You are lifting a heavy object, and – ouch! – a sharp pain radiates through your lower back.What caused the pain? Could you have a prolapsed disc? Chances are you might.
A bulging or prolapsed disc occurs when the jelly-like center of a disc ruptures through a weak spot in the rigid outer wall, similar to the filling being squeezed out of a jelly donut. Back or leg pain, tingling or numbness may result when the disc material touches or compresses a spinal nerve. Treatment with rest, pain medication, and physical therapy is the first line to recovery. Most people improve in 6 weeks and resume regular activity. If symptoms persist, surgery may be necessary.
An intervertebral disc connects adjacent vertebrae in the spinal cord. Each disc forms a fibrocartilaginous joint (symphysis) to permit movement, to hold the vertebrae in place, and to function as a shock absorber of the spine. The discs are like a jelly donut – a soft gelatinous inner portion encased within a rigid outer ring that cushions the vertebrae from daily wear-and-tear.
The majority of spinal disc herniation occurs in the lumbar spine (95%). The second most common site for herniation is the cervical region (i.e., neck).
Bulging Disc vs. Prolapsed Disc: What are the differences?
Injury can cause the soft inner portion of the disc to protrude through the outer ring. A bulging disc (protrusion) occurs when the disc annulus remains intact but flattens and forms an outpouching that can press against the nerves. A bulging disc doesn’t always affect the entire perimeter of a disc – it only affects the outer layer of tough cartilage. A bulging disc happens more frequently than a prolapsed disc.
Disc herniation (or prolapse) usually is a further development of a previously-existing bulging disc. When a tear in the fibrous ring of the disc allows the inner content to bulge outwards beyond the ring, the disc is said to be herniated. If the prolapsed disc compresses your spinal cord or nerve, you may experience numbness and radiating pain. A tear in the disc ring may cause inflammation, which can produce varying intensities of pain along the affected area even in the absence of nerve root compression.
Signs and Symptoms
If a bulging disc has not yet reached the stage of herniation, you may experience little to no pain. Bulging discs tend to create pressure points on adjacent nerves which may cause mild tingling and numbness.
Symptoms of a prolapsed disc vary significantly depending on the location of the herniation and your susceptibility to pain.
- Neck or lower back pain: Although prolapsed disc can occur in any part of your spine, it is most common in the neck or lower part of your backbone (lumbar spine).
- Pain worsens when you’re active: Even mild activities such as breeze walking, bending, coughing or sitting can aggravate your pain because the prolapsed disc puts pressure on the sciatic nerves, a condition called “sciatica.”
- Numbness, tingling, or weakness in the area surrounding the affected nerves may be felt. You may experience cramping or muscle spasms in your back or leg.
- Loss of bladder or bowel control is rare and severe. It may be caused by cauda equina syndrome, which occurs when the spinal nerve roots are compressed. It requires immediate medical attention.
When the spine is unbent, such as in lying down or standing, the internal pressure is equalized on all parts of the disc. When sitting or bending to lift, internal pressure on a disc can increase. Herniation of the disc into the spinal canal often occurs when the stomach side of the disc is compressed when sitting or bending forward, and the materials get pressed against the tightly stretched and thinned annulus fibrosis on the back side of the disc. The combination of internal pressure and membrane-thinning from pulling results in the rupture of the confining membrane. The contents of the disc then leak into the spinal canal, pressing against the nerves, which may trigger intense pain.
A bulging or prolapsed disc is most often the result of natural, age-related wear and tear on the spine. This process is called disc degeneration. Discs in young people have high water content – this water content decreases as people age. The discs shrink and the intervertebral space becomes narrower. This normal aging process makes the discs more prone to herniation.
Accumulation of microtrauma over time can lead to disc injury. The best example of repeated microtrauma is poor posture. Slouching over time leads to weakness and poor disc integrity and displacement of the disc fluid posteriorly – this exerts pain-inducing pressure on your spinal nerves.
A traumatic injury, such as an accident, may also cause your disc to bulge or prolapse.
- Old age: As you age, your intervertebral discs become weaker and become less flexible and therefore vulnerable to tearing or rupturing with even a minor strain.
- Overweight: Excess body weight causes extra stress on the discs in your lower back.
