Disc Bulges

What is a disc?  

When we talk about discs, we’re referring to the spongy shock absorbing things between each of the bones in your spine (vertebrae). Think of them like the gel cushioning in the heel of a runner. And they’re not too different from that. They have a think, fibrous outer layer, that is very strong and flexible. This attaches to the bone above and below, providing stability to your spine through these thick attachments. On the inside is a gel-like material that does the majority of the shock absorbing. This inner gel stuff is wholly contained within the thick outer layer, and doesn’t exist anywhere else in your body, it’s very specialised!! Overnight, while there is less pressure on your spine, your disc sucks in fluid via osmosis, and through the day, it slightly compresses from your day’s dose of gravity. Like squeezing a sponge under water, the compression and decompression assists the transfer of fluid in and out. This fluid exchange though compression and decompression is how the disc stays healthy. Movement of the spine also achieves this, which is one reason our spines love to move.

How does it bulge and then what happens? 

Discs can bulge quickly or slowly. A high impact movement can cause an acute disc bulge, something like trying to catch a falling piano (so don’t try that). The impact is so great that the inner gel material breaches the outer disc wall. This causes an acute inflammatory response. Your immune system responds to the injury to the disc wall, and the foreign gel material being in a place it shouldn’t be. The acute injury itself will cause pain, as will the inflammation that comes to heal the injury. But as the injury heals, the pain will subside and you will likely recover well.  

There are different types of disc bulges. If the disc flattens and starts to expands outwards, this is a disc bulge. If the inner material starts to press outwards on the outer wall without breaching, this is a protrusion. An extrusion is when the gel breaches the outer wall. And a sequestration is when the inner disc material, and outer wall are freely floating fragments. Since the larger injuries produce a larger inflammatory response, they often cause more pain. However, there isn’t a point where they stop healing. So, while a scan will report the type of injury, a more severe injury doesn’t necessarily mean a worse outcome. Treatment should be based on how you actually feel.

With the right conditions (progressive movement, good nutrition, and sleep) the outer layer of the disc will usually heal and the gel material will be removed by your immune response. Good job immune system! 

However, discs can also bulge slowly over time. This happens when the disc isn’t healthy, and they begin to flatten and bulge outwards. There can be small tears in the outer wall, without actual inner material breaching outwards. This type of bulge produces much less of an immune response, meaning that sometimes these bulges can actually remain there undetected, and non-painful. Honestly, these ones don’t really matter; they are unlikely to be the cause of any issue, and you wouldn’t know it was there if you didn’t have a scan.  

When is a nerve involved? 

Our nerves exit the spinal cord, and pass by the outer surface of the disc, before exiting the spinal column and heading off down an arm or leg. Nerve issues can arise secondary to a disc injury if the bulge is great enough that either the actual bulge contacts the nerve, or the inflammatory response caused by a disc injury irritates the nearby nerve. It’s important to know, not all disc bulges cause nerve pain, and not all nerve pain is due to disc bulges.  

Check out the blog I posted in May about sciatic nerve pain.

What should I do if I have a disc bulge? 

Disc bulge from an acute injury? Since these are the ones that produce an inflammatory response to heal the bulge, the plan is to support your immune system and give it the space to heal well.  

Degenerative disc bulge? This is more a result of your spine being at sub optimal health for a while. A lifestyle that leads to an unhealthy spine is very likely to cause pain. Sedentary? Poor diet? Poor sleep? Chronic stress? If you’re ticking any of these boxes, I would spend your energy addressing these things, rather than trying for solutions to a disc bulge that is unlikely to change.  

Do I need an injection or surgery? 

Corticosteroid injections (aka cortisone) can be given to people suffering from a severe disc injury. They are a very strong anti-inflammatory, and when they work, can provide amazing relief from severe pain. In the best cases, they completely remove the pain for long enough for the injury to heal in the background. It should be noted that they don’t always work this well. Being an anti-inflammatory, one downside is that it can impair your body’s natural healing response. Therefore, it should only be considered when you are in such pain that you cannot function, or you have tried at least 3 months of good physical rehab. This decision is obviously made with a doctor, but should not be a first line treatment.  

Injections can also be used to confirm the location of the issue. When a scan shows multiple issues, an injection to a specific area can confirm that this is in fact the issue, and if surgery is required, there is more confidence that the surgery will be directed to the right area.  

Surgery for a disc injury is not a fix, and is rarely needed. I always recommend that people do what they can to avoid surgery, but there are times when it is the best option. The conversation about surgery shouldn’t begin unless the pain remains so intense and consuming that you are unable to commence any movement, or if you have trialled at least 3 months of good physical rehab. Aside from pain, the other main reason to consider surgery is worsening nerve compression. If the disc injury is compressing a nerve for greater than 3 months, surgery should be a real consideration. Thankfully, the vast majority of nerve compression resolves well before this.  

Signs to look out for: 

Most of this article is trying to reassure you that you are most likely to recover from a disc bulge. However, some of these injuries can be very serious.  

If nerves that are responsible for bladder and bowel functions are impeded (you’ve lost control of these), then you should go to the hospital.  

If you are having unrelenting pain, that doesn’t improve with a medication, you should go to the hospital.  

If you are unable to move at all due to pain, you also may have to go to the hospital.  

Sometimes all that is required is some more powerful drugs to get you through the worst of it. Other times, surgery can be required. 

Summary: 

If you’re had an acute injury and have a disc bulge, it needs you to look after it with physiotherapy and exercise, but it will heal. If you have chronic disc bulges, they are likely not the cause of your issue.

In both cases, your spine needs to move! Start where you feel comfortable, progress slowly, and you’ll feel the benefits in a few short weeks.

If you have a disc bulge and not sure what to do next, give us a call, we’d love to help 🙂