A bulging disc occurs in the lower back when one of the cushiony pads in between each vertebra of the spine becomes compromised. Usually, this occurs as the gel-like material inside these pads either bulges, tears, spills out, or cracks. Plymouth Bay Orthopedic Associates, Inc. in Plymouth, MA is committed to providing the best treatments for our patients with this condition.
How Can You Treat a Bulging Disc? 5 Things to Know About Lumbar Disc Herniation
1. Pain Management
Over-the-counter medications such as acetaminophen (Tylenol) and anti-inflammatory drugs such as Advil and Aleve can help to control pain. Your doctor can also prescribe corticosteroid injections near the spinal nerves. He or she may also recommend muscle relaxants.
2. At-Home Therapy
At-home treatment focuses on pain management and prevention. Depending on the severity of symptoms, bed rest could be helpful for a short period of time. However, too much rest can actually create stiffness in the muscles and make things worse. Therefore, light movement with intermittent rest is the most effective way to manage a slipped disc at home.
The application of ice during the first 48 hours after pain has started is helpful, as it reduces inflammation and alleviates muscle tension. Ice also creates a numbing effect, so it helps soothe the initial pain, especially if it is intense. Just make sure to use a barrier between your skin and the ice (like a paper towel or washcloth) to avoid injury.
Heat therapy may be best after those first 48 hours, as heat helps to relieve painful muscle spasms. Methods for applying heat include taking a warm bath, using a wrap that applies continuous low-level heat to the area, or by using a heating pad. Again, if you are using a compress or heating pad of any kind, always make sure that you use a barrier between your skin and whatever heat source you are using.
Low-impact physical activity can help keep your muscles strong and flexible, which will help alleviate symptoms. Light walking, swimming (or other hydrotherapy), and cycling or using an elliptical trainer are usually manageable for people with a slipped disc. Activity will also benefit your mood and put the reigns for your health back in your own hands.
You may find it difficult to find a comfortable sleeping position with a bulging disc. Some people find they sleep better on their sides with a pillow between their legs (which helps spinal alignment). Others find that lying flat with a pillow under their knees works best. Experiment with pillows and different positions, and take notes about what works best.
3. Physical Therapy
Physical therapy is often recommended to relieve pain by stretching the muscles and relieving spinal pressure. It also helps the patient learn how to perform daily activities in a way that mitigates pain and minimizes risk. Massage can also relax the muscles and keep them supple.
4. Surgical Treatment
If your symptoms worsen despite physical therapy and home treatment, your doctor may consider you a candidate for surgery. If the pain persists for longer than several weeks and you are experiencing progressive numbness or tingling, the portion of the disc pressing on the nerve and causing pain may need to be removed. Fortunately, most surgeries recommended for slipped discs are minimally invasive and involve only the protruding part of the disc.
5. Preparing for Your Appointment
It is a good idea to write down any thoughts or observations about your pain before you see your doctor. We will have many questions about the nature of your pain and what triggers it. Be sure to write down things you may forget later, such as how you feel after certain activities or if heat or ice worked better for your pain.
Be prepared to answer questions such as:
- Which activities do you find yourself avoiding due to pain?
- When did the pain first begin?
- Have you noticed any changes in your weight, or in your bowel or bladder habits?
- Does your pain travel?
- Do you smoke?
Understanding Lumbar Disc Herniation
Form and Function of the Vertebrae
Your backbone, or spine, is made up of 33 bones called vertebrae. In between these vertebrae are discs that act as shock absorbers, taking pressure off the bones and allowing the back to maintain its strength and flexibility. These cushions (or discs) are made up of an inner gel-like substance called the nucleus pulposus contained within a firm, rubbery outer shell called the annulus fibrosus.
Anytime this annulus fibrosus is compromised, the inner gel-like substance it contains can slip or bulge out through the surrounding shell. Because the lumbar vertebrae are located in the lower back, a bulging (or slipped) disc at this location is directly beneath the root of the spinal nerve. This can create a unique set of symptoms, as the pressure can induce nerve pain that affects the lower half of the body.
Why Herniated Lumbar Discs Occur
Like many things, a risk factor for lumbar disc herniation is merely the aging process. When we are young, there is a high water content to our discs, making them supple and flexible. As we grow older, the moisture content decreases, causing the discs to become more brittle and prone to injury.
