By Dan Perez
Have you been told by your doctor that you have a bulging disc in your spine? If so, here are some things you should know.
1. Bulging discs can only be definitively diagnosed from an MRI(magnetic resonance imaging) study, not an x-ray study. If a doctor told you that you have a bulging disc just by looking at your x-ray, find another doctor fast.
2. A certain amount of disc bulging is normal, or typical in the population. The primary function of a spinal disc is to assist the spinal column in supporting the weight of the body. Since it is viscoelastic (can change shape, due to its fluid behavior), a disc will naturally bulge outwards when standing, like pressing down on a donut. If you had your MRI in the late afternoon, gravity will have acted on your discs for many hours already (unless you were lying down the whole day, which is obviously unlikely), and will show discs with slight bulging, even when you are recumbent (most MRI machines are recumbent; i.e. the patient lies down during the study).
3. What really matters is if there is injury to the disc, and whether or not it is obstructing nerve tissue in any way.
The architecture of a disk can be imagined as a slice of an onion, but with a jelly center, encased tightly by a vertebra above and below. If an injury event causes that jelly center to punch through successive rings in a focalized (as opposed to broad) spot, but the last couple of rings remain intact, you have a disc protrusion. If the jelly punches all the way through the outer ring and is still connected to the disc, it is called a disc prolapse. If the jelly center punches through the outer ring and breaks off and settles in the spinal canal, it is called a sequestered disc.
These can be painful, as there is internal injury to the disc and the protrusion can potentially press against an exiting nerve root or spinal cord, depending where it is located. Pressure to an exiting nerve root in the lower spine most often causes same side leg pain, numbness and/or weakness. Disc prolapses and sequestered discs are usually addressed via spinal decompression surgery or discectomy (total or partial removal of disc); disc bulges are usually first handled conservatively via manual therapy (physical therapy, chiropractic) and exercises.
A disc injury can also not involve bulging. An annular tear or fissure is when the rings of the disc separate circumferentially (along the perimeter), instead of split radially (outwards from center). These can be equally painful, as they are deep and difficult to heal.
If you have a disc bulge, there is still hope for recovery without surgery. It all depends on your body's ability to heal itself. In this sense, those who have a greater chance of recovering from a bothersome disc bulge have an otherwise healthy spine: no to minimal arthritic changes, good bone density, healthy ligaments and tendons (basically, younger patients) good spinal flexibility, well-conditioned spinal musculature, and not overweight.
Here are some stretches/ maneuvers you can do that may help reduce the size of a disc bulge before it progresses to a surgical case. Warning, do not attempt to do these exercises if they cause a significant, sharp increase in pain. Do them slowly and pay attention to the changes in pain characteristics during the exercise. If you notice reduced pain with a certain movement, then continue.
1. Place yourself on movement restrictions for at least a few months: no heavy lifting, no jumping, no prolonged sitting, no frequent bending at the waist.
2. Eat a healthy diet consisting of plants and animals only; i.e. minimize processed food including grain foods. Flood your body with the necessary vitamins, minerals, and anti-oxidants to give it a boost as it attempts to repair your bulging disc.
3. Lose the weight, if you you are overweight. This alone will take significant pressure off of your injured disc. Eating a protein and good fat based diet along with lots of plants is a natural, healthy way to drop the pounds without having to rely on exercise too much.
4. Stretch your back frequently. Lie on your back, knees bent with feet on the floor. Take a deep breath in and gently and slowly arch your lower back as your stomach rises; exhale and flatten your back against the floor; repeat 10 times 4x/day.
Another exercise you can do is lie on your back and hold both knees tightly to your chest. Try to shape your spine in an egg-shaped curve, especially the lower spine. Hold for 20 seconds; repeat five times. Alternatively, you can get a large exercise ball (Swedish exercise ball) and lie on top of it, with your lower back at the very top. The curvature of the ball will slightly traction apart the disc.
5. Ask your doctor if you are a candidate for using an inversion therapy table. While this can stretch the spinal discs using gravity, it is not for everyone.
As your pain decreases, it usually means that the bulge is decreasing in size. At this point, you can do light back extensions: stand with feet 6" apart. Place both palms behind your hips, and gently arch your back. Hold for ten seconds; repeat five times, several times a day.
Alternatively, lie on your stomach. Make a triangle with your hands (hands open, touch index and thumb fingertips together) and place under your chest. Push up (extend your elbows) and arch your lower back, while arching your neck back as well (this is called the cobra position in yoga). When you do lower back extensions, the backs of the vertebra pinch together and force the bulge towards the center of the disc.
Here is a video of stretches/ maneuvers you can do that may help reduce the size of a disc bulge before it progresses to a surgical case: http://www.youtube.com/watch?v=1b1sz3QXeVQ. Once again, do not attempt to do these exercises if they cause a significant, sharp increase in pain.
Remember to do these exercises slowly with good form and control; remember to breathe.
Dan Perez, DC
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