There are three main sections of the spine: cervical, thoracic, and lumbar. While a bulging disc most commonly develops in the lower back, it can occur anywhere along the spine. While commonly confused with a herniated disc, a bulging disc left untreated can become a herniated disc.
The spine’s intervertebral discs sit between adjacent vertebrae. If a disc is bulging, the disc shape changes and its perimeter is bulging outwards, which can compress nearby nerves and cause a variety of symptoms. Treatment focuses on improving disc health, function, and preventing further damage.
Before discussing symptoms of, and treatment for, a bulging disc, let’s explore some basic spinal anatomy for a well-rounded understanding of the structure and function of the intervertebral discs.
Anatomy of the Spine
The bones of the spine are called vertebrae, and they are separated by the spine’s intervertebral discs.
As the vertebrae are stacked on top of one another, a shift in the positioning of one or more vertebrae can cause the spine to become misaligned and an unnatural and unhealthy spinal curvature to develop.
The spine’s natural and healthy curves give it added strength, flexibility, and facilitate its even distribution and absorption of mechanical stress.
The cervical spine refers to the neck; thoracic is the middle/upper back, and the lower back is known as the lumbar spine.
The intervertebral discs sit between adjacent vertebrae and provide cushioning so the bones of the spine don’t rub up against each other, creating friction, during movement.
The discs also give the spine structure, and while a single vertebra on its own can’t facilitate much movement, when multiple vertebrae combine forces, a considerable range of motion can be achieved.
In addition, the discs act as the spine’s shock absorbers so mechanical stress is evenly absorbed and distributed throughout the entire spine, protecting it from injury.
In order for the spine to perform optimally, its intervertebral discs need to be healthy; without them, the structure, health, and function of the entire spine is disrupted.
There are many conditions that affect the spinal discs, including a bulging disc, but before we move on to defining a bulging disc, let’s first touch on the structure of the discs themselves.
Intervertebral Disc Structure
The intervertebral discs have two main parts: a soft gel-like inner nucleus and a tough and durable outer annulus.
While both the inner nucleus and outer annulus consist of water, collagen, and proteoglycans (PGs), the inner nucleus has the highest concentration.
Collagen is the glue that holds the body’s joints and structures together, and hydration is important because once a disc becomes overly dehydrated, known as disc desiccation, it is at risk for developing a number of conditions such as degenerative disc disease. PGs are important because they attract and retain water.
So now that we’ve discussed the structure of the dics, let’s move on to the important roles played by the spine’s intervertebral discs.
Roles of the Intervertebral Discs
As mentioned, the spine’s overall health and function is dependent upon its ability to maintain its natural and healthy curvatures and alignment.
A misaligned spine means a spine that’s exposed to uneven forces and pressure, which leads to uneven wear and tear, and can lead to spinal degeneration and the development of a number of spinal conditions.
As mentioned, the discs of the spine help give it structure, giving the vertebrae something to attach to, and the inner nucleus helps facilitate flexible movement.
As the spine’s shock absorbers, the intervertebral discs help protect the spine, brain, and important organs, and remember, the brain and spine work in tandem to form the body’s central nervous system (CNS).
The CNS facilitates communication between the brain and the rest of the body, which is why conditions that affect the spine can produce such a myriad of effects felt throughout the body.
The challenge with maintaining the health of the intervertebral discs is that they don’t have their own vascular supply, meaning there’s no direct route into and out of the discs for receiving blood (oxygen and nutrients) and eliminating waste.
The discs lacking their own vascular supply is part of the challenge behind disc desiccation; the only way the discs can maintain their hydration is through movement, good circulation, and osmosis.
Movement helps the discs stay hydrated and rejuvenate themselves by keeping fluid levels as high as possible, and circulation around the spine is important because it’s through a process of osmosis that the discs absorb fluid and nutrients needed for cellular repair, including PGs.
When we’re born, the spinal discs consist of 80-percent water, but that level decreases as we age and as the spine experiences age-related degenerative changes, and this is why discs can become desiccated.
