A bulging disc is a condition in which a disc loses its original shape and expands (bulges), which can place pressure on a surrounding nerve root and cause pain. Discs are the gel-filled pads that cushion the individual vertebrae of the spine, acting like shock absorbers and allowing movement and flexibility of the vertebrae. Sometimes spinal discs are likened to a jelly donut with a central softer component (nucleus pulposus).
When a disc “bulges,” part of its tough outer wall can protrude into the spinal canal and press on a nerve, which causes pain. Depending on which nerve is pressed by the disc, the pain can appear in a leg, arm, or elsewhere. When this type of pain develops, especially after an accident or injury, it is important to consult your pain doctor.
There are three different distinctions for disc problems:
Disc protrusion: The disc’s outer wall remains intact, and the disc protrudes 180 degrees or less of the disc’s circumference.
Bulging Disc: The disc’s outer wall remains intact, and the disc protrudes more than 180 degrees of the disc’s circumference.
Herniated disc: A bulging disc’s outer wall tears, allowing the inner fluid to escape.
A majority of disc injuries occur in the lumbar (lower) region of the back because the lower back bears most of the torque and force of daily movements. About 10% of disc injuries affect the upper portion of the spine.
It is also important to note the difference between a bulging disc and herniated disc. A disc that is damaged may bulge, pushing into the spinal canal and causing pain. However, a bulging disc has not broken through the outer wall of the disc (ruptured). If the outer layer of the disc tears and the soft inner part of the disc leaks out, the result is a “herniated disc.” Perhaps most importantly, you should know that a bulging disc may become a herniated disc.
Causes of a Bulging Disc
Spinal discs absorb the wear and tear that is placed on the spine. Over time, the discs start to degenerate and weaken. The most common location for bulging disc is between the fourth and fifth lumbar vertebrae in the low back. This area continually absorbs the impact of bearing the weight of the upper body. The lower back is also critically involved in the body’s movements throughout the day, such as the twisting of the torso (rotating side to side), bending, and lifting.
Degenerative disc disease is the most common cause of a bulging disc which can result in spinal osteoarthritis. Other factors that can cause or contribute to bulging discs include:
Strain or injury.
Treatment for a Bulging Disc
There is a wide range of non-surgical treatments available for a bulging disc, some of which may work better for some patients than others.
Specific treatment largely depends on the length of time the patient has experienced symptoms and the severity of the pain. Other considerations include the nature of the symptoms (such as weakness or numbness) and the age of the patient.
For many, the symptoms from a bulging disc will diminish over time. While there are no hard and fast guidelines for treating a bulging disc, the primary goals of any treatment are twofold:
To provide relief of pain, especially leg pain which can be quite severe and debilitating.
To allow the patient to return to a normal level of everyday activity.
Conservative therapy often begins with medication and physical therapy. In some cases, restricted activities may be necessary until the pain subsides. Treatments include:
Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are the first-line medications for a bulging disc. For more severe pain, prescription medication may be necessary. In some cases, a muscle relaxer can help if there are muscle spasms.
Physical therapy. A physical therapist can prescribe positions and exercises designed to minimize the pain of a bulging disc by relieving pressure on the nerve. Exercise is an essential component of rehabilitation in almost all cases of back pain.
Chiropractic. Spinal manipulation can be moderately effective for low back pain that has lasted for at least a month. The treatment is best for low-back pain.
Massage. This hands-on therapy often provides short-term relief for patients dealing with chronic low-back pain.
Ultrasound therapy. The back is treated with sound waves, which are small vibrations that are produced to relax body tissue.
Heat or cold. Initially, cold packs can help relieve pain and inflammation. After a few days, switch to gentle heat for relief.
Limited bed rest. Too much bed rest can lead to stiff joints and weak muscles, which can complicate recovery. Instead of remaining in bed, rest in a position of comfort for 30 minutes, and then go for a short walk or do some light work, avoiding activities that worsen the pain.
Braces and support devices. These devices can help by providing compression and stability to help reduce pain.
Steroids. Cortisone injections (epidural steroid injections) can provide longer-term relief, because the medicine is injected into the area around the spinal nerves. Oral steroids can be helpful in reducing swelling and inflammation.
Anticonvulsants. Drugs originally designed to control seizures can be helpful in treating radiating nerve pain often associated with a bulging disc.
Spinal decompression therapy. A non-surgical form of intermittent spinal traction can help reduce bulging discs symptoms. Pain relief may last for months at a time.
Electrotherapy. Treatment often includes using a transcutaneous electrical nerve stimulator (TENS). More advanced treatments can consist of percutaneous electrical nerve stimulation (PENS), and repetitive transcranial magnetic stimulation (rTMS).
Stem Cell Therapy. Medical researchers believe the harvesting and re-injecting the body’s own stem cells may help repair worn-out discs.
There are also alternative and complementary treatments that may help ease the pain of a bulging disc, including:
Acupuncture. Although the results are usually only modest, acupuncture appears to ease chronic back and neck pain reasonably well for some patients.
Yoga. A combination of physical activity, breathing exercises and meditation, yoga can often help improve function and relieve chronic back pain in some people.
Reiki. Reiki is a Japanese treatment that aims to relieve pain by using specific hand placements.
Moxibustion. This method uses heat specific parts of the body (called “therapy points”) by using glowing sticks made of mugwort (“Moxa”) or heated needles that are put close to the therapy points.
If non-surgical treatments do not provide pain relief after 12 weeks of use, and the pain is severe, surgery may be an option. Fortunately, only a small number of patients with a bulging disc need surgery. However, surgery may be necessary if the patient experiences:
Severe pain that makes it difficult to maintain a reasonable level of normal activity.
Progressive neurological symptoms, such as worsening leg weakness or numbness.
Novus Spine & Pain Center
Dr. Torres established Novus Spine & Pain Center in Lakeland, Florida with a goal of providing the highest quality pain management care to every patient. Whether pain is the result of an injury or from another condition, Dr. Torres offers many different treatment options.
Novus Spine & Pain Center utilizes a comprehensive approach and cutting-edge therapies to restore normal function and allow patients to regain an active lifestyle while minimizing the need for opiates. As our patient, you are our top priority. Our goal is to help you achieve the best possible quality of life.
Our Mission Statement:To provide the best quality of life to people suffering from pain, by providing state of the art treatments, knowledge and skill, compassion, and respect for all.