Bulging discs are painful and can be caused by misalignments of the spine, wear and tear, and trauma. Chiropractic adjustments can realign the spine and alleviate the pressure on the disc.
What is a bulging disc and in what way is it different than a herniated disc?
Dr. Gregg Rubinstein: That’s a really good question, Liz. You always ask the good ones. That’s one of the terms that has been confusing people for a long time. There is a pretty simple differentiation but for most people, your average lay person, they don’t really make a big differentiation, but it is quite useful to know as a treating physician, it helps give some clarity.
The primary difference between a bulging disc and a herniated disc is when you have a bulging disc, it will bulge equally in all directions. For example, if I took a balloon and put it between my two hands and I pushed my hands closer together, the balloon is going to bulge equally around my hands. It will bulge out in all directions. Now, a disc can do that because there are fibers that hold it in place and sometimes they can get stretched and the disc starts to bulge beyond its normal physical imprint, right? It has like its own footprint in the spine but if it blows up beyond that, the space that it starts to occupy is typically where we see the neural tissues, in particular, the spinal cord and the spinal nerves as they are exiting from the spine, so anything that takes up in space from the neural tissues will take away head room or space and leave them more likely to get irritated.
Now, the difference on the flip side is the herniated disc. Now, a herniated disc will only herniate or push out beyond its endplate in a very specific direction. Now, if it goes straight back, it will impinge upon the spinal cord. If it goes posterior or lateral, then it’s going to hit the nerve root or where the nerve is coming off the spinal cord and going out to the body. The herniated discs tend to be the result of an injury to the fibers that hold the disc in place, where they actually tear and then this material herniates or pushes out through and very often can irritate the neural structures. It is kind of a subtle difference, but if, for our listeners out there, I think it’s better for them to understand that a bulge is just a general bulge. A herniation goes in a very specific direction and more often will result in impinging on neural structures and causing symptoms or symptomatology.
What are some causes of bulging discs?
Dr. Gregg Rubinstein: There are a lot of things that can cause discs to bulge. Typically, uneven pressure on the discs caused by misalignments, or what chiropractors call subluxations, is quite commonly cited as a reason for a disc to bulge. If they’re used very hard, the fibers that hold the disc in place can stretch out and then the disc will bulge in all directions. If they’re truly stressed hard and fibers actually tear inside the disc, then you can see that disc herniation scenario where it goes out in the specific direction where those fibers actually failed specifically, but it could be from blunt force trauma of someone ice skating falls directly on their butt, that could be enough pressure to rupture those fibers and cause the disc to herniate or bulge.
Disc injuries can happen slowly over time from just excessive wear and tear. If someone is loading heavy material into trucks day after day and unloading trucks or sitting for long periods of time in awkward positions, construction workers who might be carrying heavy materials like roof shingles up ladders all day long, overuse. Those are the things that contribute to the disc bulge or the disc herniations, but most commonly with the herniations, it more commonly associated with some type of trauma, whether it be repetitive microtrauma or a single one more significant trauma.
How does someone know they have a bulging disc? What are the symptoms?
Dr. Gregg Rubinstein: Well, bulging discs and herniated discs, I use an expression that I heard. I don’t even remember where I heard it, but the expression is “The map is not the territory.” Sometimes you can look at a map and then when you’re actually in the area of the map and you’re looking around, it doesn’t look anything like the map, so some people can actually have herniated discs or bulging discs and be totally asymptomatic, not have any pain at all, but pain is often an indicator that most people use to determine if their health is less than ideal. It’s not the only indicator, having pain, but if you’re having back pain then there’s a chance that the disc can be either bulging or herniated, so it can be a precursor to problems that are yet to come. Again, honestly, the best way to maintain your spine is to maintain it in a healthy manner throughout the course of your lifetime, not waiting for these problems to happen, so if you get the spine checked and make sure it’s in good alignment, again, less stress on the disc, less likely to see it.
When we have herniated discs that are more significant and are producing a lot of pain, the typical pain pattern you’ll see will be pain, often stronger on one side than the other in the lower spine. Then radiation of that pain through the buttocks, into the leg and then we call it something called paresthesias, which would be distal, so you’ll have pain close to the site and then you’ll have numbness, tingling maybe in the knee or in the foot, so farther down the line, so we can see that in severe cases. We can see weakness, we can see muscle spasm, local tenderness, but the really only surefire way to guarantee that you’ve diagnosed a disc, whether it’s bulging or herniated is to do x-rays, MRIs or some study like that, but truly, the MRI is the definitive study to determine how healthy the soft tissues of the discs are in the spine.
What chiropractic treatments help correct bulging discs?
Dr. Gregg Rubinstein: Well, obviously, if someone has already gotten to the point where they have bulging or disc herniations, you’re going to start off doing your corrective adjustments to realign everything and equalize the pressure on the disc. If you can open up the spine and stretch it out and create negative pressure, sometimes even some of that disc material can actually, it can create a vacuum and that can suck back in, into the disc itself, but maintaining proper alignment and keeping even pressure on the disc is what’s going to make sure that the disc doesn’t bulge or continue to degenerate and eventually herniate.
The fiber, again, if you think about it, it’s kind of like a water balloon inside that fishnet stocking. If there’s even pressure pressing down all across the water balloon, it should sit right at the center, but if there’s more pressure on the right than on the left, then obviously it’s going to bulge out on one side and then we need to maintain proper alignment. The chiropractic adjustment helps realign the vertebrae, get the pressure off the discs, even everything out, line it all up right and then get the irritation off the nerves which then allows the body to heal slowly, as the body repairs and replaces the damaged cells with healthy new ones.
Are there exercises people can do on their own to help keep discs in place?
Dr. Gregg Rubinstein: Absolutely. There’s a lot of general exercises and specific exercises which help re-hydrate and invigorate the discs. One of the things that’s interesting is the disc’s ability to stay hydrated is directly dependent on how much pressure is on the disc and that’s why, I don’t know if you’ve ever heard this, but when you go down to sleep, when you wake up in the morning, you’re actually like a half to three quarters of an inch taller, because when you’re not weight bearing, the disc’s ability to pull more water in is increased so that the discs hydrate in the overnight and you’re actually taller in the morning. If you can eliminate pressure on the disc itself, they’ll pull in more water and they’ll actually be healthier. Those are the things that are truly important but there are specific exercises for people with herniated discs, if the disc is herniated towards the back, then they’ll want to do flexion exercises. If it’s moving more towards the front then they’ll want to do extension exercises and that’s truly where your chiropractor or physical therapist is truly going to advise you on which exercises are going to be best.
Again, going back to what I said earlier is that when you move and you exercise, you actually make the joints healthier, because you’re storing up the synovial fluid. You’re increasing the amount of blood flow and nutrients to the area, which again, will keep the discs healthier and stop them from degenerating faster, so exercise is a huge part of it, but it’s a little bit, there’s no one specific exercise for all disc patients. You want to make sure that they’re doing regular exercise to keep healthy and then if they have a specific direction, there is some experimentation to figure out which exercises are going to be the best for that particular disc patient.
To speak with Dr. Gregg Rubinstein, visit www.ChiropractorMidtown.com or call 917-534-6484 to schedule an appointment