Bulging Disc

By Emily Kolar, PT, DPT

Bulging Disc

Overview of a Bulging Disc

A bulging disc is a spinal condition affecting the intervertebral disc that is located between the spinal vertebrae. A common spinal diagnosis is a bulging disc, sometimes referred to as a slipped disc. If the disc is further injured, it may be described as a herniated disc, indicating more of the disc is involved. Bulging discs are classified by the direction the disc has bulged, for example, lumbar disc L4/5 posterior or posterior lateral. While imaging may reveal a bulging disc, an individual could be asymptomatic. A spinal segment consists of the intervertebral disc and facet joints. If the biomechanics are malfunctioning, an injury or dysfunction may occur within the spine, resulting in a bulging disc.

 

Anatomy and Physiology

The intervertebral discs are located throughout the spine (7)cervical, (12)thoracic, and (5)lumbar (1 sacral). The vertebral disc provides support and shock absorption throughout the spine while also allowing movement. Vertebral discs consist of an inside nucleus pulposus, outer rings annulus fibrous, and the cartilaginous endplate that connects the disc to the vertebrae. In biomechanics studies of the spine, the results show disc movements change with certain positional changes. When an injury occurs to the intervertebral disc, the disc may bulge, resulting in spinal dysfunction.  Therefore, this is important in the treatment aspect in physical therapy.

Signs and Symptoms

Symptoms will vary, and only a few may be present;

• Pain.
• Increased discomfort with certain positions; compression on the disc.
• Increased symptoms sitting vs. standing.
• Tender or hypersensitivity to touch.
• Swelling.
• Referred pain/symptoms down limbs arms or legs.
• Nerve pain or sciatic nerve symptoms.
• Altered dermatomes; skin sensation and myotomes; muscular weakness.
• Reflexes are diminished or absent.
• MEDICAL EMERGENCY: loss of bowel/bladder control or decreased sensation in the saddle region or genitals may indicate spinal cord involvement and require immediate medical attention.

Diagnosis of a Bulging Disc

Seek medical attention; contact primary care physician, urgent care, walk-in clinic, specialist, etc. An Individual will be screened utilizing various tests and measures to determine if a bulging disc is present.

• Evaluation.
• Imaging.
• Mechanism of Injury.
• Risk factors.
• Comorbidities.

Treatments for a Bulging Disc

After licensed professionals make a medical diagnosis, different steps can then be taken according to each individual’s condition and tissue healing stage. According to the tissue healing timeline, a bulged disc is typically treated in different phases; acute, sub-acute, chronic phases. Treatment methods are typically non-surgical for a bulged disc, but if the condition worsens or surgery is indicated, it may be an option in some cases.

Initial steps may include:

• Rest.
• Modalities; ice (24-48 hrs).
• Medications; steroids, anti-inflammatories.
• Behavior modification.
• Imaging.

The next steps include referral for physical therapy and orthopedic specialist who may prescribe the following:

• Therapeutic exercises.
• Postural interventions.
• McKenzie exercises
• Monitoring.
• Further imaging.
• Surgical vs. non-surgical interventions.

Maintenance

• Body mechanics.
• Postural Adjustments.
• Lifestyle changes.
• Spinal protection.

Rehabilitation

A variety of techniques will be used during rehab to address the individual’s injury. Physical therapy applies evidence-based knowledge and clinical practice guidelines to treat a spinal dysfunction of a bulging disc. Physical therapy has shown to be beneficial when treating a bulging disc by:

• Decreasing further injury.
• Alleviating signs and symptoms.
• Promoting proper tissue healing.

Therefore, physical therapists will use the following treatment methods:

• Patient education.
• Body mechanics.
• Postural interventions:
  • Manual intervention.
  • Therapeutic exercises.
  • Core Stabilization exercises.
  • Mechanical traction.
  • Mobilizations.
  • Home exercise program.
  • Maintenance.
• Therefore, to schedule for physical therapy at one of the 12 JOI Rehab Centers, please call 904-858-7045.

Related Articles and Videos: Robotic Spine Surgery at JOI, Low Back Pain & Lower Back Muscle Anatomy and Low Back Pain

JOI and JOI Rehab

JOI Physicians continue to offer online new patient appointments. This is another option to make it more convenient to make new patient appointments with less phone hold times. Follow the link below to select your JOI MD and schedule online.

Finally, you can still call 904-JOI-2000 to make new patient JOI Physician Appointments if that is your preference.

By: Emily Kolar, PT, DPT