Vertebral discs are soft tissue that act as a shock absorbing system between the vertebrae that make up the spine. The discs are composed of an outer layer of tough cartilage (annulus) that surrounds softer cartilage (nucleus). A bulging disc protrudes outward and can put pressure on a surrounding nerve root, which can result in pain that radiates down the back and/or other parts of the body.
A bulging disc is a condition in which the disc protrudes or bulges, often putting pressure on a surrounding nerve root and causing pain.
Some healthcare providers define terms such as “bulging disc,” “disc protrusion,” and “herniated disc” differently, so ask for clarification if a doctor says you have any of these conditions. Here is a distinction you may hear:
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 (nucleus pulposus) to escape.
Discs are between vertebrae in the spine, acting like shock absorbers that allow movement and flexibility of the vertebrae. Just like any other body part, as the body ages or with excessive stress, the outer layer of the discs can weaken over time. The weakening can cause the disc to distort or “bulge.”
When a disc “bulges,” part of its tough outer layer can protrude into the spinal canal and press on a nerve, which can cause pain. Depending on which nerve a disc presses upon, there can be resulting pain in a leg, arm, or elsewhere. However, a bulging disc may not cause pain if the portion that is bulging does not press against a nerve.
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. Only 10% of disc injuries affect the upper portion of the spine.
If the outer layer of the disc tears and the soft inner part of the disc leaks out, the result is a “herniated disc.” In some cases, a bulging disc can become a herniated disc.
What Causes a Bulging Disc?
Injury and age-related degeneration can cause a bulging disc. With age, the discs begin to dehydrate and show signs of wear and tear, resulting in the tough outer core stiffening whereby it may bulge out around its circumference. However, a bulging disc will not always affect the entire perimeter of a disc, but at least a quarter (if not half) of the disk’s circumference is usually affected.
A disc may bulge because of:
Bad Posture. Improper sitting, standing, or sleeping can strain the neck and back, creating conditions for a bulging disc. Good posture involves keeping the body in proper alignment. When sitting, the back should be straight with the shoulders back. Support the lower back with a lumbar support, pillow, or towel. If possible, avoid remaining in one position for extended periods of time.
Degenerative Disc Disease. As a part of the aging process, discs in the spinal column become less structurally sound. These changes make the discs susceptible to bulging. Some factors that can accelerate the aging of the discs include a sedentary (non-active) lifestyle and smoking.
General “Wear and Tear.” Both the vertebrae and the discs deteriorate over time, due to the natural aging process. Disc wear and tear and protrusion may be attributable to changes in the distribution of body weight.
Injury or Trauma. Bulging discs usually develop slowly, over time. However, an accident – the most common cause of a herniated disc – can occasionally cause a long-term injury that may cause a disc to bulge.
Lifestyle. Men and women who participate in contact sports, have a family history of disc disease, or are obese should watch for signs and symptoms of a bulging disc.
Occupational Hazards. Work that requires repetitive lifting, bending, standing, and driving, can increase the risk for a bulging disc. Improperly carrying heavy objects may also result in a bulging disc.
What are the Symptoms of a Bulging Disc?
A bulging disc may have no signs or symptoms (asymptomatic). In fact, about half of the people with a bulging disc never experience any symptoms or pain. Some patients only learn they have a bulging disc after imaging tests for another medical issue. However, most people immediately feel pain if a bulging disc presses on a nerve.
Pain from a bulging disc may begin as a spasm in the back or neck that limits movement. If the bulging disc compresses a nerve, pain may develop in a leg or an arm. Some of the more common bulging disc symptoms include:
Pain or tingling in the neck, shoulders, arms, hands or even fingers can be the result of a bulging disc in the cervical (upper spine) area.
Pain in the upper back that radiates to the chest or stomach can signal a thoracic (mid-spine) bulging disc. It is important to determine the root of these symptoms since they can also be a sign of heart, lung, or gastrointestinal problems.
Muscle spasms and lower back pain may be evidence of a bulging disc in the lumbar (lower back) region. The lower back holds most of the upper body’s weight, which is why approximately 90% of all bulging discs occur in the lumbar spine. Sometimes, the bulging disc will place pressure on the sciatic nerve, causing sciatica that includes pain radiating down one leg.
How is a Bulging Disc Diagnosed?
As noted earlier, symptoms of a bulging disc may not appear in the back, but in the other parts of the body. A medical diagnosis will identify the actual cause of the pain and other symptoms that may be a result of a bulging disc.
A proper diagnosis to determine the cause of pain is through a combination of three steps:
Review of medical history.
A physical exam.
