Disc Bulge

Disc bulges (or herniations) occur when the fluid from the inside of a disc leaks out and presses against a nerve. The best course of treatment utilizes a combination of therapies.

Disc Bulge

What is a disc?

An excellent way to think of a disc is it being a spacer between the bones of the spine. Without discs, the spine would be a block of bone, making movement impossible. Essentially, the discs are necessary to allow the spine to move. The disc has two main components, the outside layer (annulus fibrosus) and the inside (nucleus pulposus).

The outside layer (annulus fibrosus) consists of dense collagen fibers. The inside (nucleus pulposus) is a fluid similar to the consistency of phlegm. I like to think of collagen as being like rope fibers. When dense and tightly bound, they're durable and keep the inside (nucleus) from bulging out.

What is a disc bulge?

A disc bulge is when the inside (nucleus pulposus) maneuvers its way through the collagen fibers of the annulus fibrosus. When the nucleus leaks out far enough, it can cause pain within the disc itself or irritate nearby nerves.

Are there different types of disc bulges?

Yes. A disc bulge is actually not a specific diagnosis. It's a general term to describe when the inside nucleus comes out into the annulus. More precise terms to describe disc bulges are protrusions, extrusions, and sequestrations.

A protrusion is the beginning phase of the process when the nucleus is still fully contained within the annulus. An extrusion is when the nucleus has completely come out of the annulus; however, it is still intact. Sequestration is when the nucleus has reached all of the way out and broken off.

What causes a disc bulge?

Disc bulges occur when the collagen fibers of the annulus fibrosus start to separate, similar to the unraveling of rope fibers. When the outside layer collagen fibers unravel, the inside gel-like fluid of the nucleus will begin to weave its way through. Eventually, it can come out far enough to irritate a nerve.

Genetics is a significant contributor to this process happening. Some people are just more prone to having a disc bulge. Another influence is nutrition. It has been known for a long time that smoking can significantly accelerate collagen degeneration. However, it's now becoming clear that diets high in refined foods can cause chronic inflammation, which contributes to faster deterioration as well.

Another consideration is posture and movements. Repetitively moving through the spine can cause a breakdown of collagen. In these circumstances, it's beneficial to adopt new postures and movement patterns to slow down the progression of degeneration. For example, exercises that strengthen the glutes (butt muscles) without stressing the spine are a good start.

Also, not moving or exercising enough can be bad for the spine. "Motion is lotion" is a good saying to understand why it's essential to maintain quality mobility.

How does a disc bulge cause pain?

When the nucleus pulposus (fluid inside portion of the disc) reaches the outer border of the disc (annulus fibrosus), it creates an inflammatory response. Inflammation is what irritates nerve receptors, resulting in pain.

The disc's outer layer can be a source of pain due to its large amount of pain receptors. Sometimes, the bulge will come into contact with a nerve, which can be the source of pain. When a disc bulge causes nerve pain, it's often referred to as a pinched nerve. The most common example is when a disc bulges in the low back, causing sciatica.

Where can disc bulges happen?

Disc bulges can occur almost anywhere in the spine. However, they most frequently occur in the low back (lumbar spine) and neck (cervical spine).

How are disc bulges diagnosed?

An MRI is the imaging method of choice to diagnose a disc bulge. However, it's usually recommended to try conservative therapies such as chiropractic for six weeks before getting an MRI. The reason conservative treatment is recommended first is that disc bulges will often be able to heal when using the correct therapies.

Orthopedic tests can also help determine the likelihood of having a disc bulge. For example, moving the spine in specific ranges and monitoring what you feel and where you feel it can give insight into what the issue is.

What is the best treatment for a disc bulge?

There are several options for treating a disc bulge, and usually, a combination of several therapies will be best. For example, spinal decompression, nerve mobilizations, stretches, mechanical diagnosis therapy, spinal manipulation, and myofascial release can all be helpful.

Spinal decompression is a great way to create more space around the nerve, relieving pressure and pain. Intermittent traction is when the therapist slowly comes in and then out of decompression several times and is particularly effective for disc bulges. When decompression is intermittent, there is a more extraordinary ability to promote a healing response around the disc and nerve.

Neurodynamics is a technique that increases circulation and mobility within the nerve affected by the disc bulge. Neurodynamics is also called nerve flossing and looks and feels similar to a stretch. However, these stretches are exact for the nerve involved, and neurodynamic stretches are not held for long periods. Instead, the nerve is slowly moved in and out of a stretch, similar to the intermittent traction described above.

Mechanical Diagnosis Therapy can identify the best direction to stretch the spine. In some instances with disc bulges, it's best to round the spine frequently to enlarge the opening where the nerve exits the spine. However, some disc bulges respond best to backward bends to help the fluid (nucleus) seep back into the center.

Spinal manipulation is the traditional therapy used by chiropractors and is an excellent option to reset joint mobility. Spinal manipulation also helps to reduce muscle tightness along the spine and can have reflex responses that relieve pain and accelerate healing.

Myofascial release is similar to getting a massage and helps relieve muscle tension. This can benefit disc bulges because the tight muscle response around a disc bulge can impede the healing response.

Stretching the surrounding muscles is a great way to improve overall mobility.

Rehabilitation helps strengthen muscles in or around the area of injury. Strengthening is beneficial in the later stages to develop more resilience and prevent future occurrences.

How long does a disc bulge take to heal?

Disc bulge healing varies depending on the cause and severity. Other factors to consider are a person's age, overall health, and if the appropriate therapies are being done.

In some instances, disc bulges can feel better within a couple of weeks. On the other end of the spectrum, disc bulge pain can sometimes take nine months before it begins to feel better.

Most commonly, six weeks of conservative therapy (such as with a chiropractor) are recommended. When a combination of treatments is applied appropriately, there is a greater chance for a more speedy recovery.

Chiropractor that treats disc bulges

Our chiropractors perform a thorough exam to discover which treatments will work best for you. Each therapy can be valuable; however, the critical component is applying them in the necessary situation. Before committing to a chiropractor, it is recommended that they utilize and have experience with the therapies mentioned above.

Are there any other options that can help a disc bulge heal faster?

Yes. What's considered healthy lifestyle choices, in general, are usually essential to promote healing. Examples include getting good sleep, managing stress, and maintaining a good diet.

Sleep is essential for recovery. If the body is not getting adequate and quality sleep, then the healing response will suffer. Everyone is different, but it is mainly recommended for 7-9 hours of sleep/night. Keep in mind that quality is essential too.

Nutrition can be critical in the recovery of a disc bulge. Avoiding processed foods can keep inflammation down, which is crucial for a faster healing response.

Managing stress and anxiety can be valuable. Stress responses increase cortisol, and cortisol is a stress hormone that can slow the recovery process.

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