So now that we understand the structure of the spinal discs, their function, and the challenges behind keeping them healthy and hydrated, let’s talk about what it means to have a bulging disc.
What is a Bulging Disc?
While a bulging disc is sometimes confused with a herniated disc, they have key differences.
When a disc is bulging, this means its shape has changed and the disc has lost height, and instead of maintaining its central position between adjacent vertebrae, the outer edge of the annulus is bulging outwards: how a marshmallow being squished between two crackers would look.
When a disc is bulging, it can put pressure on a nearby nerve and cause pain at the site and/or radicular pain that’s felt in other areas of the body such as the arms, legs, and feet.
While most bulging discs occur in the lumbar spine (lower back), they can also occur in the cervical spine (neck) and the thoracic spine (middle/upper back).
One of the dangers of a bulging disc is that it can easily become a herniated disc, especially if left untreated. A herniated disc occurs when the inner nucleus pushes through a tear in the outer annulus, protruding into the space within the spinal canal and impacting nearby nerves.
So before we get into the treatment options for a bulging disc, let’s address some of the causative sources and common symptoms.
What Causes a Bulging Disc?
Bulging discs occur because there is a reduction of the inner nucleus’s gel-like interior, causing compression and bulging of the disc.
The most common cause of a bulging disc is natural age-related spinal degeneration.
Adults over the age of 40 can start experiencing varying degrees of spinal degeneration, and women are more likely to experience this due to hormone and bone-density changes related to menopause.
In addition, the cumulative effect of certain lifestyle choices, and other factors, can also contribute to spinal deterioration over time.
Smoking, genetic factors, leading a sedentary lifestyle, carrying excess weight, chronic poor posture, and repeatedly lifting heavy objects incorrectly can affect the health and function of the spine and its intervertebral discs.
Any activity or habit that can weaken the spine has the potential to expose a disc to compression.
Spinal injury and trauma, like a car accident or fall, can also cause disc compression that can cause a bulging and/or herniated disc to develop.
So if a disc is bulging, what are the types of symptoms a person can expect?
Bulging Disc Symptoms
Bulging disc symptoms will vary based on a number of important patient/condition characteristics: patient age and overall health, causation, condition severity, and the bulging disc’s location in the spine.
Some people don’t experience any noticeable symptoms, but as disc degeneration progresses, and if it that bulging disc herniates, the following symptoms are common:
- Back pain that tends to get worse with movement like coughs and sneezes
- Back-muscle spasms
- Weakness/numbness in the legs and feet
- Bladder/bowel impairment (severe cases)
- Walking issues
- Changes to coordination/balance/gait
- Sciatica
A bulging disc in neck can cause the aforementioned symptoms, but rather than affecting the legs, it’s more likely to cause symptoms like numbness and/or weakness, in the upper body; a bulging disc in the back involves the thoracic (middle/upper) and/or lumbar spine (lower back) and is more likely to affect the legs and lower body.
The severity of symptoms will also depend on the degree of nerve involvement; the more nerve compression there is, the more likely a bulging disc is to cause pain and feelings of tingling, numbness, weakness, and other related issues such as bladder/bowel impairment.
So once a bulging disc is diagnosed, what are the treatment options available?
Bulging Disc Treatment Options
When it comes to bulging disc treatment options, there are different focuses from pain management to working towards preventing further damage, and improving the health and function of the discs and their surroundings.
The crafting of customized treatment plans will depend on condition severity and wherein the spine the bulging disc is located, along with the additional aforementioned variables.
Medication
The most common form of treatment includes the use of anti-inflammatory medications to manage pain and reduce inflammation, and in patients with severe pain, precise steroid injections delivered to the affected area, particularly when guided by ultrasound, can provide relief.
It is important, however, to understand that while medication is a common form of treatment, there is a big difference between addressing symptoms of a condition, and treating the condition itself.
