In the first part of the disc series I covered the degenerated disc. In this column I will address the bulging disc. Please refer back to my earlier column for normal disc anatomy.

In a normal disc the gel-like center, the nucleus, is contained within the tough fibrous rings that make up the annulus. As the fibrous rings become unhealthy due to trauma or even normal wear, they can tear, allowing the inner gel material to go out into the tear. If the tear is big enough it can cause the remaining intact outer ring of the disc to pouch outward or bulge due to the amount of pressure the gel is under (as it is bearing the weight of your body above it). The gel can then put pressure on the sensitive outer ring which has nerve endings that can cause you to feel pain. Thus, a bulging disc can cause you to have back pain. Also, these nerve endings have attachments to the exiting spinal nerves that can cause you to feel pain into your arm or leg. This would be a referred pain into the extremity rather than a radiating or pinched nerve pain.

The typical age for someone to experience a disc bulge is 20 to 50 and most often occurs at the lowest level of the spine, L5/S1. Although, it can occur at pretty much any age and at different spinal levels. An acute disc bulge usually occurs suddenly and is usually without any provocation at that moment, although it is essentially the end result of prior wear and tear or traumas. You may be just bending over to pick something up or sneeze or twist- the straw that broke the camel’s back. It is among the most painful and debilitating of the spinal disorders. The pain can be sudden and severe and may cause you to become “crooked” or unable to stand up straight. Many patients have related going to their knees due to the intensity of the pain. Other common symptoms are difficulty bending forward, difficulty on arising from sitting or especially on getting out of bed in the morning. Prolonged sitting or standing gives increased pain. Sneezing or coughing can be very painful. You may also have pain going into the arms or legs and/or tingling or numbness.

The only way to image a bulging disc is through a MRI. You cannot see the disc on plain x-rays as the disc is soft tissue and will not show up. An interesting phenomenon with disc bulges is that they may show up on the MRI but not be symptomatic or you may have all the symptoms of an acute disc bulge and it will not show up on the MRI. You don’t treat from the image however; you treat from the patient’s history and symptoms.

One of the first things I recommend my patient’s to do to treat a disc bulge is to use ice. A good rule of thumb is 20 minutes on/ 2 hours off as much as possible. I also may put a lumbar brace on the patient which can be quite comforting. I am hesitant to do this if the patient has pain into the leg as I have found the brace can increase the pain in the extremity. You also want to avoid prolonged sitting and lying especially in the initial onset phase as to get up from such can be quite difficult. You want to have some degree of movement for the spine; walking is good if you can tolerate it. You especially want to avoid sneezing or coughing, good luck with that, as that can send you to your knees. Disc bulges respond well to chiropractic care. It is somewhat amazing to see the patient barely able to walk into the office for their initial visit and with time and treatment they become pain free again. In my office I treat disc bulges with manipulation primarily in the form of flexion/distraction for which I use a specific table for such. My job is to reduce the disc bulge by inducing the gel material to go back towards the center of the disc and to keep it their while the torn rings undergo healing around it. Even though this can occur and the patient gradually becomes more functional and in less and less pain the tissue healing that occurs is with scar tissue and it is never quite as strong as the original. When I see someone with an apparent acute disc bulge I will ask them if they have ever had this happen before. Many of them will answer yes as it is a problem that will tend to recur over the years of time. If they answer no, then I inform them that unfortunately it will tend to recur periodically and usually without any provocation. Once you have it once you will probably have it again. The typical disc bulge patient can do about anything they want in terms of physical activity without any problem then one day on bending over to pick up a penny off the floor their back will “go out”.

My advice to a recovered disc bulge patient is to get into a Yoga program or a stretching class. Back strengthening exercises are also in order as well as to keep their weight down. One of my best suggestions to help prevent recurrence is to not do anything “stupid”. By that I mean that on most occasions when I have a returning disc bulge patient they relate to me that they had done something “stupid”. They were in a hurry, should have gotten some help or should have known better than to do the activity in the first place. Some commonsense can go a long way.

My next column will be on disc herniations or ruptures.

Dr. David D. Godwin
Chiropractic Physician
Salisbury Chiropractic
Salisbury, NC 704-633-9335
www.salisburychiropractic.us