Understanding the difference between a disc bulge or a herniation is not a straightforward one, especially without a proper chiropractic or medical evaluation. The symptoms of both these conditions can be different but also similar depending on the severity of the bulging disc. Sometimes even the ultimate outcome/treatment can both be similar or vary significantly. As a Chiropractor in West Vancouver, I have seen my share of both. The good news is that most patients will recover with conservative care but some will ultimately need surgical intervention to get relief.
The key difference between a disc bulge and a herniated disc is the size and shape of the displacement of the disc. A disc bulge is exactly as it sounds. The integrity of the outside of the disk is still intact, it’s just that parts of the disc have bulged outside the circumference of the vertebra that is above and below it.
A herniated disc usually occurs when the tough cartilaginous fibers that surround the outside of the disc is torn and a part of the soft inner portion of the disc oozes out and either touches or irritates the spinal nerves that are near the disc and vertebral joint. This usually causes a lot of discomfort for the patient.
What is a Disc Bulge or Herniation exactly?
In short, a bulging or a herniated disc is a problem with one of the soft cushions (a disc) in between the vertebrae of the spine. These discs sit between the vertebrae, the bones of your spine, and keep the bones protected against shock, movement, and greater injury.
When a disc bulge or herniation occurs, the inner part of the disc is pushed outwards and outside of the boundary of the vertebrae that is above and below it. The inside, the nucleus, is soft, whereas the outside, the annulus fibers that act as a protective ring around the disc is tough and fibrous. It needs to be to protect and hold in the discs but yet supple enough to allow for the mobility of the spine.
When a disc bulge occurs, it’s as similar to a jelly-filled donut that has been squashed but no jelly has oozed out. In a disc herniation, the jelly filling in the donut has oozed out of a torn or broken side of the donut. The filling, in this case, the softer inside disc material has either moved further out and might touch and irritate a spinal nerve. This would cause pain that can travel down the irritated nerve causing pain in the affected leg, foot, arm, or hand. Numbness, tingling, pain, and weakness can also manifest down the same nerve tract.
Not everyone who has a disc bulge or herniation will feel symptoms. Herniated discs do not always require surgery as some with conservative care will even self-resolve.
Symptoms of a Disc Bulge or Hernia
It is most common for a herniated disc to occur in the lower back. This is the area that is most likely to have the most compression, strain, or repetitive movements during everyday actions, and as a result, this is where disc bulges and herniated discs will usually happen. Discs can also bulge in the neck, although this is not as common.
The most straightforward and common symptom of a disc herniation is pain. This is most common in the legs if you have a herniated disc in the lower back. You will likely feel short, sharp, and burning pains in the legs, calves, and sometimes the feet. You will also experience numbness and /or tingling in most cases.
If you have a herniated or bulging disc in the neck the pain will be in the arms and affect your hands and fingers. Numbness and tingling down the arms to the hands on the affected side might also be the first sensations before any pain occurs.
Pain and numbness might also be joined with general muscle weakness. A patient might notice this if they’re unable to pick things up, stumble on a weak leg, or generally are unable to carry out activities that they’re used to doing. Foot drop when walking or the sense that the affected leg will give out with weight-bearing are some of the other symptoms.
What Causes a Herniated Disc and What Can You Do To Prevent It? Tips from Your Chiropractor
Generally, disc herniation happens because of the wear and tear put on your spine as you age or with repeated heavy loading of that part of the spine. You don’t have to be old to get a disc bulge or herniation. Young adults that engage in repetitively heavy work or heaving lifting in the gym can experience a disc injury as well. This is commonly referred to as disc degeneration. The soft discs become worn out and less protective. The outer fibers of the disc can fray and eventually tear with the repetitive micro-trauma.
Disc herniation can be caused by a variety of reasons. Incorrectly lifting heavy objects can cause disc herniation, and so can twisting/turning your spine while doing manual labour. Very rarely a traumatic incident involving the spine can result in a disc herniation. Usually, a combination of lifting and twisting a heavyweight at the same time can cause either a disc bulge or a herniation. So simply, the steps to prevention would be to avoid repetitive heavy lifting and twisting of your back and neck. Lifting heavy loads while rotating your spine is certainly not a good idea.
Is there anything that makes a person more susceptible to a herniated disc?
Although age is a common factor, other risks/lifestyle factors can play into how likely a patient is to experience some form of disc bulge or herniation.
- Weight. Being overweight puts extra strain on your lower spine, the area that is most likely to have experienced more wear and tear in general. Extra stress will lead to extra compressive forces loading the discs. If the discs are already weak, that added load bearing stress will tear the annular fibers that surround the disc which will make it easier for the disc material to bulge or herniate outwards.
- Manual labour or strenuous exercise. Those with jobs that involve a lot of repetitive manual labour, such as lifting or pushing, are more likely to experience a bulging or a herniated disc. The same can be said for high-impact exercises such as how cross-fit athletes train can also further cause more trauma to the discs. Lifting too much weight in the gym when your body is not prepared is a recipe for a disc injury.
- Smoking. Smoking cigarettes reduces oxygen intake throughout the body, and this includes your spinal discs. Oxygen helps repair your discs but also keeps them healthier in the long-run.
- Genetics. Lastly, some people are just more likely to inherit hereditary traits that lead to disc injuries and arthritic conditions.
What treatment options are there for a disc bulge or disc herniation?
Luckily, for most people that have disc bulges, there are no symptoms. You can quite happily live your life not even knowing that you have a disc bulge. Most of the time, you’ll only find out that you have a disc bulge due to an unrelated event where you have to get a CT or an MRI for your body. That finding is noted in the radiologist report as in incidental finding and that’s it.
If you start experiencing some mild to moderate numbness, tingling, or mild pain down your arm, or leg, either your doctor or myself as a Chiropractor would perform some tests to confirm that you do have a disc bulge. If you do have a mild or moderate disc bulge, as a Chiropractor in West Vancouver, I would treat you with traction and some mild manipulation depending on the severity and location of the injured disc. I would also give you some home exercise that you need to do a few times a day. Depending on the severity, there is no need for you to see me every few days for months and months to get better. A lot of care can be done at home. Typically, with conservative care and the location of the injury, you should start feeling better again when the disc heals up over a few weeks to a few short months. Pretty soon you can go back to enjoying a pain-free and active life again.
In other circumstances where the disc bulge is large enough or has become a disc herniation, and has started to irritate a spinal nerve, your doctor will probably prescribe you with pain medication to help you cope. A referral to a spine surgeon or specialist is the next step if your symptoms are not resolving. If surgery is recommended, the relief after surgery is almost instantaneous. With some minor home care and exercises, you can return to your normal lifestyle quite quickly.
Regardless of the outcome, as a Chiropractor in West Vancouver, I believe that preventative care is prudent. Keeping your spine and disc as healthy and strong as you can is a choice that you can make early on. Lifestyle, diet, and exercise changes account for a lot. Having your spine maintained and evaluated regularly by a Chiropractor is also a good idea. Most of us have our teeth cleaned, and checked regularly by the dentist, so why not have our spines looked after by your chiropractor as well?