That being said, injury is the second most common risk factor for herniated discs. High-impact traumas such as a car accident or a fall can jar the spinal column in a way that it causes a disc to slip. Physically demanding work can also create injury over time.
Not everyone who has a bulging disc experiences pain, so individual symptoms will vary. The most common symptom is nerve pain, especially pain along the sciatic nerve down the back of the leg. This is often experienced as a sharp, radiating pain.
Other symptoms include a dull or throbbing lower back pain, numbness, or tingling in areas of the lower half of the body (feet, calves, toes, etc.), and pain that becomes worse when bending at the waist or leaning forward.
How Is a Herniated Lumbar Disc Diagnosed?
Our doctor will do a physical exam that will reveal the source of pain and determine whether or not a herniated disc is the cause. However, a physical exam is only the first step, as they will also need to rule out other sources of trauma. Our doctor may use one or more of the following methods to get a full and accurate assessment of the condition of your spine:
The physical exam may include gait monitoring and a neurological check, where the doctor will observe your walking and note any areas that may have numbness or tingling. They may also try a leg raise test, where you will lie on your back and the doctor will raise your leg as high as it will go without pain. The exam may also include range-of-motion tests where you will be asked to move in certain ways that will reveal any movement limits you might be experiencing.
While X-rays are not the best imaging source for detecting bulging discs, they can detect other causes of pain such as broken bones, tumors, and bone abnormalities. It is important to rule out other potential sources of discomfort that may have been discovered during the physical exam. X-rays are a common and non-invasive way to eliminate other possible problems.
Magnetic Imaging Resonance (MRI)
An MRI uses strong magnetic and radio waves to scan the body and create images of parts of the body that can’t be seen as well on an X-ray or CT scan. MRIs are useful for seeing joints, cartilage, and ligaments. This ability to view soft tissues is what makes an MRI test a good option for detecting bulging discs.
Computed Tomography (CT) Scan
For some people, an MRI is not advised and a CT scan may be recommended instead. A CT scan emits several radiation beams at the body, as opposed to an X-ray’s single radiation beam. This produces a more detailed image that detects multiple layers of density.
Computed Tomography (CT) Myelogram
This is a CT scan that uses a dye injected into the areas surrounding the spinal cord. The contrast dye helps doctors see exactly where there might be any blockages, slips, bulges, tears might appear along the spinal canal. This can help determine the exact location and size of the hernia.
This test measures electrical activity inside muscles. By inserting needle electrodes directly into the muscle, doctors can see how the muscle responds to electrical impulses and how quickly it sends signals from one part of the muscle to another. This builds a clear picture for the doctor of whether or not a bulging disc is the cause of a nerve or muscle disorder.
Protecting Spine Health
In addition to low-impact cardio exercises, yoga is an excellent exercise for spinal alignment. Gentle stretching sequences are best, and chair yoga is an excellent option for people who may have difficulty with balance. As with any new exercise program, check with your doctor first to be sure that it is right for you.
Try to become conscious of your posture while you are walking, standing, and sitting (especially if you spent a lot of time at a desk). Avoid platform or high-heeled shoes, and try sleeping on your side rather than your stomach. Remind yourself not to slouch whenever you think of it, and stretch often.
Maintaining a healthy weight is essential to a strong spine and flexible back muscles. Lumbar vertebrae are especially susceptible to weakness caused by excess weight. Try to eat balanced meals, and move your body for at least ten minutes a day. Even if you think it doesn’t make much of a difference, your body will notice.
All in all, through exercise, good posture, and weight control, we can reduce the likelihood of trauma to our spinal column. However, the aging process and risk of spinal injury can make anyone susceptible to a slipped disc. If you are experiencing symptoms, it is important to be seen by a medical professional as early as possible.
Quality of Life Is a Phone Call Away
There are several options for treating a bulging disc, including pain management, physical therapy, and surgery. It is important to have a candid conversation with a doctor to determine which option is best for you.
Our physicians are a team of highly trained experts in orthopedic conditions like bulging discs. We would love to answer your questions and welcome you as a new patient. Please call Plymouth Bay Orthopedic Associates, Inc. in Plymouth, MA today for a consultation.