Discs don’t slip!

It’s well known that the way we think about our body can influence the amount of pain we feel (Bushnell et al., 2013).

On an individual level, this makes a lot of sense. If I believe that my body is broken, crumbling and out of alignment, I am far less likely to be proactive or positive about my condition, and far less likely to engage in healthy habits like exercise.

What the Research Shows

The impact of negative language used by Physiotherapists has been studied in a randomised control trial based in the Netherlands (Fieke Linskens et al., 2023).

The study showed that patients who received negative or nocebic information showed

significantly higher levels of anxiety, concern, and a perception their symptoms would last longer compared with the other group.

Broken Body Beliefs Can Keep Pain Alive

From my own clinical experience, it’s clear to see that the patients who think that their body is damaged, broken or not working right, feel more helpless and experience more disability related to their condition. A person in pain who harbours ideas that their back is “out” worries more about what their pain means, and will frequently avoid challenging physical activity because they don’t want to ‘damage their body further’.

To try and simplify what is happening neurologically - the brain is always trying to determine

the level of danger that the organism is in, and the level of protection that is required at the

time. The central processing unit of the brain (Thalamus) is constantly receiving information

from the body, and the brain has to determine how to respond to this. The brain files through

past experiences, beliefs and contextual clues to work out how intense an alarm signal is

needed to alert the organism to the presence of danger.  

If I believe that my back is misaligned or out of place, then it is far more likely that my brain

will produce a strong, intense protective alarm signal (pain) to get my attention and change my actions.

Your Spine Is Not a Jenga Tower

Nothing typifies this more than the commonly held notion of a “Slipped Disc”. This outdated

language is still used too frequently in Medicine, without thought about the consequences it

may have on a patient.

Without turning this blog post into an anatomy lesson, intervertebral discs are strong, thick fibrous structures that attach sturdily to the vertebrae on either end, and have never just ‘slipped out’ of the human spine. Intervertebral discs can bulge, herniate and occasionally extrude but they have never and will never slide in and out of the spine like a hockey puck. In one biomechanical study, young adult thoracic disc segments required the equivalent of over 300 kg of force to compress by just 1 mm (Stemper et al., 2010). In fact, they don’t really behave like a disc at all. Really, they should be called what they are, a Living Adaptable Force Transducer (Explain Pain, 2003). Like any other anatomical structure, our discs can be injured in various ways, but with time recovery and optimal loading they can recover and return to function very effectively (Chiu et al., 2015).

Unfortunately, the information on the internet is frequently inaccurate, unhelpful, and far from

evidence based. Even the NHS still has a page (see here) related to this “diagnosis”, explaining the condition with anatomically misleading language.

Why Better Language Matters

It’s easy enough to dismiss this as semantics, but the words we say do impact how we

interpret our bodies, and ultimately how we feel. The notion of a “slipped disc” implies that the spine is like a Jenga tower that might fall down at any moment with just a misstep or a small forward bend. Our beloved NHS needs to make sure the information on diagnoses is up to date with the science around back pain!

Perhaps it’s worth observing the way we speak about the body, and even being mindful of our sub-conscious beliefs around the body, that have the potential to impact the pain we experience. Next time your back hurts, remember that even when there is pain the spine is still a strong, adaptable structure!  

This post was authored by my colleague in Pain Science Christopher Harris, who has a blog at https://peakmovementphysiotherapy.com/blog/

References:

Bushnell, M., Čeko, M. & Low, L. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci 14, 502–511 (2013). https://doi.org/10.1038/nrn3516  Butler, D. S., & Moseley, G. L. (2003). Explain pain. NOI Group. Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical rehabilitation, 29(2), 184–195. https://doi.org/10.1177/0269215514540919 Fieke Linskens, F. G., van der Scheer, E. S., Stortenbeker, I., Das, E., Staal, J. B., & van Lankveld, W. (2023). Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: A randomised controlled trial in healthy respondents. Patient education and counseling, 110, 107649. https://doi.org/10.1016/j.pec.2023.107649

NHS. (2024, April 24). Slipped disc. NHS. https://www.nhs.uk/conditions/slipped-disc/  Stemper, B. D., Board, D., Yoganandan, N., & Wolfla, C. E. (2010). Biomechanical properties of human thoracic spine disc segments. Journal of craniovertebral junction & spine, 1(1), 18–22. https://doi.org/10.4103/0974-8237.65477