Bulging Disc - What You Need to Know
do you have a BULGING DISC?
Have you been told a bulging disc is causing your back or your neck pain? If yes have, then relax, you are not alone. I have been a chiropractor in Townsville for over 35 years and at least once a week, a patient will tell me their symptoms are from a bulging disc.
The truth is that when you have severe neck or back pain you are often sent for a CT scan or an MRI to find the cause. If a bulging disc is found it is often automatically assumed to be the cause of all your symptoms. Unfortunately, this diagnosis is often oversimplistic and is sometimes just plain wrong. This can be very confusing and misleading for you as a patient.
The challenge is how to tell if the bulging disc is causing your symptoms. Is it a part of a more complex problem or not actually causing any symptoms at all.
This blog will explain what a bulging disc really is and how to tell if it is causing your symptoms. First, let’s start with what a disc actually is and does.
So, what are spinal discs?
There are 24 moveable bones (vertebra) in your spine. Between each of these vertebrae are flat circular cushions called intervertebral discs. These discs create a gap between each of the vertebrae. This space is where the nerves exit from the spinal cord to travel through the rest of your body.
All the vertebra and discs together form your spinal column. These discs make up one fourth of your spinal column’s length.
What is a disc made of?
Your spinal discs are made up of two parts as shown below.
- The hard outer layer is called the Annulus Fibrosis. It is a hard casing made up of rings of densely packed fibrocartilage in concentric layers (like the layers of an onion).
- The inner core is called the Nucleus Pulposus. It is a jelly-like glycoprotein that can move within the disc (like the soft centre of a chocolate).
The discs are very firmly attached to the vertebra above and below it. They are also held in place by the ligaments connecting each of the vertebra.
Due to the thick attachments of the disc to each vertebra, there really is little, if any, potential for the disc to slip or move.
What does a disc actually do?
The function of a spinal disc is to:
- Absorb weight-bearing forces and act like shock absorbers in your spine which helps prevent spinal degeneration
- Allow the vertebra to bend and twist freely so we can have a greater flexibility in our spine and overall movement
- Work together with your vertebra to create a protective layer around your spinal cord to protect it
SO WHAT IS A BULGING DISC?
A bulging disc is where there is damage or weakening to the structure of the annulus fibrosis (outer layer). This allows the nucleus pulposus (inner core) to move beyond its normal position inside the disc causing the wall to bulge outward as shown below.
What the difference between a bulging and herniated disc?
With a bulging disc, the outer layers of the annulus is still intact and the nucleus is contained within the outer wall of the disc. When the outer layers of the disc are damaged and the nucleus escapes from within the disc, it is called a herniated disc.
WHAT CAUSES A BULGING DISC?
To some degree a bulging disc is just part of the normal aging process. Unfortunately, nobody is immune to gravity bearing down on their spine 24/7 and walking on two legs changed the gravitational stresses that pass through our spine and discs. When you combine this with our 21st century lifestyle which incorporates a lot of sitting, lack of exercise and obesity, our discs are just wearing out faster.
That said, there are a number of things that have been proven to cause bulging discs:
- Repetitive trauma such as poor posture, poor ergonomics or repetitive heavy work can lead to disc degeneration and a bulging disc. These long-term injuries are often also associated with poor muscle strength, obesity and other factors such as smoking.
- An Injury caused by sudden forces or load on the disc such as a car accident or an awkward heavy lift. This sudden increase in pressure on the disc can cause damage and tears to the annulus.
- Spinal Degeneration. While some degeneration is a normal part of the aging process, poor spinal function and posture will dramatically speed up disc degeneration.
HOW IS A BULGING DISC DIAGNOSED?
A bulging disc can only be diagnosed by cat scan or MRI. You cannot see a bulging disc on an x-ray and it is impossible to detect a bulging disc by examination or palpation as you can’t feel a bulging disc.
WHAT ARE THE SYMPTOMS OF A BULGING DISC?
