In Albury Wodonga, our Osteopaths see disc bulges on a daily basis. There is one main reason for this……they are extremely common in the general population.
So what are discs and what is a disc bulge?
The intervertebral disc is important in the normal functioning of the spine. It is a fibrocartilage cushion that sits between 2 vertebra and makes up the joint between these 2 bones. There are 5 discs in the lumbar spine (lower back).
Discs allow the spine to be flexible without losing it’s strength. They also provide shock absorption within the spine along with preventing the vertebrae from grinding together. Discs are made up of 3 major parts; the nucleus pulposus (inner portion), annulus fibrosis (outer portion) and cartilaginous endplates that anchor the discs to the vertebrae.
Discs can take a lot of load and pressure without causing any problems. However, there are times when certain types of pressures and loads that can cause strain and irritation to the outer portions of the disc. Sometimes this pressure and load can cause the inner portion of the disc to push its way through the outer portion, which we know as a bulge.
So what now?
Disc bulges can cause back pain, increased pain with prolonged sitting and bending, pain with cough/sneeze/straining, and in rare cases pain, numbness and pins and needles radiating down the leg if it irritates a nearby nerve.
Across our lifespan connective tissue changes with age, and the structures of the spine adapt to cope with the physical loads of daily life. These changes can be seen on scanning and are usually termed ‘degenerative change’, which isn’t helpful to people who have back pain for the first time. It’s scary being told that you have ‘degenerative change’, when in fact it is very normal and nothing to be worried about. You can even give yourself a pat on the back for these changes, as your body has changed to adapt to what activities you have done throughout your life!! Well done you!! Disc bulges, narrowing of the disc space and disc dehydration are all common aged related connective tissue changes!
What is even more interesting is that people without low back pain can go and get scanned, and they will have the same, if not more findings on the image as people with pain! This is a very important thing to remember, pain doesn’t equal tissue damage!
So what do you do if you have a bulge?
Remain active!! This cannot be stated enough. Most of the time disc bulges resolve with time, regardless of treatment, just like soft tissue sprains in other parts of the body. Short term rest initially will help with pain management, but this doesn’t mean staying in bed doing nothing!! Gentle movement will help with pain management and keep you moving which is super important.
After the initial intense pain period, gradually increase your activity level as pain permits. An exercise program that includes strength, flexibility and fitness is important not only for the recovery but for minimising risk of another lower back pain episode.
Manual therapy like osteopathy can help relieve pain and help get you moving again, but this is only recommended in the short-term, exercise and movement is the key to long-term recovery. There is a small amount of evidence that NSAID’s/steroids and pain relieving medication works. The strongest evidence to pain relief with disc bulges is heat and movement!
Good news is that invasive surgery and procedures for pain relief are rarely needed, and should only be used as a last resort when time, exercise and other options haven’t worked.
- Pain doesn’t equal damage to the disc
- Discs recover on their own in time without any special interventions
- Movement is key! Remain active
- Exercise can help with recovery and long term risk reduction