5 Low Back Disc Bulge Facts You Must Know

Back pain is one of the most common musculoskeletal conditions Australians experience in their lifetimes and can unfortunately lead to chronic pain or disability if not managed correctly.

When a lower back issue ‘flares up’ every movement can hurt, it’s hard to get comfortable or get to sleep, you are tired and it can cause great worry or anxiety. We understand it is a very frustrating and confusing time. Read our 10 Helpful Facts for Low Back Pain to gain control of your condition.

As physiotherapists, we see this type of presentation extremely regularly and some common client questions/statements we hear are:

• Is my back damaged?

• I’ve been told I have a bulging disc.

• Is my disc bulge permanent?

• My disc is out, can you just put it back in?

• My MRI from 5 years ago shows a disc bulge at L4/L5.

When someone presents with such questions, we as physiotherapists have a responsibility to listen, reassure, and educate the client with exactly what is happening and give a realistic prognosis of recovery. This is why using evidence-based facts are critical.

Fact 1: Lumbar intervertebral discs are STRONG!

The disc of the lumbar spine consists of a jelly like substance in the centre with a stronger, fibrous ring surrounding it. Above and below the disc is the vertebral body bones.

When you carry out daily activities such as staircase walking, lifting a weight from the floor, and moving a weight forward in front of your body, forces of up to 170kg are placed on the lower spine and discs. The lumbar spine is designed to tolerate load. ^

Interestingly, running exercise, which places large amounts of force through the lower back and legs has been found to strengthen, and increase size of the lumbar discs. $

Fact 2: Most disc bulges in the lower back are normal and age-related.

A disc bulge most commonly occurs with normal age-related changes after the age of 20 years old. Here the discs don’t hold as much water, losing height, which can impact the flexibility of the spine.

Less common causes are from a single lifting effort of something heavy and repetitive lighter lifting when you aren’t strong enough, or spending a lot of your waking life in sitting positions (a topic for another day). It is very important to highlight that increased age doesn’t increase the likelihood you will experience low back pain.

Fact 3: Pain doesn’t always equal damage.

Low back pain and other musculoskeletal pain is often caused by increasing load too quickly through the lower spine for example gardening for an entire weekend when you aren’t used to it, spending 50% more time at the desk, or going a little bit too heavy with deadlifts at the gym.

The pain felt because of this is a message from your brain causing chemical irritation in the lower spine to protect itself and in most cases does a very good job. This pain sensation doesn’t indicate you have caused damage at that moment.

Other factors such as diet, sleep, fatigue and stress can play a part in amplifying the sensations of pain through the increase in the hormone cortisol. These factors also lower the threshold for pain to be felt anywhere in the body.

Fact 4: MRI findings of lower back disc bulge DO NOT predict pain and pathology.

For years, many people that have suffered similar back issues, had MRI’s, and been told they have a permanent disc protrusion may have been given incorrect or outdated information.

Research from 2014 has found that clinicians should not use MRI to make a final diagnosis for lumbar spine pain. This is because there is no association found between pain and disability and the MRI findings (even those without pain had disc protrusions on the MRI!). *

The use of MRI with lower back pain has historically produced many unrelated false alarms to health professionals which could shape the clients’ beliefs that could have negative long- term effects.

Fact 5: Lower back disc bulges can heal and reduce in size on their own!

In a review of studies from 2017# of people with disc protrusion findings on MRI, they found that 2/3 or 66.66% spontaneously heal and reduce gradually on their own. Some even recovered on MRI within three months and not years like many people expect.

Unfortunately, there is no way a disc can be physically “put back in place” from a single “magic” technique. What we can do is treat the symptoms to reduce pain, improve load tolerance and movement patterns with exercise, gradually return to normal activities, and change the habits or contributing factors that may have caused the issue.

It is vitally important for people to be accurately informed of the current research and clinical guidelines to get a realistic view of their condition with the appropriate support, guidance, and expertise for each individuals’ unique journey.

References:

^ ncbi.nlm.nih.gov/pmc/articles/PMC4035320/

$ https://www.nature.com/articles/srep45975

* ijmhr.org/ijpr_articles_vol2_2/IJPR-2014-608.pdf

# ncbi.nlm.nih.gov/pubmed/28072796