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Disc Bulges

Disc bulges, disc herniation, discogenic back pain, “slipped disc”, disc protrusions, disc prolapse....these are all terms that refer to a pathology of the intervertebral discs that can be a source of spinal pain.

Intervertebral discs are jelly like structures that sit between the bones of the spine. When the wall of the disc tears or becomes thin, it can protrude causing inflammation to affect the nearby nerve roots.

MRI of a disc bulge at the very base of the spine (L5/S1)
Illustration of a disc bulge from side to side and top down.

They can occur in the neck (cervical), upper back (thoracic) and lower back (lumbar).

Typically disc bulges present as follows:

  • High levels of pain at rest that may be worsened by particular movements or strain.

  • Pain increasing overnight.

  • Pain usually felt radiating from the low back down the leg or from the neck down the arm. This is a common source of "sciatica".

  • When a disc herniation pushes up against a nerve root coming out of the spine a radiculopathy can occur.

  • This can cause pins and needles, numbness and paralysis on the effected limb as electrical impulses to and from the limb is interrupted. This is usually specific to level disc rupture.

In more serious cases the disc can push up against the spinal cord known as central canal stenosis. This can cause numbness, pins and needles and paralysis in both legs when occurring in the lumbar spine or in both arms (and possibly legs) when occurring in the neck.

In the most severe cases the spinal cord can be significantly compromised and interrupt bowel/ bladder function. These cases should seek immediate medical attention at the closest hospital.

Generally lumbar disc bulges are rare and over diagnosed. There are many false positives of lumbar and cervical spine disc bulges in people without a history of pain as displayed in a study by Brinjikji et al (2015). You can read the full article at the following link:

This is why a thorough history and examination with a musculoskeletal specialist is vital to accurately diagnose the source of your pain.

Healing time frames can vary greatly depending on severity but usually the discs will heal between 3 and 6 months with another 3 months of rehabilitation required.

Cortisone injections can be helpful to reduce pain in the short term but should not used as a substitute for rehab.

Some cases do require spinal surgery but conservative management through physiotherapy should be exhausted first in most cases.

Physiotherapy for disc bulges:

  • early intervention including manual therapy/ soft tissue massage, dry needling and specific exercises to reduce pain and stiffness.

  • Advice on prognosis, self management at home, relative rest while remaining as active as appropriate and healing timeframes.

  • Rehabilitation exercises at home to help the disc heal under ideal conditions.

  • Long term strength training to prevent chronicity.

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