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Bulging/ Herniated
Intervertebral Discs
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 By
Doug Wallace, PT, ATC. Doug
is the Director of Rehab at the West Caldwell Care Center, in West
Caldwell, NJ. He graduated from Stockton in 1995 with a BS in
Physical Therapy. He then took additional classes at William
Paterson University to get his ATC. |
| What is it? |
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.
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.
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| It hurts where? |
As the disc starts out bulging, a localized pain of the effected area
is the common symptom. As the bulge progresses, so will the
pain and resultant disability. If there is localized swelling
around the disc, the affected nerve roots will begin to express pain,
parasthesias and progressive weakness to their respective areas of
innervation. If herniation occurs, significant pain and disability
will occur, affecting the local area of the disc and the area innervated
by the nerve root.
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| 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.
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| Injury progression... |
Typically as the central nucleus of the disc begins to migrate, progressive
pain and resultant disability will occur. It is not uncommon
for someone to disregard this pain and discomfort and consider the
pain to be related to a sprain or strain of the back or neck.
But if left untreated, and the condition progresses, increased pain,
spasms, and disability will likely occur as the nerve root becomes
irritated, with numbness, tingling, and burning sensations likely
radiating over the effected dermatome, and progressive weakness being
experienced in the innervated muscles.
If the bulging nucleus continues beyond the confines of the surrounding
cartilage, this will lead to a partial or complete herniation, depending
on the amount of the nucleus that is pushed out. When this occurs
the symptoms will be similar to a bulging disc but substantially magnified,
with the parasthesias leading to possible compromised sensation and
the weakness progressing to possible paralysis.
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As can be expected, the ability to continue to participate in a sport
or activity is largely dependent on the severity of the symptoms and
the individuals personal ability to tolerate them. However it
is only logical that if the disc problem worsens to a point of weakness
and compromised sensation, it is likely that the person will not be
able to effectively perform, no matter how strong their will and pain
tolerance.
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| Similar Injuries |
Many injuries may be present at the same time as the disc pathology
and mask the underlying disc problem. A simple strain or sprain
of the local spinal soft tissue, damaged vertebrae, or growth on or
around a nerve root may imitate the disc herniation symptoms.
A shift in the normal bony alignment may also mimic the effects of
a disc problem by directly placing abnormal pressure on the nerves,
or indirectly from the inflammation caused from the stress on the
supporting soft tissue.
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| 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.
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| Participation Status |
Athletes who are in the initial stages of a bulging disc will likely
be able to continue playing and only be plagued by the initial symptoms
of pain, spasms, and the associated limited mobility. These
symptoms may actually become decreased or alleviated as the athlete
plays or practices due to the stretching of the soft tissue and interruption
of the pain/spasm cycle. These symptoms will likely prove to
limit the player’s participation individually as each person’s tolerance
to the symptoms. However if the warning signs are not heeded,
and treatment is not sought, it is likely the problem and symptoms
will worsen and eventually as the bulging disc/s advances, the symptoms
could become disabling to the athlete. If the condition continues
to worsen a complete herniation may occur, and the athlete will
likely need to seek physician intervention for medical management. |
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