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Bulging Disc

Bulging Disc

Introduction

Our spinal column is made up of vertebrae and in between individual vertebral bones are rubbery, elastic discs, such that it appears to be in a stack-like position. These discs serve as cushions for the spine’s movements. They resemble a jelly donut, having an outer core (annulus fibrosus) made up of concentric sheets of collagen fibre, and the inner core (nucleus pulposus). Unlike a herniated disc condition, in bulging discs there is no tear or rupture in the tough exterior. Naturally with age, these discs eventually wear out. The disc loses its shape and moves out of its normal position to the spinal column due to pressure from the nucleus of the disc. Hence, it is often called disc protrusion.

It is commonly misconceived to be the same thing as a herniated disc, but there is a difference. It is far less severe and in most cases shows no symptoms. It is therefore possible for people to have a bulging disc without realizing it all. Nevertheless, it’s possible that the bulging disc can cause a pinched nerve or eventually result to a herniated disc condition which can bring excruciating pain in the neck down to the arms and fingers and also in the lower extremities.

Bulging discs usually occur in the lower back or lumbar area of the spine specifically in the lowest two segments L4-L5 and L5-S1. The spinal nerves associated here are sciatic nerves. Hence, if the respective nerves are affected it results to sciatic pain.

Causes

A bulging disc is a common disease typically found in middle-aged people. It occurs when pressure from the inner core of the disc causes the outer wall to protrude into the spinal column which can cause pinched nerves which result to numbness, weakness, and tingling sensations in the arms and hands down to the fingers and down to the lower extremities. The following are the possible causes of a bulging disc.

  1. Aging

The natural process of aging is one of the most common causes of a bulging disc. Overtime, the discs degenerate – decreasing in water content rendering it brittle and less-flexible. The pressure on the weakened discs eventually result to it bulging out from its normal position and into the spinal canal.

  1. Spinal Trauma

An injury usually doesn’t come as a sudden change but rather, it progresses overtime and leads to a bulging disc condition. The injury can be a result of various accidents such as high-impact sports, car accidents, etc. Blunt force on the spine can result to damages in the outer wall of the disc when unexpected torsion happens.

  1. Genetics

It’s possible that a family has a history of spine diseases and conditions which will increase the likelihood of the development of a bulging disc since most of them have lesser density and increased elastin in the concentric collagen fibres of the outer wall of the disc.

  1. Smoking

Smoking releases toxins in the body which affect the discs in the spine. It impedes the nutrient cycle to keep the discs healthy. Thus, increasing the rate of deterioration of the discs.

  1. Poor Nutrition

Poor nutrition can lead to weight gain that overall contribute to the deterioration of the disc specifically the weakening of the outer wall of the disc.

  1. Bad Posture

Sitting, standing or sleeping improperly increases the strain on the spine, specifically on the outer wall of the disc that can lead to a bulging disc. It creates muscle imbalances that increase the development of a bulging disc.

  1. Occupational Hazards

Some jobs require constant lifting, bending, etc. which increases ones risk in developing a bulging disc.

Symptoms

Symptoms can vary depending on the location and gravity of the condition. Bulging discs are a result of the weakening of the tough exterior of the disc which results to pressure from the inner core that causes the outer layer to bulge out of its original position and into the spinal canal. Normally, plenty of people suffer from this condition without feeling any kind of symptom. However, in some cases the bulging disc can cause a pinched nerve that then results to painful symptoms.

The common symptoms are the following:

  • Localized pain
  • Numbness
  • Weakness
  • Tingling sensations
  • Muscle spasms
  • Loss of Motor skills

Bulging discs usually appear at the end and side sections of the bulging discs, which can possibly affect a nearby nerve. If the affected area is in the lumbar (lower) spine section then symptoms commonly appear in the lower back, buttocks and legs and feet. If it exerts pressure on one or more of the sciatic nerves then the symptoms are more commonly known as sciactica. Rarely, one of the symptoms include loss of bladder or bowel control. If the cervical (upper) spine section is affected then it usually appears in the neck, arms, hands and fingers. Lastly, if the affected area is in the thoracic (middle) spine section then the symptoms are usually in the upper back, stomach and chest. It is often mistaken for cardiovascular and gastrointestinal problems. However, it is less common to develop a bulging disc in the thoracic region because of its stability being attached to the rib cage.