Here at the Scoliosis Reduction Center®, when necessary, medications can be part of treatment, but only as one facet, while the primary focus is on addressing the condition’s underlying cause for sustainable results and prevention.
Lifestyle Choices
Part of my assessment and diagnostic process with patients that have a bulging disc is to determine if the disc problem is caused by natural age-related deterioration, lifestyle choices, or an injury.
Once the underlying cause is determined, I can be proactive with treatment, particularly in terms of trying to prevent a bulging disc from becoming a herniated disc.
If a patient smokes, has chronic poor posture, a sedentary lifestyle, and/or is carrying excess weight, these are choices that can be reversed, with guidance, and eliminating those aspects of daily life that are contributing to disc deterioration can be a valuable part of effective treatment.
If a patient’s work involves repeatedly lifting heavy objects, I’ll observe how they lift, and provide guidance on ergonomics and how to lift with the legs, rather than straining the back repeatedly: exposing the spine and its parts to uneven pressure, compression, and risking injury.
Once causation and lifestyle is addressed, I move on to assessing the level of deterioration that has occurred. While there are never treatment guarantees, I work closely with each patient to help prevent further degeneration by improving the affected disc and its surroundings through exercise/physical therapy, and chiropractic care.
Exercise and Physical Therapy
Before any form of exercise and/or physical therapy is applied, assessment from a medical professional is necessary. Not only can the wrong types of exercise be ineffective for treating a bulging disc, they can also exacerbate spinal deterioration and related symptoms.
Exercise and physical therapy are an important part of my treatment approach for a bulging disc. Through condition-specific exercise and gentle activity, I can help patients work towards strengthening important muscles that support/stabilize the spine, thereby reducing pressure on the spine and the nerves within.
Custom-prescribed exercises and stretches can also promote spinal flexibility and help reduce the likelihood of a bulging disc progressing to the point that it becomes a herniated disc, with its inner nucleus protruding into the space within the spinal canal.
Some of the best exercises for disc bulges, in terms of prevention and rehabilitation, are spinal decompression, the cobra stretch, the cat-cow stretch, bird dog stretch, planking, knee hugs, piriformis stretch, and back flexion.
Performing the aforementioned exercises and stretches in a gentle and controlled manner, particularly when bending and/or lifting, can help strengthen spinal/core muscles for optimal support, and relieve pressure on the affected disc.
In addition, as the discs don’t have their own vascular supply, increasing muscle strength through exercise and movement also improves circulation around the disc and the availability of nutrients needed for cellular repair, as the discs absorb these essential nutrients from their surroundings.
Chiropractic care is another form of effective treatment for bulging discs.
Chiropractic Care
As a scoliosis chiropractor, I know the spine, and I know how it’s affected by a number of conditions, bulging and herniated discs included.
As a chiropractor, I don’t just assess and treat one part of the spine; I assess and treat the entire spine to improve its overall function, biomechanics, health, and to proactively address a condition’s underlying cause.
My assessment/diagnostic process can also include orthopaedic and neurological testing to address important questions such as how in tact the reflexes are, if they’re sending messages properly, if there’s a loss of muscle strength and/or signs of muscle wasting, and whether or not there is a loss of sensation along a nerve path.
I can also tell a lot about a patient’s condition by their overall posture and how they walk and move; if necessary, I can order an X-ray or MRI to help reach a diagnosis.
When it comes to applying chiropractic care to treat a bulging disc, we’re talking about a variety of techniques that help determine if there is additional joint dysfunction or restriction along the spine that’s increasing disc degeneration.
I can perform gentle and precise chiropractic adjustments that address specific joint dysfunction/restriction by working towards repositioning affected vertebrae so the bulging disc’s inner nucleus can reclaim its central position inside the disc, rather than causing the disc’s outer annulus to bulge outwards and compress surrounding nerves.
Flexion-distraction is another effective technique I use as a form of spinal manipulation that uses a gentle non-thrusting technique, via a specialized table that moves, to ‘distract’ the spine while being adjusted.