- Physically demanding occupation: Repetitive heavy lifting, bending, and twisting may increase your risk of a prolapsed disc.
- Improper lifting: If you use your back muscles instead of your legs to lift heavy objects, you risk having a prolapsed disc. Alternatively, you should raise with your legs, not your back, to protect your spine.
- Gender: Prolapsed disc is more common in men than women. Middle age men between the ages of 20 and 50 are most
When left untreated, the prolapsed disc can lead to permanent nerve damage. Seek immediate medical attention if you have:
- Worsening symptoms: Loss of mobility due to persistent pain, numbness or weakness.
- Loss of bowel or bladder control: In rare cases, a prolapsed disc can cut off nerve impulses to the long nerve roots (cauda equina) in your lower back and legs. If this happens, you may lose bowel or bladder control.
- Saddle anesthesia: This progressive numbness affects the areas near to your saddle – the back of your legs, inner thighs, and the area surrounding your rectum.
The majority of patients will improve gradually throughout several days to weeks. Most patients are symptom-free by 3 to 4 months.
Treatment for a problematic disc is focused on encouraging the fluid to return and remain in the center of the disc – this keeps the torn fibers closer to one another and the structure of the annulus as healthy as possible. By maintaining the disc fluid intact, you are allowing the scar tissue to heal by itself.
- Rest: Two days of bed rest will usually help relieve pain. Do not rest long, however.
- Gentle exercise: While it may be tempting to refrain from all physical activities, this can lead to muscle weakness and joint stiffness. Instead, try to incorporate slow and controlled physical activity. Change your daily physical activities to avoid the range of motions that can cause further pain. Try not to sit still for prolonged periods.
- Physical therapies: Specific exercises will help strengthen your lower back and abdominal muscles. Back and abdominal core muscle recruitment pattern plays a crucial role. A regular order of deep, then moderate, and finally superficial muscle firing patterns is usually required for pain-free backs.
- Holistic therapies: Manual therapies such as acupuncture, transcutaneous electrical nerve stimulation (TENS), and ultrasound can help ease the pain.
- Heat/cold therapy: Initially, use cold packs to relieve pain and inflammation. You may switch to heat therapy after a few days.
- Medications: Over-the-counter pain relievers, muscle relaxers, narcotics, nerve pain medications
- Steroid injections: Epidural steroid injection into the space around the inflamed nerve may provide short-term pain relief by reducing inflammation.
If your symptoms do not subside within six weeks, your doctor may recommend surgery to either:
- Remove the protruding or damaged portion of the disc
- Replace the disc with an artificial one
- Remove the disc and fuse your vertebrae
Most people with a prolapsed disc don’t need surgery.
Neck (cervical vertebrae) exercises
- Shoulder stretch: Hold your hands together behind your back, interlacing your finger. Slowly lift your locked hands. Hold the stretch for a while, and then gently unwind back to the starting position. You can repeat the shoulder stretch a few more times.
- Chin tucks (to target the upper cervical area, underneath the skull): Stand tall with your head facing forwards, shoulders back. Then lightly bow your head until you feel a moderate stretch in the neck if you’re aiming for a deeper stretch, touch the chin slightly more. Hold the stretch for few seconds and then return to your starting position. You may repeat ten
- Shoulder-blade squeeze (to target the lower cervical region): Stand with your feet hip-width apart, chin slightly tucked, back straight and arms hanging loosely at your sides. Slowly pull your shoulders back and bring your shoulder blades together until you feel a slight pull. Hold for 10 seconds. Loosen stretch if you feel pain.
AVOID Any extreme exercises that may shock the cervical spine, such as weightlifting. Avoid workouts that require you to bend forward or use your shoulders or arms in front of your body, which could irritate the injured disc.
Because there are various causes of back injuries, prevention must be comprehensive. Back injuries are predominant in manual labor, so the majority of low back pain prevention methods have been applied primarily toward biomechanics.
- Exercise: Strengthen your saddle muscles to support your spine. Do not remain seated for long periods; stretch periodically.
- Maintain good posture: Good posture reduces the pressure on your spinal discs. Ergonomic workspace helps too.
- Lift heavy objects safely: Bend and lift from your knees, not your waist – this allows your legs to bear a majority of the weight – instead of your back.
- Maintain a healthy weight: Excess weight puts pressure on your spinal discs.