Risks

As one grows older, the risk for developing a bulging disc increases. It occurs with the natural process of aging that overtime the discs begin to deteriorate. This risk factor is evidently unavoidable. However, there are certain factors that can quicken the deterioration of the discs that eventually lead to a bulging disc condition.

  • Age
  • Poor posture
  • Excessive weight gain
  • Smoking
  • Poor lifting techniques
  • Height (the taller a person is, the higher the risk)
  • Dehydration
  • Repetitive standing, bending, etc.
  • Osteoarthritis

Some of these factors can easily be avoided by making changes in one’s lifestyle. By avoiding these factors, the chances of having a bulging disc are decreased.

Prevention Methods

Due to the constant deterioration of the discs in the spine, some will develop certain spine conditions. One of those is bulging disc condition where the outer wall of the disc eventually becomes brittle and weak while the inner core exerts pressure causing the disc to bulge out of its original position. It is most common in the lumbar (lower) region since this section is responsible to support the body’s upper body weight. Bulging disc is quite common and most of the time no symptoms occur from, but it still best to know what one can do to prevent the development of this spine disease.

The following can help:

  • Exercise

Exercising will help one stay fit and avoid abnormal weight gain if coupled with proper diet. It will also strengthen the muscles which will help support the body weight. This will help remove pressure from the spine. It’ll keep one flexible and aid in the spine movements.

  • Control weight

The heavier a person is, the harder it is for their spine. Maintaining a healthy diet with proper exercise will help keep discs in the spine healthy. The best food are the ones high in fiber and omega fatty acids, and low in saturated fat.

  • Stop smoking

Smoking impedes the nutrient cycle of the spine through toxins released in the body, which means that discs won’t receive the necessary nutrients to keep it healthy which will speed up the deterioration process.

  • Proper Posture

Standing and sitting straight helps relieve pressure from the spine from constant strain of supporting the body weight.

Treatment

There are several options to treating a bulging disc. Treatments vary from conservative methods to spine surgery. A physician is the best source of advice on which treatment is necessary for the patient’s condition. The treatment depends on the gravity and location of the affected disc. It is quite common to begin with conservative treatments before surgical procedures are considered.

Conservative treatment

If the diagnosis of the physician concludes that there is no immediate need for a spine surgery, then patients are directed to conservative treatment methods. A combination of conservative treatments can be made if necessary to improve the condition. A bulging disc can be treated overtime and must focus on easing the pain and improving the condition. Since the discs in the spine naturally deteriorate as one ages, there are certain things that must be avoided in order not to quicken this process i.e. obesity, poor posture, smoking, etc. Treatments will include addressing these factors if any are involved, and usually last for six weeks. The following are examples of conservative treatments.

  • Non-steroidal Anti-inflammatory medications are usually over-the-counter medicines administered to relieve and pain and other symptoms.
  • Narcotic Pain Medications are given when over-the-counter medicines do not work. Physicians can opt to prescribe narcotic drugs but are only to be used for a certain period of time because of its addicting nature.
  • Chiropractic care

This involves realignment of the spine in which professional chiropractor will make the manual adjustments to relieve pressure on the bulging disc in the neck or back. Therapeutic soft-tissue massages will also relieve parts surrounding the spine.

Plenty of patients consider this treatment because it does not involve incisions or the introduction of medical instruments into the body. Unlike the medications, it does not involve harmful substances that can eventually become addicting. If one chooses to continue with this method then the chiropractor will have to know the full diagnosis of the condition through imaging tests, physical examinations and the like. Once the final diagnosis is done, the practitioner can choose to gently stretch the spine to relieve pressure from the discs by creating more space in between the vertebrae. Or, one could also be asked to lay in several cushions to allow gravity to do the balancing of the pelvis and spinal column.

