Disc Herniation and Disc Bulge
Back pain affects nearly everyone at some point in their life. For some of us who are unlucky, this pain can be very severe and affect nearly everything we do. One of the most sudden causes of severe back pain is suffering a disc bulge, medically known as a disc herniation. Below, we cover some important things to know about this condition.
What is a Disc Bulge?
The spinal column in the human body is made up of a series of irregular bones called vertebrae, which provide protection to the spinal cord. Descending from the neck, your vertebral (spinal) column comprises seven cervical vertebrae, twelve thoracic (mid-back) vertebrae, five lumbar (lower back) vertebrae, the sacrum, and the base, which is known as the coccyx.
These vertebral bones are padded by intervertebral discs, which act as shock absorbers during activities like walking, bending, lifting, and twisting. Each disc is made up of a soft, gelatin-like inner part and a tough outer part. Injury to the spine or spinal weakness can result in the inner part of the disc pushing out through the outer part, leading to a disc bulge, also known as disc herniation or disc prolapse.
What Does Disc Bulge Pain Feel Like?
Disc bulge pain usually starts as lower back pain, which may radiate to both lower limbs. You may experience stiffness in your lower back, causing restricted movement. The pain is typically sharp and excruciating. You may feel discomfort in the hips, thighs, and calf muscles. If the disc bulge occurs in the cervical spine, you may experience localised pain in the neck and shoulders, along with weakness or numbness in the arms and fingers. Symptoms may also include numbness and tingling sensations. Many people with disc bulges find it difficult to walk for prolonged periods and often experience pain even with short walks. The pain can worsen at night or with certain movements, accompanied by burning, tingling, and achiness in the affected area.
What Causes Disc Bulge Pain?
A disc bulge occurs when the soft inner part of the disc pushes against the outer layer. The most common location for this is between the lumbar spine (L5) and sacrum (S1), often leading to nerve compression. As you age, your discs start to shrink and lose water content, making them more prone to bulging. Other causes of disc bulges include mechanical injuries, accidents, lifting heavy objects, obesity, prolonged sitting or driving, a sedentary lifestyle, and smoking (which decreases oxygen supply to the disc and accelerates degeneration).
How is a Disc Bulge Diagnosed?
Your healthcare provider will first conduct a thorough physical examination to identify the source of discomfort. This may include a neurological exam, assessment of nerve function, muscle strength, and range of motion tests to determine the severity and location of the disc bulge. Imaging tests such as X-rays, MRI, CT scans, and discograms may also be used for a more accurate diagnosis.
What Are the Treatments for a Disc Bulge?
It is usually observed that 90% of patients show improvement within three months with non-surgical care, as the size of the bulge may decrease over time. The most recent advancements in non-surgical care for disc bulges include spinal decompression therapy, which has shown promising results. Other conservative treatments include physical therapy, extension exercises, chiropractic care, bed rest followed by gradual activity, non-steroidal anti-inflammatory medications, muscle relaxants, and oral steroids. The body’s immune system also plays a role in removing damaged disc material. If conservative management fails, selective nerve root corticosteroid injections may be an option. Surgical interventions, such as laminotomy and discectomy, are considered if symptoms persist or worsen.
When Should I See a Doctor?
You should see a doctor if your back pain persists despite over-the-counter pain relievers, or if you find yourself unable to perform activities you previously could. Seek medical attention if your pain worsens or is accompanied by any of the following red flags:
Age under 20 or over 55
Pain triggered by light tapping over the lower back
Fever and chills of unknown cause
Numbness or tingling in the legs
Unexplained weight loss
Difficulty urinating, involuntary urination, numbness around the groin, foot drop, or weakness in the lower limbs (these may indicate a neurological issue)
What Are the Risk Factors for a Disc Bulge?
About 90% of bone mass is acquired by age 20, and bones begin to lose mass around age 40. Risk factors for developing a disc bulge include:
Age under 20 or over 50
Jobs that involve heavy lifting, repetitive bending, or prolonged sitting
Obesity and tall stature
Smoking, which decreases oxygen supply to discs, leading to degeneration
Lack of physical exercise and a sedentary lifestyle
High blood pressure and cardiovascular issues
Genetic predisposition to disc degeneration
Prolonged hospitalisation, which can weaken supporting muscles due to inactivity
When Should I Consider Surgery?
If you have persistent, disabling lower back pain lasting more than six weeks and have not responded to non-surgical treatments such as epidural injections, pain medications, and physical therapy, surgery may be an option. You should also consider surgery if:
Your pain is worsening, despite conservative treatment
You experience progressive weakness, numbness, or tingling that does not improve
You develop cauda equina syndrome, a rare condition that causes nerve damage below the spinal cord, leading to numbness, severe pain, and loss of bladder or bowel control
Summary
A disc bulge can be a painful and debilitating experience, but around 90% of patients see improvement within three months of conservative care. Physical therapy is an excellent treatment option, and maintaining a healthy lifestyle is crucial. Regular exercise and a balanced diet can help keep your weight in check and reduce strain on your spine. If your symptoms persist or worsen, consult a healthcare provider to explore further treatment options.