Highlights from the post: http://trustmephysiotherapy.com/?p=231
"Intervertebral discs. The all-important mighty disc. The center of spine dysfunction. The bringer of pain. The elusive mystical creature that lives in your back and makes pain travel down your leg. Discs have gained quite a reputation in society today. Everyone seems to “know” a little about discs and have a lot more to say about them. Most tend to view discs as quite fragile, easily injured, and even easily mobile structures in your spine. But how accurate are the common beliefs? As I continue to have conversations with patients AND health care providers it becomes more evident that an accurate perception of these anatomic structures in relation to anatomy, function, and pain isn’t all that clear.
The interesting thing about the vertebral end plate is that there is both a bony and cartilaginous endplate that create an exceptionally strong connection to the annulus of the disc making it IMPOSSIBLE for the disc to SLIP. Yes, you heard that right. DISCS CANNOT JUST SLIP OUT OF PLACE willy-nilly like a bar of soap in the shower. The endplates function to hold discs in place, evenly spread applied loads, and to provide anchorage for the collagen fibers of the disc. They also act as a semi-permeable interface for the exchange of water and solutes which can be seen in the following illustration.
I can’t count the number is times I’ve heard the following quotes. “I’ve had back pain ever since I slipped a disc back when I was 29”. “Don’t bend over like that you’ll slip a disc”! “Don’t lift that, it’ll slip your disc”! “I can’t do that I’ve got a slipped disc”. The problems with these statements are that discs DO NOT and CAN NOT slip.
Can discs get injured? Sure. Can discs heal? Absolutely.
End story is that discs are VERY strong.
Additionally, a disc “injury” quite often happens in the absence of any pain and you don’t even know about it. Plenty of high quality research shows that the odds are you have a pain free and benign disc “injury” as you sit here and read this article.
The true heart of the issue and point of this article is not to get in a fight over semantics with discs “slipping” and what really happens. Instead, it is to convey the importance of being educated on the true nature of the anatomy in which we deal with and educate patients on daily. How can we expect patients to succeed if we pump them full of false information that likely creates vivid mental imagery of a spinal disaster? If we reinforce feelings and mindsets of fragility related to the spine we are committing a physical therapy sin. We are breaking our vow to do no harm. We are promoting a scenario that is in contrast to our very name. We are PHYSICAL therapists. It is unlikely many people have strong urges to get back to being PHYSICAL if they are afraid they have a “slipped” disc that is out of place and teetering on the edge of a catastrophic blow out.
If you read this article, I ask you to join into an agreement with me to stop being part of the problem. Be purposeful in the language you use and manner in which you explain conditions to patients. I hate to be the language police, but it is becoming increasingly obvious that what we say to our patients CAN have quite the enduring impact.
I do hereby solemly swear to make a diligent effort to choose the language I use to explain injuries and painful states to my patients, friends, family, and other healthcare providers. I will abstain from using terms including, but not limited to, slipped disc, ruptured disc, degenerative joint disease, degenerative disc disease, torn disc, frozen shoulder, impingement, pinched nerve, trapped nerve, crushed nerve, crushed disc, etc. I vow that I will try my dammedest to not be a twatwankle that encourages fear avoidance behavior and ideas that the human body is fragile."