Herniated and Bulging Disc: Diagnosis, causes and treatments

Herniated and bulging discs are the most common causes of lower back pain or sciatic nerve pain.

Most of the time, bulging and herniated discs occur on the last tract of the spine ( lumbar tract of the spine ).

Less common are bulging and herniated discs at the level of the cervical tract of the spine. 

Bulging and herniated discs at this level of the spine, are more dangerous than the ones at the level of the lumbar tract of the spine because they can compress more spinal nerves.

Definition of bulging and herniated disc

There are 4 stages of herniated nucleus pulposus of the disc:

  1. Bulging Disc
  2. Disc Protrusion ( Contained Herniation )
  3. Disc Extrusion ( Non-Contained Herniation )
  4. Disc Sequestration ( Sequestered Herniation )

A bulging disc is a medical condition less dangerous than a herniated disc. 

A bulging disc consists of a small disc protrusion into the spinal canal that results in a compression of spinal nerves.

A herniated disc ( Protrusion, Extrusion, Sequestration ) consists of a big protrusion or complete rupture of the intervertebral disc with few chances to return to its normal status by itself.

Spinal nerves compressed by the bulging or herniated disc irritate and cause pain or/and malfunction.

Diagnosis of Bulging and herniated disc Bulging

we can confirm the diagnosis of bulging and herniated discs mainly with two types of diagnostic methods:

  1. X-Ray 
  2. MRI Scan

X-Ray is less accurate than the MRI scan because we can assess only the vertebras of the spine. We could presume the possibility of a bulging or herniated disc by the reduction of the space between two vertebras. In fact, the reduction of the space between the two vertebras means that the intervertebral disc could be compressed or reduced in thickness.

MRI Scan is the elective diagnostic method as it assesses the soft tissues and bones. With MRI-Scan we can have a clear series of images about the structural condition of the intervertebral discs and vertebras. 

MRI Scan provides different views of the discs and vertebras, showing the entity of the protrusion.

MRI Scan can give the diagnosis if it is the case of a bulging or herniated disc.


Causes of Bulging and Herniated Disc

Generally, bulging discs are caused by mechanical stress on the vertebras that compress the disc, but sometimes by structural issues of the spine too, or both at the same time.

The most common causes of the bulging disc are:

A. Biomechanics causes:

  1. Overtraining of the lower back muscles.
  2. Inactivity ( weak muscles ).
  3. Long time in a sitting position ( Desk Job ).
  4. Exercise wrongly executed ( e.g. Dead Lift Exercise ).
  5. Lifting heavy weights.

B. Structural Modification of the Spine:

  1. Scoliosis.
  2. Kyphosis.
  3. Lordosis.
  4. Flat Spine.
  5. Osteoporosis of the spine.
  6. Osteoarthrosis of the spine.

Commonly, the cause of bulging or herniated discs is a combination of biomechanics and the structural issue of the spine. 

This happens because the structural modifications of the spine affect its Shock Absorber function of the load that acts on it.

The physiological curvatures of the spine act like a shock absorber of the forces that act on it. So modification of the spine’s curvatures reduces its capacity to contain and absorb the forces acting on the single vertebras that, receiving more load than usual conditions, can compress the intervertebral disc.

Herniated Disc L4-L5 (MRI Scan)
Herniated Disc L4-L5 (MRI Scan)

Treatment of Bulging or Herniated Disc

Bulging Disc Treatments

A bulging disc is a condition that generally can be treated and resolved without invasive treatment ( surgery or local injection ).

Bulging discs can be treated with a combination of hands-on treatments and exercises such as:

  1. Sports Massage
  2. Instruments Assisted Soft Tissue Manipulation ( IASTM )
  3. Spinal Decompression
  4. Physio exercises.

The sports therapist or physiotherapist, performing these sports therapies and physiotherapies, will aim to decompress the tract of the spine where is localized the bulging or herniated disc.

The sports therapist performing hands-on treatments will reduce muscle tension and improve mobility in the area of disc compression.

Physio exercises and active and passive stretching can reach improvement in muscle flexibility and joint mobility as well.

Strengthening exercises are useful when there is a muscle weakness that has contributed to the prolapse of the intervertebral disc.

Sometimes bulging disc can progress toward a herniated disc.

Herniated Disc Treatments

A herniated disc is a more serious medical condition and has, generally, more severe symptoms.

The most common herniated discs are the ones at the level of the last lumbar vertebras:

  1. Herniated Disc between L4-L5
  2. Herniated Disc between L5-S1


These two types of herniated discs cause a compression of the Sciatic Nerve with the typical symptom of shooting pain that runs down the leg.

Sciatic nerve pain can be caused by a bulging disc too, but generally with milder symptoms than the ones caused by a herniated disc.

Herniated discs can be treated with the same sports therapy and physiotherapies treatments of the bulging disc mentioned above. 

Of course, these treatments can be less effective than when there is a bulging disc.

Herniated discs very often need more invasive treatments depending on their entity and symptoms.

The most common invasive treatments for herniated discs are:

  1. Spinal Injection ( Epidural Steroid Injections ).
  2. Ozone Therapy ( Injection of Ozone in and around the herniated disc )
  3. Herniated Disc Discectomy.
  4. Spinal Fusion ( Vertebrae Fusion )

Whatever you have bulging or herniated discs, don’t go for self-therapy but seek the help of your trusted sports therapist or physiotherapist that can advise you with the best recovery plan.

The ideal back pain treatment aims to treat both the root causes and symptoms that have caused it.

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