However, there are still plenty of research that needs to be conducted to ensure the safety and effectiveness of this method. Eventually, since this method was simply considered to alleviate the symptoms, surgical procedures must be considered if there is no improvement in the patient’s condition

  • Epidural steroid injections to reduce inflammation

Epidural injections contain two main ingredients. One is a corticosteroid, and the other a fast numbing agent. This helps reduce the inflammation pinched nerve and block all other nerve pain. The numbing sensation is reported to last only for about four to eight hours while the steroid waits for up to two to three days before any pain relief is experienced. It helps with those who suffer from a bulging disc condition because the injections can provide relief from the painful symptoms in just a short period of time. It is usually coupled with physical therapy and oral medications.

They are administered by direct injection in the epidural area of the spine, and lasts for only a couple of minutes. Pain relief immediately starts to kick in once the procedure is complete. Usually it is followed by some initial observations. These injections are not effective for every patient, but others have positive results of alleviated symptoms that last up to a few months. The procedure can be repeated at three week intervals for three times.

As mentioned above, it is usually coupled with other conservative treatments since these injections do not cure bulging disc conditions. It however can alleviate the pain as the bulging disc slowly heals.

  • Physical therapy which can include exercise and stretching

Physical therapy involves pain management techniques, exercises, massage therapy and functional training. Physical therapy for bulging disc condition is designed to relieve the pain and reduce inflammation, strengthen core muscles to decrease pressure in the spine, improve the nutrient cycle in the spine. The series of therapy one will undergo will be made by a licensed physical therapist after assessing the condition. They physical therapist can conduct some tests to determine the condition. A physical examination may include checking one’s posture. Nerve tests may include moving one’s body. Tissues surrounding the spine will also be examined for signs of inflammation and spasms.

The following activities can possibly be included in a physical therapy plan:

  • Joint mobilization is a skilled passive movement of articular surfaces to decrease pain and increase joint mobility.
  • Spinal Traction which can be performed with a machine. It aims to decompress the spine to relieve pain.
  • Ultrasound therapy has deep heating effects that increase circulation in the tissues in the back to improve healing.
  • Electric stimulation is a therapeutic treatment that uses electric stimulation to relieve the muscles and spine from pain.
  • Soft tissue massage is directed to massage tissues, muscles and ligaments, to increase circulation and decrease tension.

Consulting a physician is the first step to knowing which exercises are suitable. The main idea is to strengthen the core muscles to provide support for the weight of the body and reduce pressure form the spine. It also helps increase flexibility and allow the nutrient cycle in the spine to improve.

The exercise program usually builds on itself to avoid strenuous activities that may only worsen the bulging disc condition. Again, it is best to have a physician or a medical professional assist in creating an exercise program. The physician will explain the kinds of exercises that are appropriate, how they’re performed and the frequency of the exercise.

The following are common exercises for bulging disc condition:

  • Pilates and yoga
  • Elliptical machine and stationary bike workouts
  • Stretching exercises
  • Stability ball exercises
  • Trampoline exercises

Keep in mind that not all exercises are suitable for a bulging disc condition, a simple leg raise can potentially strain the back and cause more damage to the spine so always follow the physician’s advice.

  • Ice and Heat therapy helps relieve pressure form the pinched nerve
  • Life style changes, including losing weight and quitting smoking – losing weight can help reduce existing pressure on the spine and stopping smoking can allow nutrients to freely flow to the body thus keeping the spine healthy.

Surgery

When conservative treatments does not yield improvement, then surgery is considered for those suffering with symptoms from a bulging disc condition. The surgery aims to relieve pressure form the pinched nerve that was caused by the bulging disc. Hence, plenty of the symptoms in a bulging disc condition involves a pinched nerve that causes one to feel pain, numbness, muscle weakness and tingling.

A decompression must be done in order to decompress the pinched nerve. This is achieved either by the removal of a portion of the bulging or the removal of the whole disc. Minimally invasive decompression surgery is conducted if only a portion is planned to be removed. Minimally invasive stabilization surgery is conducted if an entire disc is to be removed. Minimally invasive procedures create a small incision where the affected disc is removed and an artificial disc is placed in its place.

