It is well known that back pain is more and more common over time. More of the population is currently or will experience some form of back pain in their lives. This is a huge problem now that is not going away, in fact, it may be getting more and more prevalent.
Getting more specific with back pain there are two conditions of the spine that can occur as a result of injury and are most often associated with lifting and repetitive use. This two conditioning are bulging and herniated discs.
Both affect the same area of the spine, but in different ways – so what is the difference?
To begin this differentiation it is important to understand which part of the spine we are talking about and the surrounding structures and systems. In the spine, there are several segments that make up the larger spine including the cervical, thoracic, lumbar, and sacral spine.
Each of these areas is individual bones called vertebrae and are stacked on top of each other with the discs in between. All together they form the spine and are supportive of the entire body physically and acting as a highway for the various bodily systems.
The discs consist of a hard, fibrous shell with a soft inside that encourages mobility among the vertebrae. The discs change in height throughout the day by hydration and age. It should be known that it is common for people to have a bulging disc with or without symptoms.
This is something that happens over time and with certain lifestyles. It is not considered normal but it is a common occurrence. MRI scans completed on people with no back pain have found to have bulging discs and several other conditions too.
How do you know if you have a bulging disc and how is it different from a herniated disc?
The biggest thing to keep in mind is that you may have one and not know it at all – which is ok.
A bulging disc is just that – the disc between the vertebrae is bulging out the side but still intact. The disc exists outside the usual space it occupies as a result of spinal compression, rotation, flexion, or extension over time or with high load. If there is no pain, a range of motion limitation, or other sudden onsets of symptoms then there should be no reason to suspect a bulging disc.
On the other hand, assuming you have back pain, numbness or tingling, or other symptoms, how do you know if you having a bulging disc or a herniated disc? Imaging is the only way to absolutely confirm a bulging or herniated disc but either way the treatment is the same. As with any sudden onset and lasting symptoms consult your healthcare professional and pursue lifestyle changes and physical therapy in this particular case.
The main goal of treatment for this condition is to prevent a bulging disc from becoming a herniated disc and restore normal function of the patient.
As mentioned above, a bulging disc may or may not be symptomatic which is unlike a herniated disc. More often than not a herniated disc will cause pain because there is pressure on the nerve near the site of herniation.
A herniated disc typically starts as a bulging disc with repeated exposure to flexion or extension (bending of the spine back and forth) and over time herniates, or break the hard shell of the disc and the substance inside escapes. This sensation has been described as a “leaking” feeling in the back followed by sharp and intense pain. Not only will you experience pain the glutes, back, and possibly down the leg with normal activity but especially in some of these specific conditions:
1. Supine leg raise
For this test, you will lay down on your back and lift one leg up as high as you are able and then pull your toes towards your knee. Perform this slowly within your own ability to move the leg. If you experience increased symptoms with this position it is a positive test for a disc herniation.
2. Heel walk
Walking on your heels with toes off the ground is another test for a herniated disc. In this test, if one or both toes cannot lift up then this is a positive test.
3. Slumped leg raise
Similar to the supine leg raise this test is done sitting down and having a rounded, or slumped spine. Once in the rounded position straighten the leg as high as able and pull your toes towards your knee.
It should be noted that if you are unable to move on your own or are experiencing severe pain these movements should not be performed and you should go straight to your healthcare professional. These tests should be performed by a doctor or physical therapist, but if you are able at home they may provide some insight into your condition.
Once you have a diagnosis of a bulging or herniated disc it is time to being the rehabilitation program. Working with a physical therapist they may provide some manual therapy to the area but exercises are going to be the key to your success.
Additionally, lifestyle changes in movement and lifting will be required to not worsen your condition or have it occur again.
As with most back issues movement is key. If you are able to move the next task is to try and keep moving.
Walking even short distances on flat, even surfaces will be beneficial in the rehabilitation process. Depending on if you have an anterior or posterior (front or back bulge) disc bulge the exercises will differ. But seeing that posterior bulging and herniated discs are more common the extensions exercises are going to be most effective.
Extension exercises vary in form but all offer the same effect: extension of the spine allows the vertebrae to come together pushing the disc back into place over time. Over time the exercise can progress in intensity and complexity as long as symptoms improve. Starting with lying face down with or without a pillow underneath your waistline for support is an initial indicator of pain tolerance.
If that position is good you can move on to extension exercises, if not you may need to focus on walking and getting comfortable on that face down or prone position.
A specific, and progressive list of exercises for bulging and herniated discs:
Prone laying with or without pillow support
Prone Press Up
Camel Exercise (no Cat)
These should be done at the direction of a physical therapist to the specific sets and reps prescribed. Also, during this time repetitive motions and heavy lifting should be avoided especially as symptoms persist as it will only help to maintain the disc issue. Your healthcare provider will set restrictions on lifting and bending activities with specific weights and motions to avoid.
Typically these restrictions are no more than 5-10 pounds with no rotation, especially is bent forward or backward. It is not worth the risk of creating more pressure and herniating a disc while trying to rehabilitate a bulging disc.
What is the Difference?
To summarize the above information, the primary difference between a bulging and herniated disc is the intensity of symptoms and anatomy of the event. The cause and treatment are often one in the same. Mechanically they are very similar in the idea that too much of one motion or too much pressure in one position, most often bending forward (spinal flexion), will increase the prevalence of this disc issue.
A bulging disc is the swelling of the discs outside the boundary of the vertebrae is sits on. A herniated disc is a bulging disc that has since herniated, or leaked the inner fluid through a perforation due to the pressure of compression by the vertebrae.
In more simple terms, you may think of the spinal discs as jelly donuts. This analogy works but keep in mind it is not completely accurate because the spinal discs are significantly more robust than jelly donuts.
The spinal discs can withstand much more pressure due to the hard outer shell in their anatomical structure. But the inside substance is similar to jelly filling and when compressed with pressure over time the liquid will move to the outside of the disc and eventually burst with enough pressure.
Once the issue is resolved and symptoms are under control the next step is to prevent it from happening again. The best way to accomplish this is to keep up with the exercises and movement and adjust how you lift and move. You should avoid certain positions that encourage stress on that area by keeping a neutral spine while lifting and relying on your legs for power and your core muscles of the trunk to stabilize that movement.
Learning proper lifting technique and finding effective strategies to lift novel and common things in your life (the couch or the newspaper) will promote safety and longevity in the spine.
If you do not have a history of disc issues and no symptoms keep in mind that many people develop these with age as repetitive motion, regardless of the activity or weight, can encourage disc issues over time. Often times lifting common objects such as the newspaper, child, or trash off of the floor leads to back pain because they are not items that warn us to be careful and use proper technique, and we also complete those lifts more often than ones at the gym or work.
However, with no history, there is no reason to avoid any certain activities, positions, etc.
Live an active lifestyle and be aware of the importance of resistance training, stretching, and how you move your body to encourage a healthy spine.
If you have concerns bring them up to your healthcare provider and get an individual plan to work on.
It is, unfortunately, something that naturally happens to the body that has had an incredibly negative association. There are people that have this issue with severe pain and require surgery and medication to continue their activities, but there are many people who have this condition and live pain-free and without imaging would never know the discs were bulging.