Flexion-distraction therapy works by increasing the gap between the spinous processes (visible bony projections of each vertebrae) so that related disc space is also increased; the extra space can cause negative pressure within the disc space, facilitating the return inward of the pushed-out disc.
Manipulation under anesthesia (MUA) can be another effective chiropractic technique for treating intervertebral disc issues and involves stretches and adjustments performed on the affected area while the body is in a relaxed state and the spine and its surroundings are as loose and flexible as possible: making them more responsive to treatment.
Through a chiropractic-centered conservative treatment approach that integrates different treatment modalities for the best potential results, I work closely with patients to improve the function of their spinal discs by assessing/addressing the underlying cause of the bulging disc, preventing further damage (herniation), and improving the affected disc’s surroundings to improve its function and overall health.
So what about surgery as a bulging disc treatment option?
Bulging Disc Surgery
No surgery comes without its share of risks, and when it comes to spinal surgery, this is also true.
Spinal surgery is costly, lengthy, invasive, and can come with a number of potential side effects and risk of complications, not to mention how some surgical procedures impact the overall health and function of the spine.
When it comes to surgery as a bulging disc treatment option, the majority of patients don’t need surgery.
When/if a bulging disc becomes a herniated disc is generally when surgery can be presented as a potential treatment option, although even with a herniated disc, most patients respond well to nonsurgical treatment options.
There are different types of surgeries for addressing a herniated disc, the most common including discectomy, laminectomy, corpectomy, laminoplasty, and spinal fusion.
Some procedures, like a discectomy, involve removing all or part of a damaged disc, while others, like a laminectomy, involve creating more disc/nerve space by removing a portion of bone covering the affected nerve.
Surgical techniques can involve the replacement of an unhealthy disc with an artificial one, the fusing of adjacent vertebrae, coupled with full removal of the unhealthy disc, and attaching hardware to the spine to support/stabilize it (spinal fusion), and/or a combination of these different techniques and procedures.
While spinal surgeons have their patients’ best interests at heart, these procedures are complex, risky, and can cause potential nerve damage, infection, adverse hardware reaction, and the long-term effects of living with a spine that has been artificially altered: a loss of spinal flexibility, increased pain, and a spine that’s more vulnerable to injury.
For those who choose to forego a surgical recommendation, or want to try less-invasive nonsurgical treatment options before considering surgery, there are numerous options to explore with the potential to improve the health of the intervertebral discs and overall spinal function.
Conclusion
When it comes to living with a bulging disc, the condition can produce a number of symptoms, or no noticeable symptoms at all, depending on patient age and overall health, causation, severity, and where the bulging disc is located.
Common symptoms can include back and/or radicular pain felt in the arms, legs, and feet and the level of pain tends to be determined by the level of nerve involvement.
When an intervertebral disc becomes a bulging disc, it’s experiencing degenerative changes, most commonly related to aging, but can also be the result of lifestyle choices, or a spinal trauma/injury.
When a disc is bulging, it has changed shape due to a loss of fluid in its inner nucleus, known as disc desiccation, and causes the disc to bulge out around its perimeter, pressing on nearby spinal nerves.
While a bulging disc can happen in any section of the spine, it most commonly affects the lower back and neck.
When it comes to treatment for a bulging disc, these include both non-surgical and surgical options, although surgical options are more related to when/if a bulging disc becomes herniated, meaning its inner nucleus has pushed its way through a tear in the outer annulus.
Here at the Scoliosis Reduction Center®, I specialize in nonsurgical conservative treatment options for a number of spinal conditions, bulging/herniated discs included.
Through an integrative approach that combines physical therapy and chiropractic care, I help prevent a bulging disc from becoming herniated by working towards strengthening the spine and the affected disc by improving muscle strength and circulation in the area.
A variety of spinal-adjustment techniques can also help the disc to return to its central position between adjacent vertebrae so it is no longer bulging and intruding on the space within the spinal canal, through which nerves pass.