The traditional surgical procedure is called the open spine surgery. This involves a large incision either in the back or in the throat to access the affected area. The disc is replaced with a stabilizing metal implants and a bone graft. This causes that section to be permanently immobile.

Open Spine Surgery vs. Minimally invasive Surgery

For open spine surgery, this procedure is that it has been used for so many years. Professionals will have high level of expertise because of much greater experience in this kind of surgery. It’s much easier for doctors to have a clear visual on the structure of the spine. Also, only one large incision is needed so the surgeon can perform multiple operations on the spine. Hence, for those with severe bulging disc conditions, an open spine surgery may be the only option.

The minimally invasive surgery does not pose any harm to back muscles’ because of the smaller incision made. It has a faster recovery period. There is less pain, lower risk for infection and minimal blood loss compared to open spine surgery. It is a lot more cost-friendly due to minimized hospitalization and the surgical procedures

Now for some cons, the open spine surgery can take several months for recovery and rehabilitation. It has a high risk for infection, excessive blessing, affected muscles from incision and failed back surgery syndrome (FBSS). FBSS is the continuing occurrence or worsening of symptoms after the surgery and may even require further surgery.

For the minimally invasive surgery has less proper visual for the surgeons conducting the operation compared to the open spine surgery. The surgery renders it difficult to perform multiple operations on the spine. Hence, it is not suitable for some with severe cases of a bulging disc. Because it is not the traditional method of surgery for treating herniated disc conditions, plenty of surgeons are a lot less experienced in this field. Hence, the success of the operation will greatly depend on the doctor’s specialty in this kind of surgery.

Recovery

The recovery period is different for every patient. Although the physician might inform one of things to expect, the recovery is still dependent on various factors. The following are some of the factors:

  • Location of the bulging disc
  • Severity of the affected disc
  • Severity of the pinched nerve
  • Type of surgery performed
  • Kind of Treatment plan

The physician will be providing the patient with some specific instructions to follow for the recovery period to ensure optimal results. Again, the recovery plan may differ per person depending on the location and severity of the condition. Some may have a more active and faster recovery period due to the fact that they have only suffered a mild bulging disc condition.

Physical therapy may be included in the recovery plan for some of the patients, while others may only have to perform home exercises that will ease the spine back to activity and increase strength and flexibility. However, one should always be cautious not to overwork one’s muscles or it may lead to further injuries.

While many factors during recovery remain uncontrollable, there are certain factors that are under the patient’s control. The following are tips for patients on the recovery period,

  • Although physical therapy and other rehabilitation process may present difficulty, always handle the therapies seriously. Follow the therapist instructions and follow through on all appointments.
  • Follow everything to the letter – guidelines for optimal recovery. One might already feel recovered but if the physician declares that some activities still need to be avoided then follow it.
  • Think realistically but positively at the same time. Not everyone has the same time frame hence focus on the recovery plan that was given by the physician and follow through with exactness. Avoid comparison or setting unrealistic expectations. Recovery does not happen in an instant.

Miscellaneous

Bulging disc in the neck

Our spine is made up of vertebrae and in between individual vertebrae are discs. These discs serve a cushions and shock absorbers from the spine’s movement. Eventually they wear out becoming more brittle and weak. A bulging disc occurs when the outer wall (annulus fibrosus) of the disc weakens and is pushed out by the inner core (nucleus pulposus), causing it to bulge and move out of its original position. If you have a bulging disc in the neck, often it can be treated with conservative treatments.

Common symptoms are:

  • Pain at the site of the pinched nerve
  • Pain in the arms or hands, etc. that is connected to the pinched nerve
  • Muscle weakness and spasms
  • Numbness
  • Tingling

Based on the location and severity of the condition, usually conservative treatments are done before any surgical procedures are considered. However, should be there no improvement in a patient’s condition, then a surgery will be advised by the physician.

 

 

 

 

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