Most people have heard of a disc bulge or herniation, as it is one of the most common injuries to the spine. It is commonly misunderstood as well. So, what is a disc bulge? And what exactly is a disc anyway?
Intervertebral discs are very unique and complex structures. Situated between each vertebra, the disc allows movement between adjacent vertebral bodies, helps absorb shock, and transmits loads through the spine. It is composed of a tough outer layer (annulus) and a gelatinous, highly-hydrated inner component (nucleus pulposus). While the nucleus pulposus redistributes applied loads, the annulus fibrosus acts as the primary load-bearing component of the disc.
As we age, the gross structure of a disc naturally changes as the nucleus pulposus dehydrates and becomes much more fibrotic. This change causes the nucleus pulposus to be much less able to redistribute pressure in comparison to its more hydrated state. These degenerative changes, in addition to excessive loads on the spine, can lead to tears in the annulus and subsequent migration of the nucleus pulposus. The term disc herniation is broadly defined as a localized or focal displacement of the nucleus pulposus beyond the limits of the annulus, which can lead to compression of spinal nerves.
There are several interesting statistics surrounding disc herniations. Although somewhat common (5-20 cases per 1000 people annually) and one of the largest contributors to neck and lower back pain in the community, studies have shown 60% to 90% of lumbar disc herniations can be successfully treated with a conservative approach. Furthermore, research shows a large percentage of patients with disc herniations identified by MRI are asymptomatic, and this percentage increases with age. There are countless studies showing that people can have disc bulges and be pain free, others can have pain without disc pathology, and some will improve despite their MRI findings remaining the same.
Another frequent question is: “Can a herniated disc heal on its own?” While an intervertebral disc itself is an avascular structure, studies have shown that disc herniations often undergo spontaneous regression, causing a significant reduction in the size of the bulge or a disappearance altogether. In fact, a study by Chui et al. in 2014 found that the higher the grade of disc herniation, the higher the rate of spontaneous regression. While the actual mechanism of how this happens is unclear, researchers believe it is due to the disc dehydrating and retracting in size as well as the body undergoing an anti-inflammatory process.
So where does PT come in? Physical therapy is most effective in the treatment of lower back and neck discomfort due to a disc herniation by desensitizing the body to painful movements. This is often achieved through a specific prescription of repeated movements, such as repeated back extension in standing or lying on your stomach (prone). When performing movements to end-range, large fiber proprioceptors can block the transmission of pain in the brain, helping reset one’s central nervous system. Repeated movements also help decrease the fear of movement (or the perceived threat of movement) as well as mobilize facet joints, reduce neural tension, and elevate the water content of discs.
If you or a loved one suspect a disc herniation, struggle with neck or lower back pain, or want to learn more, give us a call today at 757-578-2958. You can visit our website to book a PT evaluation. We’re here for you!
Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical rehabilitation, 29(2), 184-195.
Contributed By Dr. Kirkland Tucker, PT, DPT
Restorative Therapy Co
Comments