Is A Bulging Disc
Causing Your Sciatica Symptoms?

A bulging disc is a common cause for sciatica and lower back pain. Of course, not all back and leg pain is caused by herniated discs. Learn if yours might be and what you can do to get out of pain.




What Is A Bulging Disc?

The spine is comprised of bony vertebrae separated by discs. The discs function to help provide cushioning as well as allow for movement of the spine. Discs are comprised of a jelly like center called the nucleus pulposus and a thick fibrous ring called the annulus. A bulging or herniating disc is when the jelly like nucleus begins to leak out of the center. The disc most often bulges posteriorally and laterally. If the size of the bulge is big enough and in the right location, it can pinch the spinal nerve, causing symptoms to radiate into the leg.


bulging disc


What Causes A Bulging Disc?

From a structural standpoint, a bulging disc is caused by the weakening of the outer ring of the disc (the annulus). What causes this weakness? Repetitive bending or flexing of the lower back, lifting, and sitting can all weaken the posterior aspect of the disc, increasing the risk for disc herniation. Posture, specifically sitting in a slouched position, is one of the major causes of bulging discs.

Typically, discs break down over time. Although there might be one incident that initiates the significant pain, the structural changes have been occurring over time. Commonly people report the cause of their pain as something like, “I bent down to pick up my socks and my back went out”. In actuality, this was the proverbial “straw that broke the camel’s back”. More than likely it was the slow weakening of the disc over time and not this one incident that caused the disc to bulge.


Typical Disc Symptoms

In some cases, a significant bulging disc will mean pain with any position or movement. In these situations your back may feel as if it is crooked/shifted or you may be unable to completely straighten your back. Coughing and/or sneezing may also cause pain.

With a bulging disc you may or may not have leg pain or leg weakness. Generally, the greater the disc bulge, the more likely you will have leg symptoms. The region of symptoms in the leg is determined by the specific nerve root being compressed.

In addition to leg pain, lower back muscles will often feel very tight or feel as if they are in spasm. Understand that the cause of the muscle pain and spasm is your body trying to protect the area from movement. Some people mistakenly believe the muscles are the cause of the pain. In reality, the muscles are responding to the underlying disc injury. Thus, treatment of muscle spasms alone will not impact the true cause of the symptoms.

In most situations involving a disc, sitting, bending, driving and any lifting are the most painful activities. In standing, bending to touch your toes can also recreate your pain. Functional activities such as bending over to wash your face or brush your teeth will aggravate symptoms. Finally, walking and standing will generally ease symptoms.

In significant cases when the disc is pushing against a spinal nerve, leg weakness can occur. The specific muscles involved will be determined by which spinal nerve is being compressed. The ability to walk with your heels up or to walk with your toes up are the most commonly affected muscles due to spinal nerve compression.


Diagnosis

The only definitive way to diagnose a bulging disc is via a MRI. X-rays only show the spacing of the vertebrae and thus cannot show if a disc is bulging. Although a MRI is the best diagnostic test, a complete history of symptoms and a thorough physical exam is also very accurate in determining if a disc is the cause of the pain. The benefit of a MRI is that it can indicate the specific level of the bulge as well as the extent of the bulge.


herniated disc


It is important to point out that if a MRI indicates a disc bulge, it does not always mean the bulge is causing your pain. Many people have disc bulges that do not cause any symptoms. Thus the diagnostic tests are only a part of the overall examination.


Typical Conservative Treatment

Treatment of a disc bulge will depend on the severity of the bulge and your symptoms. If you are experiencing significant back or leg pain, or leg weakness, seek medical treatment. If you are experiencing numbness/tingling in the groin region, or are experiencing bowel or bladder changes, this is a medical emergency and you should seek treatment immediately.

The good news is that a huge majority of bulging disc injuries respond to conservative treatment. In only a fraction of cases will surgery be necessary.

When a disc bulges, inflammation occurs. Thus, the use of an anti-inflammatory medication is a great treatment choice (consult your doctor regarding medication). An effective oral anti-inflammatory that is frequently prescribed is a medrol dose pack. This is a steroid medication taken over the course of a number of days. Although other medications such as muscle relaxers and pain medication can be helpful, anti-inflammatory medication is by far the most important.

When oral anti-inflammatory medication is not successful in reducing leg or back pain, epidurals are generally the next treatment choice. An MRI must be done prior to the epidural in order to determine the specific disc that is bulging. The best practice for performing epidurals is to do them under fluoroscopy which is simply utilizing an x-ray during the injection in order to help the doctor visualize exactly where the injection should be given. Generally up to three epidurals will be given.

Another great way to assist in reducing inflammation is using ice therapy. Ice will help to reduce the pain and muscle spasms associated with this condition. Even if you have leg and no lower back pain, ice the lower back area 10 to 15 minutes, at least three times a day.


Physical Therapy

In less severe disc bulge cases, there are some simple things you can do to ease your pain. First is to find positions of comfort. Walking or standing may be your first choice but maintaining any position for too long will become uncomfortable. With that in mind, spend more time walking and standing but still try to change positions frequently. Prolonged bed rest should definitely be avoided.

If your lower back is not crooked or shifted, try lying down on your stomach. If pain allows, prop yourself up on to your elbows. Maintain this position for up to a few minutes. The position of being on your stomach will guide the disc away from the painful structures including the spinal nerve.


low back prone on elbows stretch


If you do have to sit, make sure you have support of your lower back to maintain a neutral spine. Reducing herniated disc related pain hinges on avoiding aggravating activities such as prolonged sitting, bending, and lifting.

sitting posture


Simple exercises can help you to control your low back and leg symptoms. Learn more about how you can control your acute herniated disc related low back pain by clicking here for a detailed exercise program: herniated disc exercises.


Surgery

Any spinal surgery should be approached with extreme caution. Even when an MRI demonstrates a significant disc bulge, conservative treatment should always be attempted first.

Research indicates that a significant majority of disc bulges resolve without the need for surgery. Typical conservative treatment must include anti-inflammatory medication, ice, epidurals, and physical therapy. Only when significant pain continues and conservative treatment has failed should surgery be considered. The most common surgical procedures recommended include a microdiscectomy and spinal fusion.


Summary

• A bulging disc occurs when the outer ring of the disc becomes weakened, allowing the center to move out toward painful structures.

• Lower back and leg pain aggravated by sitting and bending are the most common symptoms of a disc bulge.

• Typical conservative treatment includes anti-inflammatory medication, ice, epidurals, and physical therapy.

• To help minimize disc related pain, follow this simple exercise routine: herniated disc exercises.

• Surgery should only be considered when significant pain continues and conservative treatment has failed.




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References

Praxis (Bern 1994). 2011 Nov 30;100(24):1475-85.[The lumbar disc herniation - management, clinical aspects and current recommendations]. Stienen MN, Cadosch D, Hildebrandt G, Gautschi OP.

Eur Spine J. 2011 Apr;20(4):513-22. Epub 2010 Oct 15.Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review.Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, Ostelo R, Verhagen A, Koes B, Peul WC.

Spine (Phila Pa 1976). 2010 May 15;35(11):E488-504.Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review.Hahne AJ, Ford JJ, McMeeken JM.

Am Fam Physician. 2008 Oct 1;78(7):835-42.Acute lumbar disk pain: navigating evaluation and treatment choices.Gregory DS, Seto CK, Wortley GC, Shugart CM.