Bulging disc, Disc herniation
You or someone you know has most likely used terms like disc bulge, disc herniation, blew a disc, slipped disc or ruptured disc at some point in your life. In fact, you or someone you know probably had/have one, especially if you’re over the age of 35. Disc bulge, disc herniation… potato, po-tot-o. The first thing to understand is that all of these terms refer to nearly the same thing. They are not all entirely anatomically correct but nevertheless they all imply the same thing. The 2 most commonly used terms in the medical world are variations of disc herniation and disc bulge. There has been no clearly defined official difference between the 2 which is why you will talk to some medical professionals who use them interchangeably and some who use them to differentiate the degree or severity. For the sake of clarity, I will use the term bulging disc or disc bulge from this point on and treat them as interchangeable. It’s not the most medical of the terms, however I think it will help with the explanation.
What is a spinal disc?
To understand a bulging disc you must first understand the anatomy of the disc, the joint and the surrounding tissue. A spinal disc’s most important job is to absorb shock. They also allow for some motion in the spine while helping to hold the whole thing together but I think you’d be hard pressed to find a healthcare professional who doesn’t describe the disc’s function as shock absorbing. This allows us to run around, play sports, live our lives without damaging the vertebrae on either side. That’s the next part, vertebrae are the bones of your spine. When referring to a disc we use the vertebrae above and below to describe which disc we are talking about. For example, in the low back these vertebrae are called lumbar vertebrae so to talk about the disc that is between the 4th lumbar vertebra and the 5th lumbar vertebra you would say “L4-L5 disc” (the “L” stands for lumbar in case you were wondering). In the lumbar spine, there are a total of 5 vertebrae with the count starting on top.
Vertebrae provide structural support to the body and assist with movement but the most relevant function to this article is protection. All of the vertebrae together make up the spinal column which runs from the base of your head down to your pelvis. Within this column is the spinal canal, an opening which allows the spinal cord to run from the brain to the pelvis while being protected by the vertebrae around it. This provides protection to the spinal cord while individual nerves separate from the cord to leave the canal through passages in the spinal column and provide regional sensation and movement to our bodies (basically these nerves tell muscles to move and report sensory information back to the brain). So where is the disc in all of this? Since the discs are in-between each of the vertebrae that places them just in front of the spinal cord and canal with a nerve exiting on either side. Now a little more on discs…
Spinal discs are basically 2 parts. A stronger outer ring and a center that is a gel-like substance. The central gel-like substance is the shock absorber while the outer ring contains the gel-like center. This gel evenly distributes pressure and stress throughout the surface of the disc to protect the vertebrae and keep them from banging into each other when we’re running around. It might help to think of the disc as a jelly filled doughnut with the doughnut pastry being the outer ring and the jelly being the inner gel. Sounds good, right? While you’re thinking about eating a raspberry jelly doughnut, let’s move on to bulging discs and why it happens.
What is a disc bulge?
A disc bulge is when the gel-like center of the disc bulges through small tears in the outer ring. This bulging inner gel can then irritate or pinch the nerve that is on its way out of the spinal canal. The local damage can also lead to inflammation and pain in the back or neck near the disc. Another possibility is when the outer ring has weakened but not torn. In this scenario, the inner portion will still bulge into the weakened outer ring causing what is call a protrusion. This protrusion of disc can still irritate or pinch nerves causing pain. When the nerve is pinched, it can cause pain in the leg or arm, back pain, cause a numb/tingling feeling or even muscle weakness. So how does this happen?
The 2 most common reasons for disc bulges are deterioration of the outer ring (which allows the inner disc to bulge out) or trauma. In both cases, tears or a weakening of the outer ring results, however deterioration occurs over time while trauma is more immediate. Trauma is probably the easiest to understand. A fall on ice or car accident can drive enough force through the disc to cause the outer ring to tear which would then allow the inner gel to bulge out. Deterioration is a result of repetitive pressure/stress in the same part of the disc over time. This is one of the reasons why proper lifting habits are important. While laying in bed there is about 17 psi of pressure on your discs but when lifting with your back rounded you can be putting as much as 300 psi of pressure on the disc with most of that pressure on the back side of the disc. This kind of pressure often results in more of a traumatic presentation but if we decrease the weight being lifted and add repetition, the stretch and stress through the outer ring will accumulate into deterioration. That being said, I see most disc bulges that come from something seemingly less harmful: sitting. Sitting can increase the amount of pressure on the backside of the disc by 6 times. If you’re a sloucher this goes up to 7 times that of laying down. That’s why it’s important to sit straight and get up and take breaks. When you sit and slouch or lift with your back rounded it squeezes the front of the vertebrae together, which will push on the disc causing all of that pressure to be driven toward the backside of the disc. If you think about that jelly filled doughnut again, imagine if you squeezed one side of the doughnut… what would happen on the other on the other side? Delicious disaster.
Bulging disc treatment: Chiropractic, physical therapy and lifestyle modifications
The good news is that for most cases, disc bulges don’t require surgery. There are, of course, exceptions to this and it is still a serious condition that I recommend you seek out the help of a healthcare professional for, but it’s likely that you will not need surgery. For non-surgical cases common treatments include lifestyle modifications, physical therapy exercises, chiropractic care and anti-inflammatory medications. Medication can help alleviate some of the pain but unless your case is one where the pain is only coming from short term inflammation, these meds can’t ultimately resolve your pain without help. Resolution of pain is typically achieved through lifestyle modifications (like avoiding the damaging disc stresses that hurt you in the first place), physical therapy exercises, chiropractic care or all 3 (I find that people using all 3 get the best/fastest results). This is for a few reasons: 1. If you are avoiding the original damaging forces then you are allowing the outer ring to heal (if you have a cut on the knuckle of one of your fingers and you keep bending it it’s just going to keep opening the cut right?). 2. Specific exercises designed for you and your case will help to push the disc material away from the nerves (a good example of this is if bending forward at your desk all of the time pushed the disc material back then extending back should push the disc material towards the other direction) 3. Manipulation, when used appropriately, and other manual therapies performed by a chiropractor have been shown to be effective treatment for disc bulges (here’s one such study supporting spinal manipulation for lumbar disc herniation). All of these things add up to getting you feeling better faster! The most important thing to remember is to get yourself in to your doctor (Doctor of Chiropractic, Medical Doctor, Doctor of Physical Therapy…) as soon as you think you might have a disc bulge because things tend to go much better the quicker you start treatment. You will also want to make sure that it is not something more severe.
As I said above, I find that a combination of therapies works better than one therapy alone. This is why, at White Oak Family Wellness (our St. Charles chiropractic clinic) we use lifestyle modifications, physical therapy exercises and chiropractic care to help our patients with bulging discs. Our therapy incorporates both the principals of chiropractic and the physical therapy principals of the McKenzie Method of Diagnosis and Therapy, which was developed by Robin McKenzie (who has been called the most influential person in orthopedic physical therapy). The goals of these therapies are focused on resolution of pain, return to full functioning and prevention of recurrence. Correct me if I’m wrong but I’m guessing those are your goals too.
Please feel free to ask any questions in the comments section below!
By: Phillip Gamble, DC
Doctor of Chiropractic
White Oak Family Wellness
405 Illinois Avenue #2b
St. Charles, IL 60174
Follow us on Google+: https://plus.google.com/+WhiteOakFamilyWellnessStCharles/about?hl=en