by Brian Allred
When you have a sudden onset of low back pain, there is always that little voice in the back of your head that says, “What if it’s something big and scary, like a bulging disc?” Well, I have some good news for you, but it might not be what you would expect.
You might expect me to say that you probably don’t have a disc bulge because they are really uncommon. That’s not true, though. In fact, by the ripe old age of 20 years, about 30% of asymptomatic people have a disc bulge. That number goes up roughly 10% for each decade after that, meaning by the time you are 40, you have a 50/50 chance, and by the time you reach 70 years old, you have less than a one in four chance to NOT have a disc bulge.1 (Just to be clear, there are different degrees of injury when we are talking about discs. While herniated discs and bulging discs aren’t exactly the same thing, I am using the terms interchangeably for this post.)
I hope you caught a specific word in that last paragraph. That word is “asymptomatic.” That means that these numbers are for people who DON’T have back pain. In other words, a disc bulge isn’t necessarily a problem by itself because tons of people have that problem on an MRI, but have no pain. The first bit of good news is if you have a bulging disc, it’s probably not a big deal. The second bit of good news is that bulging discs usually get better on their own. Like most tissues in the body, the disc can heal itself. Good news number three is that IF you have a disc bulge and IF it is bad enough to be a problem, then it is likely to respond well to physical therapy. Everyone should be happy to hear that they can have an effective, natural treatment instead of pain meds or back surgery.
Structure of a spinal disc
Let’s take a step back and talk a bit about the disc. If you look at the picture, you can see the vertebrae (the bones of the spine) stacked one on top of the other. The discs are the structures between the vertebrae. Discs are shock absorbers and hinges, essentially. Structurally, you can think of them like a radial tire. It has fibers running in different directions just like a radial tire, but the disc is like a tube tire. If you’ve ever seen a tire that has a lot of miles put on it and the innertube is starting to poke out, then you know what a disc bulge looks like and why that might be a problem. Unfortunately, you can’t just go to Firestone and get a new set of discs.
I’m sure what you really want to know is, “Do I have a bulging disc?”
Physical therapists go to school for a lot of years to be able to recognize disc problems, so this will not be comprehensive, but here are some of the hallmarks of a bulging disc:
- Pain is worse when sitting and better when standing or walking
- Pain that goes into the buttock or down the leg
- Pain is worse with coughing or sneezing
- Pain is often worse first thing in the morning and/or at the end of the day
Referring to pain symptom number two listed above, if a disc is bulging far enough, it can compress the nerve running down the leg and cause leg pain. So the poor sap in the picture would have pain running down the outside part of his thigh and calf. The poor sap in the picture happens to be me, so I am especially happy about good news number three.
What to do if you think you have a herniated disc
This, of course, comes with the disclaimer that you probably shouldn’t rely too heavily on an internet post to diagnose yourself. If you are concerned about your back pain, talk to your doctor or physical therapist. After all, the goal isn’t just to KNOW that you have a disc bulge, but to do something about it. Helpful fact: Wyoming is a direct access state, meaning that you can seek an assessment and treatment directly from a physical therapist without seeing a physician first.
Physical therapy is a conservative form of care that often produces better results in treating a herniated disc than surgery or pain medications, such as opioids. An individualized treatment plan designed by your physical therapist will focus on exercises and treatments, posture correction, flexibility, and pain reduction that will aid in your recovery. Your physical therapist will provide home exercise programs that you can continue even after therapy concludes to keep the muscles, discs, and surrounding structures strong and flexible to help prevent future problems. Getting back to normal everyday activities via physical therapy generally takes between 3 to 8 weeks with a personalized program from your physical therapist.
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015;36:811–16 doi:10.3174/ajnr.A4173 pmid:25430861