Do I have a slipped disc? Tips on managing and preventing lower back injuries in youths

This series on common health concerns among youth was created in collaboration with Tan Tock Seng Hospital.

Back injuries are a common health issue affecting people of all ages. While experiencing back pains is common amongst the elderly, it is becoming increasingly prevalent amongst late adolescents and young adults.

Youth who are more active and like to engage in higher levels of activity are at greater risk of developing back injuries. Other factors that place them at risk include sitting or standing for long periods, lifting weights at the gym, and carrying heavy loads.

Back conditions affecting youths can range from simple back strains or muscle sprains to more significant injuries such as a slipped disc or spine fractures.

A slipped disc, also known as a herniated disc, a disc protrusion or a ruptured disc, is a specific type of back injury. The disc is a gelatinous structure between each vertebral level that cushions and absorbs pressure in the spine. 

A slipped disc occurs when the fibrous outer shell of disc tears, allowing the inner disc material to leak into the spinal canal. This problem can occur anywhere throughout the spine, though it most commonly occurs in the lumbar (lower back) or cervical (neck) region.

A slipped disc is usually caused by an initial traumatic event such as a fall, an awkward twist in your back during an exercise, or when lifting a heavy object.

The symptoms of a slipped disc vary depending on the location of the herniation. If you have a slipped lumbar disc, you may experience pain in your lower back area and down either one or both of your legs (sciatica). 

It may feel like an “electric shock” and occur when you stand or move around for long periods. You may also experience numbness, a tingling sensation in your lower limbs as well as weakness in your leg muscles. 

In severe cases of a slipped disc causing nerve compression, you may experience difficulty controlling your bladder and bowel function or a profound weakness of your leg (unable to lift your ankle or toes). In this case, you need to seek immediate medical attention as it would constitute an emergency.

To evaluate your condition, X-rays and/or Magnetic Resonance Imaging (MRI) of your spine can be done in addition to your medical history and clinical examination.

The MRI scan is a non-invasive procedure that provides a three-dimensional anatomy of your spine, particularly looking out for a disc herniation or any other injuries within the spinal elements (vertebrae, ligaments, nerves, etc.).

Conservative non-surgical treatment is the first step to recovery that can be utilised to manage slipped discs and other simple back injuries. For slipped discs, up to 80 per cent of individuals will recover within three months with conservative measures and without the need for surgery.

This can be done through rest, which is essential for recovering from injuries such as a slipped disc. Rest is also the simplest and most effective way to reduce lower back pain. During this time, try to avoid any strenuous activity for at least six weeks to give some time for your back to heal. 

A short course of painkillers such as paracetamol and non-steroidal anti-inflammatory medication can also help to manage acute pain. Medications such as gabapentin or pregabalin may also be prescribed to relieve pain from direct nerve compression.

Early physiotherapy also plays a significant role in maintaining good muscle tone after an acute slipped disc. Its methods help with the reduction of pain while also conditioning your back to prevent further injury.

Start with simple stretching exercises such as the hamstrings, piriformis and psoas stretches, before gradually progressing to exercises that strengthen the core, lower back and hip abductor.

Lumbar corsets or braces worn around the lower back can also help support the lower back muscles, giving them time to rest and recover. These are usually worn for a short period of time, fewer than six weeks, after an acute injury as they help to reduce excessive movement in the lower back.

If the symptoms of a slipped disc do not improve with conservative treatment, nerve injections or surgery may be an option for you. Surgery may also be recommended if you have signs of severe nerve compression such as progressive weakness or numbness in your legs.

The first step in preventing further back injuries is to maintain good core muscle strength. Your core muscles are one of the most important muscle groups that help to stabilise your lower back. These include your rectus and transversus abdominis, obliques, gluteal muscles and erector spinae muscles. 

Examples of exercises that promote core strength include planking, bridging, and leg raises. Activities such as pilates and yoga tend to focus on these core muscles and provide good conditioning for your lower back.

Secondly, pay attention to your work ergonomics. Maintaining a proper seated posture is essential to preventing future injury or degeneration of your lumbar spine. Avoid slouching in your chair, have adequate support for your lower back (either with a cushion or lumbar support), and direct your eyes to the top of the screen when you are using a computer.  

Thirdly, be extra careful if you need to lift a heavy object. Avoid bending or curling your back forward to carry a heavy load. Instead, bend at your hips and knees while keeping your spine as upright as possible. You should also keep the weight as close to your body as you can.

When lifting weights at a gym, be cautious when performing exercises such as deadlifts and squats, which cause back injuries. Observing correct positioning and posture when doing such exercises would help minimise such injuries.

Last but not least, smoking has been directly linked to accelerated degeneration of the intervertebral discs. In addition, smokers are three times more likely to suffer from lower back pain and take longer to recover from back injuries. 

Avoiding this harmful activity helps maintain a good quality of life while lowering your risk of chronic lower back pain and injury.

Proper techniques for posture and back care should be taught from a young age. Prevention is always better than cure, and taking steps to protect your back early on will go a long way in preventing degeneration and injuries in the future.

Dr Wayne Yap is a Consultant at the Department of Orthopaedic Surgery, Tan Tock Seng Hospital.