Herniated or Bulging Discs

What is a Herniated or Bulging Disc?

  • Of all back and neck injuries, few are as misunderstood as disc injuries. Questions about disc problems are a topic of conversation in our clinics every day.
  • There are numerous descriptions of disc problems and this only adds to the confusion. Slipped discs, bulging discs, herniated discs and degenerative disc disease are just a few of the common ones. Many of these terms sound horrible and often time patients are scared to death.
  • The bottom line is EVERYBODY has a disc problem of some kind. It is very normal and treatable.

Anatomy of a Herniated or Bulging Disc

  • There are discs between each of the vertebrae (except the top two) in the spine. These discs act as shock absorbers in the spine and resemble gel like material. Discs are primarily made out of collagen and water. A young healthy disc contains about 90% water. As we age the discs lose their ability to hold water and also lose their flexibility.
  • Discs are often injured during physical activity. The most common injury is a tear. Tears in a disc are not much different than other soft tissue injuries. There can be subsequent swelling, inflammation, muscle spasm and pain.
  • There is no blood in a "normal" healthy disc. Blood supply is what nourishes and helps heal soft tissue in the body. If there is no blood how do discs stay healthy or heal? Although there is no blood in normal discs, there is a significant amount of water and fluid. When we move our spines there are pressure changes in the discs and this causes fluid to be moved up and down into the bones above and below the discs. This process of fluid movement is called imbibition. When people hurt their back, generally the last thing they want to do is MOVE! Without movement discs cannot heal properly.
  • The good news is discs can heal and Physical Therapy can play an important role in the healing of a disc. Certain movements can cause disc injuries to get worse while others can assist with the healing process. It is critical that a properly trained Physical Therapist assist patients with disc problems to determine what type of movement or exercise is appropriate.

Mythos and Old Wives Tales

Slipped Discs
  • First of all let's dispel the myth of "slipped discs." Discs do not slip in and out of place. They are firmly anchored in palace between the vertebra of the spine and they absolutely cannot slip out. If someone tells you that you have a slipped disc it should tell you something about their level of expertise or possible lack thereof.
Pinched Nerves
  • Many people have been told that their bulging disc is pinching a nerve and causing their leg or arm pain. This is a bit of a touchy subject but a bulging disc CAN pinch on a nerve and cause problems, but often times people have bulging discs that appear to be pinching a nerve and the person has absolutely no pain.
  • New scientific evidence is pointing us more towards inflammation of a disc may be what causes nerve pain in the leg or arm. The chemicals associated with a torn disc and subsequent inflammation can be very irritating to the nerves around the spine. When the nerve becomes inflamed it can be extremely painful and radiate pain down the leg or arm.
  • Often, the best treatment for this type of condition is MOVEMENT! A properly trained Physical Therapist is critical in the assessment of exactly what type of movement is appropriate for your problem. The wrong movements can significantly aggravate your problem!
Do I need an MRI?
  • MRI's (Magnetic Resonance Imaging) are a very useful tool for some patients with disc problems. However, there are some significant problems with MRI's and disc problems.
  • Many recent scientific studies have demonstrated that disc bulges or herniations are NORMAL!
  • More than 50% of people who have never had back or neck pain a day in their life have a SIGNIFICANT disc bulge on their MRI. What this means is that just because you have a disc bulge does not mean you will have back pain.
  • Unfortunately many people have undergone back surgery due to having a bulging disc on their MRI and after surgery their symptoms are absolutely no better or possibly even worse!
  • Along these same lines, many people who have horrible back pain have a normal MRI and no particular source of their back pain can be found on the MRI scan. This can be quite distressing to many people, as their pain is VERY real.
  • Numerous scientific MRI studies have shown that discs can indeed heal over the course of a few months. A bulging disc today can be reabsorbed and be virtually nonexistent in a few months if it is given proper care and rehabilitation.
Degenerative Disc Disease (DDD)
  • Many patients have been told they have DDD. At first glance this sounds quite horrible and many patients are very worried about their discs. First of all, like many of the problems in the spine, DDD doesn't actually describe a diagnosis. It is simply a descriptive term that describes the degree of "wear and tear" in the discs of the spine.
  • Recent scientific studies have demonstrated that DDD can be evident in 10 year olds! What this all means is that DDD is normal, everybody has some wear and tear. Being labeled with DDD does not help anybody in terms of treatment of your back or neck pain.