Herniated or bulging disc
I have been told I have a disc bulge. What does that mean?
Disc bulges are common, often in people with no pain at all. When they do cause symptoms, most people improve with activity and exercise.
What it feels like
Low back pain, and sometimes leg pain, tingling or numbness if a nerve root is irritated. Symptoms are often worse with sitting, bending, lifting, coughing or sneezing.
What is actually happening
The discs between the vertebrae change with age, and bulges and herniations are frequently found on scans of people with no back pain at all, so a scan report on its own does not explain pain. When a herniation irritates a nerve root it can cause sciatica. Herniated disc material can shrink over time, and many people improve with conservative care.
When to see a doctor urgently
Go to an emergency department straight away if you have numbness around the groin, genitals or inner thighs, new difficulty passing urine or controlling your bladder or bowel, or leg weakness that is getting worse.
How it is assessed
Assessment focuses on your symptoms and how they behave, movement testing, and a neurological examination where there are leg symptoms, rather than on the scan alone. It screens for the warning signs above.
How it is treated
The NICE guideline on low back pain and sciatica suggests considering an exercise programme suited to your needs, manual therapy only as part of a package that includes exercise, and support to stay active and at work. Treatment includes movements and positions that ease symptoms, progressive strengthening, and a graded return to sitting, lifting and sport. If symptoms are severe or not improving, I write to your family doctor, who can arrange a surgical opinion if it is needed.
What to do first
Keep moving within comfort, walk regularly and avoid bed rest. Try not to let a scan report make you fearful of movement; have it assessed and get a clear explanation of what it means for you.
Where this is assessed
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 2:00 PM Book at Athlete's Care
- Push Pounds Sports Medicine Downtown Toronto · Tue/Thu · 8:30 AM – 6:30 PM Call Push Pounds to book
- Country Lane Physio Home office & virtual · Sat · By appointment only Message me to book
References
This page is based on the following clinical practice guidelines and research.
- National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. 2016, updated 2020.
- Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-7.
- George SZ, Fritz JM, Silfies SP, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60.