not taken seriously.

    Antalgias come in two main types:

    1. Leaning AWAY from the painful side. Read more about a POSTERO LATERAL DISK herniation

    2. Leaning TOWARDS the painful side. Read more about a POSTERO MEDIAL DISK herniation

    The pain of a slipped disk is usually relieved by

    • Perching on a high stool or edge of a desk for example
    • Lying on the back in the so-called 90/90 position: with the hips and knees flexed
    • Sometimes lying face-down on a pile of cushions under the hips
    • An ice-pack (30 mins) wrapped in a thin towel is a far more effect painkiller than pills. Follow for ten minutes with a hot water bottle. No more than 10.

    Numbness when rubbing the leg, or pricking yourself with a pin is a sure sign of an irritated nerve. In the early stages the skin may be MORE sensitive.

    Buckling of the knee, or the inability to stand on the toes or heel is an ominous sign.

    Typically, if it's a low lumbar disc, straightening the knee whilst sitting will cause pain in the back and leg.


    Low backache is extremely prevalent, and is the second most common reason for the people to seek medical attention. Not all obviously are slipped disks. Low back pain accounts for approximately 15% of the sick leave in First World countries, and is the most common cause of disability in persons less than 45 years of age.

    Every year 5% of the population will have a slipped disc. Mostly the prognosis for a grade 1 protrusion is good, and improvement often occurs with little or no intervention.

    However, if it lasts longer than 12 weeks, some authorities say 6 months, we call it chronic, and the chances of progression with leg pain is now much greater.

    While it is not recommended that every sore back needs to go to the doctor or chiropractor, pain which does not improve within a few weeks certainly demands an assessment by your chiropractor.

    The causes of slipped disk?

    Mechanical low backache or musculoskeletal backache as it is called, is the most common form of back pain. This may result from strain of the muscles or the ligaments in the back or sacro-iliac joints.

    Only 1 to 3 percent of the patients with low back ache will have a slipped disk causing frank compression of the nerve root; grades 3 or 4.

    Sciatica is the pain due to the irritation of the sciatic nerve root, a nerve which supplies the lower limb, due to lumbar disc prolapse. (There are other causes, such as Piriformis syndrome). Sciatic pain is usually present in the low back and buttock and goes down the thigh and ultimately to the foot.

    Several studies have shown that smokers are more prone to get back pain, sciatica and spinal degenerative changes. Smoking also delays bone and disk healing, increasing the chance of surgical failure. Failed Back Syndrome is a reality.


    * Your age

    * Any history of cancer (like prostate or breast carcinoma).

    * Have you lost weight?

    * Long term use any steroidal drugs or drugs for AIDS.

    * How long has your back been sore?

    * Any pain or worsening of pain whilst at rest?

    * Drug abuse including smoking.

    * Do you have a numb or weak feeling in the leg/s?

    * Had a bad fall that injured your back? Fractures? On the ice?

    * Difficulty in passing urine

    * Previous failed treatment for backache.

    * Depression can also be a factor, undermining all your health.

    What tests are recommended?

    For over 90% of the patients with back pain, no further testing is necessary beyond X-rays in the first month. Otherwise one must proceed with investigations like CT, MRI and bone scan for the back if there is no good response to treatment, or if leg pain is developing. These tests will reveal if there are bony abnormalities, a slipped disk or a spinal tumour.

    What are the treatments available?

    Low back pain should always be managed conservatively in the initial weeks, unless there is loss of bladder control, or weight loss, or fever.

    Non-surgical treatment of slipped disk includes:

    • Bed rest: This will reduce the intra discal pressure and pressure on the nerve roots. Bed rest up to 4 days is allowed provided it includes gentle exercises and periods of walking around the house. Prolonged bed rest does more harm to the patient than good, producing weakness, stiffness and pain. We recommend that you get up every hour. Massaging bed rest ...
    • Activity modification: For some six weeks after a slipped disk, patients are advised not to lift any objects, not to sit much and not to bend or twist the back.
    • Exercise: Low stress aerobic exercise is advised. Walking, cycling (only a lady’s bike) and swimming (backstroke) are allowed in the first two weeks. Pain should be the judge.
    • Analgesics: For acute pain, an icepack used for up to 30 minutes is best, but paracetamol, or other drugs like diclofenac can be used. Unlike drugs, ice has no side effects.
    • Patient education: Patient should be educated how to modify the daily activities, how to lift weight etc.
    • Physical treatment for slipped disk. Manipulation has shown great benefit when correctly applied. Inversion and McManis lumbar traction have value, but continuous traction is of no use.

    Chiropractic help

    Different chiropractors favour differing treatments depending on the seriousness of the condition.

    1. Mostly, there will be treatment with patients lying on one or both sides, perhaps with a drop mechanism for better effect, and less force. A popping sound may be heard during the adjustment, as the herniated fragment is manipulated back into place.
    2. Different forms of mobilising traction may be used to good effect. Stationary traction while lying in bed at home or in hospital has no good effect.
    3. Some chiropractors favour a mechanical device called an activator .
    4. Deep muscle work, and various modalities have good effect, best done whilst lying on the side.
    5. Intermittent bed rest may be an important aspect of the treatment in severe cases. Standing up, and walking about hourly is important. As in all acute sprains, ice acts as a powerful pain killer and anti-swelling agent.
    6. In the recovery phase, rehabilitative exercises are important. For a course of simple low back exercises, subscribe to Chiropractic Tips ...

    7. LOWER BACK EXERCISES ... demonstrated on YouTube. 
    8. Active rehabilitation

    9. Smoking. I can tell you honestly? Straight? If you have a slipped disc and you're a smoker, your chances of recovery are dramatically lowered in the chiropractic clinic. It's been proved to be the biggest risk factor in surgery - and so it is in chiropractic. As a very minimum, this is a good time to cut back hard on your smoking for the six weeks that a slipped disk takes to heal. And every day is a good day to quit. It WILL knock ten years off your life.
    10. At this link you can read how diabetes and joint problems like slipped disk are effected by smoking. Read more about Smoking and Diabetes


    In the United States each year, 1.5 million people have lumbar MRI scans to look for the cause of the buttock and leg pain called 'sciatica'. More than 1.2 million of those scans fail to find the cause in the spine. Three hundred thousand of the scans are sufficiently positive that the patient has lumbar spine surgery. Of the 300,000 surgeries for slipped disk, as many as 25% fail to relieve the pain - in many cases this is because the diagnosis of a spinal cause for the sciatica was incorrect.


    There are many other causes of sciatica. For example,

    Financial burden of Low back pain

    Back pain is providing modern society with a huge financial challenge. Despite huge jumps in technology, the economic burden to both individuals and society is soaring. For more interesting facts and figures, click here. LOW BACK PAIN ...

    For more information on the dangers of anaesthetics follow this link. ANAESTHETIC ALZHEIMERS ...

    More links about SLIPPED DISK and pain in your leg.

    Arm pain

    This page has concentrated on the lumbar spine. However, a slipped disk in the neck is equally serious; many of the features are similar, only the arm pain, a very deep seated ache especially at night, can be even worse than a sciatica. 

    Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

    Interesting challenges of the day

    1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

    2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

    3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

    Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

    4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

    He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

    5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

    6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

    7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

    8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

    9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

    10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

    11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

    12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

    13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

    And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

    Have a problem that is not getting better? Looking for a different slant on your pain? Want to pose a question?

    Interesting questions from visitors

    CLS writes:

    Greetings, Dr B.
    You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

    Your own unresolved problem. Pose a question

    Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

    You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

    The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.