Bulging Disk

Bulging And Herniated Disc

Bulging discs can be a disabling and potentially dangerous condition affecting athletes and active individuals alike. It is a condition which can be overlooked or misdiagnosed, but should not be taken lightly due to the possibility of serious consequences.

                                         Background Info    

Discs are sandwiched between the spinal vertebrae that make up the bones of the back. The disc can be compared to a jelly donut, whereas the jelly is the center of the disc, and is known as the nucleus pulposus. Surrounding the jelly is the donut portion, or the anulus fibrosus, which, as its name implies, is a series of interwoven fibrous rings, designed to contain the central portion of the disc. If the nucleus pulposus (or jelly) migrates away from the center, the annulus fibrosus will become deformed and bulge. Continued bulging of the disc may result in a partial or complete herniation, whereas the jelly is squeezed out of the donut. Depending on how much of the nucleus pulposus is displaced determines if is a partial or complete herniation. The chemical makeup of the nucleus is aggravating to the surrounding structures, including muscles, ligaments, blood vessels and nerve endings, and when the disc herniation irritates these structures pain, spasms, swelling, weakness, paresthesia or even paralysis may be caused.

HOW DOES IT HAPPEN ?

As with many injuries, there can be multiple culprits to a herniated disc. Chronic multiple microtraumas or a macrotrauma may cause the onset of the condition. Factors that may expose someone to higher risk to develop a disc problem include posture, physical condition, anatomic structure and alignment, congenital conditions, and preexisting/coexisting injuries.  For example, a baseball catcher or football lineman may have muscular imbalances and poor posture, which increase the risk of developing a herniated disc.  This may be compounded by multiple microtraumas such as bending, pushing, or twisting inherent in their position; or a sudden macrotrauma such as getting hit while protecting home plate or having to take on an unexpected double team block. In these instances the individual may be predisposed to a disc injury, and by experiencing chronic repeated stressors or a single significant episode, the forces may push the disc beyond the limits of the surrounding cartilage to cause a disc herniation.

   TREATMENT

The treatment focus is on centralizing the bulging nucleus back into the disc (which is usually only possible for bulging discs due to the difficulty with getting the jelly back into the center of the donut, after it has been squeezed out). Initial management of any pain or spasm that may coexist may be treated by modalities including ice, heat, ultrasound, electrical stimulation or massage, or a host of other common methods. As the pain is managed and begins subsiding, treatment focus will shift to the core of the problem. This will include specific exercises to assist in centralizing the disc: spinal extension exercises are indicated with posterior bulging discs; spinal flexion exercises for anterior bulging discs. Together with a calculated stretching regimen, postural management, and core trunk strengthening and stabilization exercises (to improve endurance, strength and power); successful management of the problem can be achieved. Some individuals may require spinal manipulation or mobilization techniques, deep soft tissue mobilization, neural stretching, or various other interventions by trained personnel for successful results. The intervention of a physician or orthopedic surgeon may also be necessary, particularly if the disc is herniated. However, if the bulging disc is detected early enough and properly treated, successful long-term results are highly likely.