Disc Bulges – 5 Things You Should Know

Before even starting the discussion on low back discs, you should know not all back pain is from the disc. Researchers have thought through perhaps one hundred different tissues and issues that could cause back pain. With that said, however, the disc can be very problematic and painful for many, many people.

Due to the complex nature of back pain, it is very helpful to have an experienced Physical Therapist properly diagnose the cause of back pain as this provides the framework for accurately thinking about and treating the pain.

Knowing the specific cause of our pain gives us:

  • A framework for understanding what we’re feeling and why
  • Focus, motivation, and a positive outlook on the most effective ways to manage the pain and prevent its re-occurrence
  • Independence and confidence in properly managing our spinal health for a lifetime.

 

So first things first, what does discogenic back pain feel like? Here are a cluster of signs/symptoms that indicate the disc may be causing your pain.

  • Morning stiffness -hurts to sit up or roll out of bed.  Bending to put on socks/shoes is very uncomfortable
  • Improves as the morning goes on, but is quite sore at the end of the day again
  • Sitting in a car is initially very tight and sore and leaning away from the sore side is better
  • Repeated bending forward (letting your spine round) and twisting aggravates the pain
  • Pain is typically on one side. Bending toward the side of pain worsens on that side, bending away from the pain is slightly better
  • Intermittently radiates to the buttock or down the leg
  • Numbness/tingling/burning down the leg in more advanced cases
  • Injuries happen more often and more easily over time – simple things cause back to give out or take your breath away

Please note, many things on this list could be from tissues other than disc. Pain that arises from the facets (low back joints) would also present similar to this. A muscle strain could also feel like this. However, I’m sure most people with disc injuries can nod in agreement with the list above.

What is the disc? And what is it made of?

The intervertebral disc is the round structure in between each vertebra. An L5 disc bulge would refer to the disc between L5 (the last spinal vertebra) and S1 (top of the sacrum.)

One of world’s most well respected spine researchers, Dr. Stuart McGill, refers to the disc as an “adaptable fabric.” We know that the outer part of the disc could be compared the the fabric in our clothing. Layer upon layer of collagen fibers are woven together to create a robust, strong, dynamic structure on which our spinal bones stack up. When explaining how discs wear out over time, Dr. McGill draws out the similarities between the fabric in our clothes, and the collagen “fabric” in our discs. If we wanted to ruin part of the fabric in a shirt, we would systematically pull, push, wiggle, sheer, and stretch it over time. In the same way, through improper, insufficient, and overly repetitive movements, many people are inadvertently injuring their discs over time. While some disc pain comes from one injury at one point in time, the majority of disc pain is the result of cumulative misuse and abuse over decades of life.

It is difficult to find good photos of the fibrous nature of the disc without concerns for copyright, so I want to show you my own personal finding. This gem was found behind a local elementary school. When a PT finds this kind of stuff laying around, pictures and videos are a must! Take a look at the fabric nature of the disc below!

How does the fabric of our disc change over time?

Spinal flexion, or forward bending, creates strain on the posterior/back side of our discs.  Picking something up off the floor, raking, sweeping, lifting and twisting, carrying kids, you name it – all create increased strain on our discs. The good news: our discs are an “adaptable fabric.” The bad news:  our discs are an “adaptable fabric.” We can either strengthen the collagen fibers in our discs over time, or allow them to weaken over time. The choice is largely up to us. Discs can get stronger and more injury resistant over time if we move well, move often, and move with a variety of patterns. Or, discs can weaken over time if we move poorly, move less, and do the same repetitive movements over and over.  When the outer part of the disc, known as the annulus, starts to weaken over time, it can bulge back and intermittently contact a spinal nerve. Or, with certain movements the spinal nerve can contact the disc and we can have times where the nerve gets compressed, swollen, and sensitive like a cut which can be quite painful.  In some cases the periphery of the disc can tear, allowing the inner part of the disc, the nucleus, to herniate or extrude through the tear. While this sounds terrible and painful, there is still hope.

Can a current disc bulge or herniation heal?

Research shows that discs can heal. Not all will heal perfectly, but it is worth the time, effort, and consistency to try our best to get better. Furthermore, even with imperfect discs (whose are perfect, anyways?) we can live a pain free, happy, healthy life. There is a plethora of literature supporting this line of thought, but it is too much to discuss in this post.  At the end of the day, it’s best to be optimistic and hopeful regarding our back’s capacity to heal and be robustly healthy again. We are not like automobiles that have no innate capacity to heal themselves.

How to take care of your discs – 8 easy and practical tips

Sometimes the most obvious advice is what we need to hear and heed the most. Consider these points when working to either heal from a disc injury, or prevent a future episode of disc pain:

  • Move often.  As the phrase goes, “your NEXT posture is your BEST posture.” Frequent movement is better than trying (and failing) to maintain “perfect posture.”
  •  Move well, and with variety. Don’t always stand with the same foot forward.  Don’t always lean the same way in the car. Don’t always sit on the couch the same way. Don’t always pick something up by rounding your back. Don’t always hold your kids on the same hip. Don’t always cross the same leg. What else am I missing? Brainstorm this one on your own  . . .
  • Remind yourself that by nature the disc is strong and resilient. Fearing movement is a recipe for disaster. Movement is what nourishes the intervertebral disc.
  • Take breaks to lie down during the day to re-hydrate and decompress your discs. Sometimes this may be more valuable than doing a certain exercise routine.
  • Don’t try to stretch away back pain. Discs take time to heal. Constantly stretching it may feel good short term but may not be helping in the long run. Consider consulting with a PT that can offer suggestions on low back stabilization exercises. Strength and neuro-muscular control should be more of a focus than stretching.
  • Don’t bank on adjustments/spinal manipulations or massages to help much long term. Adjustments primarily affect joint mobility and help with short term pain relief through neuro-physiological and chemical changes. There’s a time for that. Disc pain just won’t respond as well; temper your expectations.
  • Figure out WHY your disc may be hurting in the first place. Spending thousands of dollars on imaging and treatment may be a waste if there are changes you can make to stop aggravating your back in the first place.
  • Find a PT that believes in you, encourages you, wants to help you meet your goals, helps you explore moving your back through normal, healthy ranges of motion, teaches you neutral spine posturing ad stabilization, ideal lifting techniques, helps with some manipulative/hands-on therapy when needed for pain relief and restoration of function, and emphasizes taking control of your own back long term. *Inhale* Whoa. That was a lot. But there’s a lot that should go into good care! You deserve it.

This is a huge topic! There is so much more to say, and so much more that could be better clarified, I’m sure! I hope the content was helpful and well balanced. If you have any questions or comments, let’s chat!

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