Slipped disc

Also called Prolapsed disc, Herniated disc, Sciatica

Nothing slips. Most settle within weeks without surgery, and the scan findings frighten people far more than the condition warrants.

What it is

The soft centre of a spinal disc pushing through its outer ring and pressing on a nerve. Nothing actually slips, and the name has probably caused more unnecessary fear than any other in orthopaedics.

Most occur in the lower back and cause sciatica: pain travelling down the leg, often worse than the back pain itself. Discs in the neck cause the same thing down an arm. See cervical spondylosis.

The natural history is reassuring and badly communicated. The great majority improve substantially within six to twelve weeks, and the disc material is reabsorbed by the body over months. Larger herniations often resolve better than small ones.

Scans are unhelpful early. Disc bulges are found on MRI in a large proportion of people with no pain at all, so finding one proves nothing and frightens people into moving less. Imaging is for people being considered for surgery or with red flags, not for reassurance.

The one thing that changes everything is cauda equina syndrome, and everybody with sciatica should know its warning signs.

Signs you might notice

Pain travelling down one leg below the knee, often sharp, burning or electric, sometimes worse than the back pain.

Pins and needles, numbness or weakness in a defined band of the leg or foot.

Pain worse on coughing, sneezing or sitting.

Foot drop: catching the toe, or being unable to lift the foot. This needs urgent assessment.

**Emergency, A and E now:** numbness in the saddle area, difficulty starting or feeling urine passing, loss of bladder or bowel control, or new weakness in both legs. That is cauda equina syndrome and it is measured in hours.

Also urgent: pain with fever, unexplained weight loss, a history of cancer, or after significant trauma.

How it can affect day-to-day life

Fear does more damage than the disc. People told their spine is damaged move less, become deconditioned, and hurt for longer. Language from clinicians matters enormously here.

The pain in the first fortnight can be genuinely severe and needs treating properly, including nerve pain medication and sometimes a short course of stronger analgesia. Under-treating early pain is what drives people to demand scans and surgery.

Work absence compounds it. Modified duties early beat waiting to be pain-free.

Surgery has a role: it relieves leg pain faster than waiting, though by a year the outcomes converge for most people. It is a decision about how long somebody can tolerate the pain, not usually about preventing damage.

Recurrent episodes are common, and general fitness rather than back-specific exercises is what reduces them.

Supporting someone well

Keep moving and stay at work if at all possible, with adjustments. Bed rest makes it worse.

Learn the cauda equina red flags and act on them immediately. This is the one non-negotiable in the entry.

Get the pain controlled properly in the first weeks; ask about nerve pain medication rather than more of the same painkiller.

Do not ask for a scan without red flags. It rarely changes treatment and frequently increases fear.

Ask for physiotherapy; self-referral is available in most areas.

Ask what the words on any scan report actually mean for this person's age.

Discuss surgery if leg pain is not improving after six to twelve weeks, or straight away for progressive weakness.

Where to get help

A GP practice, or self-referral to physiotherapy.

A and E immediately for saddle numbness, bladder or bowel changes, or weakness in both legs.

Urgent GP appointment for foot drop or progressive weakness.

Arthritis UK and the Chartered Society of Physiotherapy both publish good self-management material.