Every week I have an opportunity to review the results of MRI’s of current and/or prospective patients. On average, a patient with longer duration low back pain has seen a medical doctor, a physical therapist and has had MRI imaging done prior to ending up in my office. Each of these patients has a few characteristics in common: 1. They have not achieved a good result or resolution of their low back pain symptoms, 2. They don’t have a firm grasp on the cause of their low back and 3. They are losing hope for finding relief.
In this post, I’d like to address a common finding on low back MRI scans, a bulging disc, and provide insight on achieving quality results from treatment.
The Spinal Disc
Between each vertebra from the second cervical bone in the neck to the fifth lumbar bone in the low back resides a disc. The disc is a pliable, solid object with a fibrous outer ring and gelatinous inner core. The disc has multiple functions in the spine including shock absorption and support for movement. A healthy disc is filled with water and substrate that allows it to reduce shock and the effects of gravity and stress on the spine. Trauma, mechanical stress, smoking, poor nutrition and aging all contribute to the breakdown of spinal discs.
Bulging Disc vs. Herniated Disc
Most people know someone or have personal experience with a disc problem, whether it be a herniated disc or bulging disc. While both conditions can result in back pain, the bulging disc is far more prevalent. Research tells us that 30% of 20 year olds and upwards of 96% of 80 year olds have bulging discs. A bulging disc occurs when the mechanical stress of spinal alignment and movement cause increased pressure on one aspect of the disc forcing the disc material to bulge to the opposite side. Think about squeezing one side of a jelly doughnut, where does the jelly go? A herniated disc is one where the inside gelatinous material breaks through the outer fibrous ring and leaks out. Think about the jelly exiting the doughnut when you squeeze one side.
In some cases, the bulging disc is asymptomatic, meaning it’s not causing any pain or symptoms. In other cases, the bulging disc can cause a variety of symptoms including localized pain, pain with certain postures/body positions or increased regional pain when maintaining a posture/body position for an extended period of time. Commonly I hear patients with a bulging disc report increased pain with sitting or standing for more than 10 minutes or when performing a specific task that requires repetitive movements like loading the dishwasher or shoveling corn. A herniated disc, for the most part, always causes a symptom which can include severe localized pain, muscle spasm and/or symptoms like pain and numbness extending into the leg or foot. Often times a person with a herniated disc cannot find a posture/body position that relieves the symptoms completely. While both conditions can be successfully treated with chiropractic, I want to focus on the bulging disc today.
Bulging Discs and Pain
As stated, many of us have 1 or more bulging discs that are not causing any symptoms. A bulging disc will have a few common traits including: decreased disc height, loss of water volume and loss of elasticity. For these reasons it is presumed that most bulging discs are the result of abnormal wear and tear of the spine. Much like the front tires on your car wear out faster when the front end is out of alignment, the discs of the spine react the same way to improper spinal alignment and abnormal movement patterns in the spine. The vast majority of bulging discs that I see are related to this degenerative, or wear and tear, process. As the disc continues to endure stress and decay, the fibrous outer ring weakens allowing the inner material to form a bulbous protrusion that can extend into any open space. Most commonly the disc will bulge laterally into the neural foramen where the spinal nerve root passes, or straight back into the spinal canal. Both areas contain delicate neural tissue that react adversely to the irritation and can result in pain. Irritation can result from direct contact of the bulging disc or as a result of inflammation from the damaged structures. Much like a knee joint will have pain and inflammation when the cartilage is worn out, the same can be said for spinal joints. Herein lies the cause of pain related to a bulging disc.
Functional Treatment for Relief
When your tires wear out because of bad alignment in your car, you don’t simply change the tires. You also correct the front end alignment to insure that the new tires wear normally. Treating a bulging disc requires the same thought process.
Spinal adjustments based on postural abnormalities and segmental misalignment is my priority. Reducing the stress on the damaged disc is paramount to the disc actually healing. Just like your body can heal a cut, it can also heal a bulging disc. But, it takes a proper healing environment which means little to no stress on the disc, proper movement of the spinal joint, quality nutrient supply to the disc and hydration. By applying the correct adjustment, improved movement and alignment is achieved. The result is decreased mechanical stress on the disc. Improving the function of the spinal segment is the first step to results.
Functional exercises are the second step in the recovery process. For years, back rehab was simply stretching and static body movements. The latest research shows that functional movements with and without load are essential to recovery for spinal disc conditions. Improving the low back and pelvic coordinated movement also reduces stress on the joints and discs in the spine. As normal movement patterns are restored there is less shearing and/or frictional stress on the disc providing a better healing environment.
Combining chiropractic adjustments with functional exercises is our primary treatment for bulging discs. This evidenced based care is allowing our patients to experience better and faster results compared to passive care alone. What once was considered a debilitating condition, bulging discs are now something we can deal with, recover from and move on to living a fully functional and pain-free life.