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Slipped disc

The intervertebral discs acts as shock absorbers, interposed between two vertebrae. They consist of a central stiff nucleus full of water, held in place by an external fibrous coating. The movement of the rachis modifies the position of the nucleus within the intervertebral disc: a forward flexion causes the nucleus to retract; whereas an extension of the rachis causes a forward displacement.

These physiological movements may become more marked by adopting poor postures or repeating particularly burdensome gestures for the rachis. In these cases, the nucleus may also protrude (bulge), or be pushed posteriorly, without tearing the fibrous ring that keeps it within the intervertebral disc. In more severe injuries, the fibrous ring can be torn and the material contained within the disc comes out (a hernia), pushing sideways, downwards, or more rarely, upwards.

Pain is severe and can pulsate, paraesthesia often accompanies this pain located around the area of the compromised root. Rachis’ movement in both flexion and extension is reduced and extremely painful.

Clinical diagnosis stems from reports of pain shooting down the upper arm from the neck as a result of the compressed nerve root (known as cervicobrachialgia). X-rays, MRI or CT scans can all be used to support the diagnosis.

In most cases, a conservative treatment can be used. During early stages, a neck brace may be required, accompanied by a course of drugs to help the patient manage their pain. Manual therapies form the start of the rehabilitation process (massage, joint manipulation and muscular stretching are all useful here), before physical therapy and exercises to restore full range of motion begin. Maintenance programmes are also important to help patients maintain their strength, but also to avoid seemingly mundane activities which may worsen symptoms (watching TV laid on the sofa, or sleeping with two pillows for example). 

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