Review of Medical History
Taking the time to obtain a full medical history is important in ruling out, or identifying, other possible conditions that may be causing the pain. The history will include information about any recurring health problems and previous diagnoses. The doctor will want to know about any past treatments and surgeries, current medications, family history of illness, and any other health concerns the patient may have. The review will include a patient’s description of the type of pain, and what triggers the pain.
Depending on the symptoms, a physical exam may include one or more of the following tests:
Nerve function. A reflex test on the legs or arms is used to determine whether the nerves produce a reaction. The test helps determine if there is nerve root compression in the spine.
Muscle strength. To get a better understanding of whether there is spinal nerve root compression from a disc, the doctor will likely conduct a neurological exam to assess muscle strength. The doctor will want to determine if there is muscle atrophy, twitching, or any abnormal movements.
Pain with touch or motion. By touching and determining which movements cause pain, a doctor can gain a better idea of where the pain is originating.
After the doctor has information relating to a patient’s medical history and has completed a physical exam, diagnostic tests may be necessary to confirm the cause. Diagnostic tests help the doctor determine the location of a bulging disc, and which nerve roots are being compressed. Diagnostic tests may include:
CT scan. A Computerized Tomography (CT) scan combines X-ray images taken from different angles, and uses computer processing to create cross-sectional images that provide more information than plain X-rays.
MRI scan. Magnetic Resonance Imaging (MRI) shows the condition the spinal nerves and anatomy, including disc alignment, height, hydration, and configuration.
While these imaging test results are important, they are only a tool. The test results are not as meaningful in determining the cause of pain as the patient’s specific symptoms and the results of the physical exam.
How is a Bulging Disc Treated?
Treatment options for a bulging disc include medications, physical therapy, chiropractic manipulation, injections, minimally invasive spine surgery, and conventional open surgery.
Most times, the symptoms of the first pain episode subside over the first six weeks from the onset of the symptoms. After that, patients that continue to experience symptoms typically find the symptoms subside over the following six weeks. The focus of treatment during this time is to reduce the pain and irritation. Treatment may include anti-inflammatory drugs and physical therapy to correct posture and maintain mobility.
Exercise is an important component of rehabilitation in almost all cases of back pain. However, it is essential to do the right exercises the correct way. Only a trained physical therapist can develop the proper exercise program based on the location of the bulging disc.
Repeated attacks or lingering symptoms require more progressive treatment. Some of these treatments include:
Conservative therapy begins with physical therapy and may include injections, Cognitive Behavioral Therapy, and coping skills. In some cases, a restricted lifestyle may be necessary in the hope the symptoms will subside over time. A course of nonsurgical treatment usually runs four to six weeks.
Spinal decompression therapy is a non-surgical form of intermittent spinal traction that can help reduce bulging discs symptoms. Pain relief may last for months at a time.
Electrotherapy treatments range from treatments patients can do at home to surgical procedures. Treatment often includes using a transcutaneous electrical nerve stimulator (TENS). More advanced treatments can include percutaneous electrical nerve stimulation (PENS), and repetitive transcranial magnetic stimulation (rTMS).
Injection medicine therapy includes epidural steroid injections, non-steroidal injections, trigger point injections, therapeutic injections, nerve blocks, nerve ablations, and joint injections.
Minimally invasive spine surgery has become increasingly popular, offering procedures resulting in less pain and faster recovery times. Conditions treated include degenerative disc disease, herniated discs, scoliosis, spinal stenosis, and more.
Conventional open surgery includes greater risks and does not guarantee success. The surgical options include lumbar decompression, micro-discectomy (or micro-decompression) to give the nerve root more space to heal, and a lumbar discectomy is a common outpatient procedure.
How to Avoid a Bulging Disc
Although the intervertebral discs begin to show wear and tear with age, there are things you can do to help avoid a bulging disc.
Maintain a healthy body weight. Excess weight creates extra stress on the back. By losing weight, and/or maintaining a healthy weight, it is possible to reduce the stress on the lower back.
Exercise regularly. Keeping core body muscles strong and toned helps avoid unnecessary stress on the back during normal daily activities.
Quit smoking. Nicotine can harm the discs in the back because it lowers the ability of the discs to absorb the nutrients necessary to remain healthy. Smoking also causes the discs to become dry and brittle.
Use proper lifting techniques. Proper lifting (using the legs) helps avoid placing excess stress on the back.
Proper posture. Slumping or slouching alone may not cause back pain. But, after a back strain or injury, bad posture can make pain worse and increase the time for healing.
Good standing and walking posture. “Good posture” generally means that your ears, shoulders, and hips are in a straight line, whether standing still or walking.
Protect your back while sitting. Place a small pillow or rolled towel between the lower back and the chair while seated for an extended period.
Sleeping posture. If possible, keep the back in a neutral position while sleeping. It may help to place a pillow between the knees for side sleepers.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating the pain of bulging discs. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.