The most common symptom is initially a sharp pain in the region of the disc, especially on movement. There is also commonly a broad aching across the region, often accompanied with muscular tightness and spasm.
Symptoms such as sciatic pain, pins and needles, numbness or weakness are not common with a bulging disc, however, they can occur. Upper back pain radiating to the stomach or chest may be a symptom of a mid-spine bulging disc. These symptoms are typically associated with a nerve compression or injury, which can occur if a bulging disc is severe, but is more commonly caused by herniated discs or spinal stenosis.
Can you have a bulging disc without any symptoms?
The answer is a resounding yes. It is extremely common for patients to have bulging discs in their spine and have no symptoms whatsoever.
Indeed, one study in the American Journal of Neuroradiology looked at how often people with no symptoms have bulging discs in their spine. This study found 50% of people over 40 years of age have a bulging disc that was not causing any symptoms. This went up to 60% in 50-year-olds, 69% in 60-year-olds, 77% in 70-year-olds and 84% in 80-year-olds.
This proves beyond any doubt that you can have a bulging disc and not be aware of it at all.
HOW LONG DOES A DISC INJURY TAKE TO HEAL?
When your disc has recently been strained or torn, the initial aim is to get you out of pain and moving again as quick as possible. These injuries will usually take a few weeks for the symptoms to settle down. The more severe the damage to the disc the longer the recovery time.
The normal healing time for tears in the annulus is about six weeks, however in some cases it can be longer. It’s important to remember that while the torn fibres are healing the disc remains weak and vulnerable to re-injury. Unfortunately, your disc will never heal to its original strength and there will always be some degree of disc weakness after its damaged.
HOW DOES A CHIROPRACTOR treat A BULGING DISC?
As we explained earlier you can have a bulging disc and be totally asymptomatic. So it’s very possible that you can have a bulging disc and, at the same time, have something completely different causing your symptoms. The first thing we do is to accurately diagnose what is causing your symptoms.
If we find a bulging disc is the cause of your pain, then the best treatment is a combination of the following:
- specific low force techniques which improve spinal function without aggravating your disc
- active rest (keep moving while avoiding aggravating activities)
- ice therapy
- non-steroidal anti-inflammatory drugs such as ibuprofen when needed
How do I look after a bulging disc?
Once your symptoms have improved, we will advise you of any long-term changes you may need to make to stay healthy, such as postural changes or workplace changes.
We will design an ongoing treatment program if indicated to maintain good spinal function in the future.
There are also many different exercise approaches which can help you stay healthy such as Pilates, yoga, swimming, hydrotherapy, or a gym program we may advise you to do.
What should I avoid if I have a bulging disc?
Whilst you are recovering from a disc injury you will need to avoid the following:
- sitting in soft chairs that put pressure on the low back
- any periods of long standing or sitting
- slouching or poor posture
- activities involving bending such as gardening housework or strenuous exercise.
What do I do if my bulging disc isn’t causing my symptoms?
This is why getting an accurate diagnosis for your symptoms before you start any treatment is important. If we find the bulging disc present in your spine is not causing your symptoms, we will work out what is.
Once we know what is causing your problems, we will design a specific treatment program that will correct the actual cause of your problems. We will use specific techniques to protect the bulging disc from any further damage.
DOES A BULGING DISC NEED SURGERY
It is extremely rare for a bulging disc to require surgery. Nearly all cases will resolve with the proper treatment, exercises, removing any aggravating factors during the healing phase and drugs when necessary.
SO I HAVE A BULGING DISC, WHAT DO I DO NOW?
- Contact your local chiropractor and get a thorough examination of your spine immediately to find the actual cause of your pain
- start your specific treatment program and exercises as soon as possible
If you think you may have a bulging disc contact our office today to find out how we can help you.
Over to you
Do you have a question about a bulging disc, or other spinal problems? Leave a comment below and we will get back to you ASAP.
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Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations
AJNR Am J Neuroradiol. 2015 Apr; 36(4): 811–816.