A spinal disc is a fluid-filled container encapsulated by cartilage between each vertebra in the spine, acting as both a shock absorber and distributor. Discs don’t really slip; they bulge, herniate, or rupture.
Can a sneeze cause a “slipped disc”? A lower back “slipped disc” is almost always the result of a process. Often, the problem starts small and builds until it becomes symptomatic. For example, a patient sneezes and experiences sudden back pain that then proceeds to leg pain. However, the sneeze didn’t cause the disc to “slip”; it was the final “straw” in a longer process. Factors that precede the pain and symptoms of discal injury include disc dehydration, abnormal discal load, and unusual stress on the disc due to disturbed mechanics.
Discs depend on water to maintain their height and perform efficiently. When we’re young, discs have their own circulation that helps keep them hydrated. As we age, this circulation ends, and the spine must move to draw water into the discs. If discs become dehydrated and lose height, they become more vulnerable to cracks and fissures. Discs are integral parts of our body’s mechanical system, allowing us to move. It’s important to see how injuries in one part of the body relate to the mechanical system as a whole. We look at injuries specifically, but also try to determine how an injury might be the outcome of disturbances elsewhere in the body. The spine functions as a whole, so mechanical disturbances in one part can influence conditions in other areas.
Imbalances in the pelvis, problems in the sacroiliac joints, low back facet fixations, and joint restrictions in the mid-back and neck can contribute to disc degeneration and injury. Disturbed mechanics from lack of muscular support or imbalance are important because discs can come under more stress from weak abdominal muscles or excess weight around the abdomen. This may cause hyper-extension, leading to disc wedging. Conversely, hyper-flexion from rounded lower backs due to weak spinal muscles or poor sitting habits causes stress on the discs in the opposite direction. If too much load is placed on the back over time, or in one dramatic episode, it can cause a discal injury. For example, a middle-aged accountant who sits for long periods, suffers disc dehydration, and has poor mechanics from weak abdominal muscles may lift a heavy object and experience acute lower back pain radiating to the legs. Months later, they may experience lower back pain after sneezing or picking up a piece of paper. This is known as “the straw that broke the camel’s back” and is diagnosed as a “slipped disc.”
How do osteopaths diagnose what went wrong? Careful history-taking, vital signs, reflexes, orthopedic and neurological testing are standard practices. We utilize diagnostic procedures unique to orthopedics and osteopathy to establish a foundation for a care program. Techniques like motion and static palpation determine areas of restriction in spinal joint function. Muscles are palpated and tested for strength, and patients may be referred for an MRI to confirm the diagnosis. The crucial diagnostic question is, “What type of discal injury has occurred?” The answer determines the osteopathic approach to treatment or referral. Some patients need immediate referral, for example, in cases of cauda equina syndrome where loss of bladder control accompanies a discal injury. This requires urgent referral to A&E, though it’s rare.
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