When someone tells you that you have a bulging disk, or you read it on your MRI report, you may wonder what that means. Is that what is causing my pain? Will it go away? Do I need surgery? How can I fix it?
These are all good questions that need to be answered before you decide what treatment is right for you. Understanding your bulging disc begins with understanding your anatomy, where the disc is, and what the disc does.
What is it?
Commonly called, the disc or the disk, the intervertebral disc connects each vertebra to the next vertebra and helps to form your spine. It allows a small amount of motion and acts as a shock absorber between each pair of vertebrae. When it becomes deformed, or pushed out of shape, it is often called a bulging disk.
Your disc has two main parts, the annulus, and the nucleus pulposis. The annulus is a tough strong ligament that wraps around the outside edge of the disc. It connects one vertebral body to the next. The nucleus pulposis is a soft jelly like material that fills the inside of the disc. Together they form a jellyroll cushion between the vertebrae.
When you bend or twist, it is the disc that allows your spine to flex and move. As you move the soft inner part of the disc, is pushed around inside of the disc. When you flex forward, the nucleus pulposis is pushed towards the back; then when you stand up straight in a neutral position it moves back to the center.
What caused it?
Humans have evolved over thousands of years as hunter gatherers, we are designed to stand and walk, and the intervertebral disc works wonderfully for that. Problems can occur when we spend too much time bending and lifting, or hunched over a desk. Long hours bending forward pushes the nucleus pulposis towards the back of the disc. Eventually the tough ligaments of the annulus will begin to stretch and push out beyond the edge of the vertebra forming a bulging disk.
Early on when you stand up the nucleus will return to the middle of the disc and the bulge will go away, but over time, repeated bending will continue to stretch the annulus and the bulge will become more permanent.
What will it do?
A bulging disk is often associated with back pain. This occurs because of the stretching of the ligaments of the annulus, and because the vertebrae are not properly aligned. When the vertebrae are not held in proper alignment by the annulus, the small joints of your spine can develop painful arthritis. Back pain from a bulging disk is often some combination of these two factors.
Other symptoms that may be associated with a bulging disk include leg pain or sciatica. This can occur when the weak spot or stretching of the annulus develops in an area where it can press on nerves. This most commonly occurs in the lumbar spine where it may press on nerves that go into the buttocks or legs.
If a bulging disk is left untreated, and you continue activities that caused it, it may progress. The back pain may get worse and if it is pressing on a nerve you may have weakness or numbness in your legs. As the ligaments of the annulus stretch and grow weaker they may eventually tear, allowing the nucleus to push outside of the disc. If this disc herniation causes pressure on nerves you may have sudden severe lower extremity symptoms such as numbness or weakness.
What to do?
Treatment for a bulging disk will depend on what symptoms it is causing. If it is just an incidental finding on your MRI it may not require any treatment at all, but we should all be smart about our backs and what we do. Avoiding, or limiting how much you bend and lift, will keep your bulging disc from progressing into a problem.
If your bulging disc is causing symptoms such as back pain or leg pain there are exercises that can sometimes reduce a bulging disk. Correcting a bulging disk will realign the vertebra and take the pressure off of any nerves that may be involved. How much relief you get will depend on the severity of your symptoms and how long you have had them.
If your bulging disc has progressed to a herniated disc more aggressive treatments may be required. Depending on your symptoms, and how bad they are, your doctor may talk to you about physical therapy, steroid injections, or surgery to relieve the pressure on the nerve.
Bulging discs are a common finding on MRI, but they may or may not be important depending on your symptoms. If your symptoms are tolerable you can discuss conservative treatments with your doctor. Things like physical therapy and over the counter pain medications can be very effective therapy for many people.
We should all practice good back mechanics and pay careful attention to our posture. Avoid bending and lifting whenever possible, and when you must bend, bend at your hips and keep your back straight. Preventing a bulging disk is much better than treating one.
David L Stevens PA-C
David Stevens is a physician assistant with 12 years experience working with a spine surgeon and he has recently taken a position with a pain management physician. He brings a special perspective to caring for his patients with pain, because he has been living with back pain ever since a motorcycle accident as a teenager crushed two vertebrae in his spine. His website at Living with Back Pain provides information and inspiration for people living with back pain. Learn more about the treatments for back pain at Back Pain Treatments.