A bulged disc occurs as a result of an injury. The original damage often occurred years prior to the symptom of back pain arriving. The problem with this injury is that discs are made of cartilage and cartilage more often than not, breaks down, as a result of mechanical stress, faster than we can repair it. Unless that is we go to a lot of trouble but even then total repair is difficult. The symptoms of a disc bulge can vary from a mild ache to an excruciatingly severe pain radiating along nerves - such as down a leg or into the hips. The bulge, just like symptoms, can come and go depending on the positional stresses being applied to the disc tissue and the subluxation (misalignment ) present at the spinal level involved.
That being the case, it makes sense to look after the disc as much as possible to prevent a recurrence.
The main sign of a problem, which most people can easily recognize is pain. Pain is usually not present at the time of the original injury. It most commonly comes on as a result of many years of disc cartilage wear and tear.
Pain relating to disc bulges occurs only when the disc tears enough to not be able to retain the jelly mass the nerve tissues (the spinal cord or spinal nerves as they exit from the spine), the jelly displaces the remaining rings of the cartilage of the disc, which then presses on the nerves. This often results in pain being felt. The tearing process itself may have progressed slowly over many years without any signs of discomfort.
Often what happens at the same time as the disc bulge, is a posterior displacement
of a vertebra (Retrolisthesis). A study has shown there is a 100% occurrence of
retrolisthesis displacement of the spine at the level of a disc bulge. (1) This points to a high probability of benefits from chiropractic adjustments for pain relief. The limiting factor in this situation is the degree of tearing of the disc cartilage and the degree of retraining the patient is willing to undergo so as to add stability through re-educated usage patterns (lifestyle).
This also points to the fact that the patient plays a major part in preventing the
recurrence of the disc bulge, further injury and any repair.
What to do now that you know you have a disc problem.?
Since nerve tissue is at the back of the disc, it is important that the jelly mass is not
given an opportunity to migrate backward towards the nerves.
1. For this reason bending forward or sitting slumped is your enemy from now
on. Bending backward or rotating is usually OK.
2 It is important to have your spine adjusted for at least 6 weeks to give
your spine the best opportunity to heal optimally (while aligned and
mobile). This works best with fresh injuries.
3 It is good to go for a 20 minute walk twice each day (2)
4 Immediately follow each walk with 30 to 90 minute rest lying down.
5 Make sure that you have the right nutrients to assist with repairs
A small study has shown that doing nothing will eventually result in the resolution of "Pain". If that is the only outcome people are after then that is the end of it usually at the end of 18 months to 2 years people with disc bulges will be out of pain.
"Conservative management [no surgery] gives satisfactory results in a high proportion of patients with disc herniation in the course of a few months of treatment onset." (5) [comment added]
However - that is NOT the only issue to be aware of here. Abnormal pressure on a disc that is bulged and a vertebra that is badly positioned and stuck in that position for 1 week or more will show the early signs of disc degeration (6) and 2 weeks or more for joint deterioration. (7)(8) These deteriorations get worse as time passes and may become permanent as time is prolonged. These situations may be either with or without pain (6)
Since the disc is one of the soft tissue structures to provide joint stability, if it is further damaged, then in spite of the fact that our "do nothing" person is gradually getting out of pain, the spine at the level of "stuckedness" is still progressively becoming more unstable. Not a good idea!
Manipulation (chiropractic adjustment) of the spine is one of the "conservative" recommendations for the care and resolution of low back pain. (8)
Pain is a sign to a person that all is not well. If pain either comes on, or gets worse from making some particular movement, that is a sign that more damage may be happening as a result of the movement or abnormal pressure being applied.
Pain is NOT BAD. Pain is essential to prevent further damage. It is your warning to get something done about what is causing the pain. It is NOT a sign that your need to turn off the alarm that has just given you a good warning signal.
Some relief from pain will certainly give you greater comfort. It is NOT a good idea to totally turn off pain. Knocking the pain down to "liveable levels" is probably the way to go, which can be done by a range of over the counter analgesics (pain dampeners).
Non-steroidal antiinflammatories (NSAIDS)
Inflammation is one of the signals to the body that a repair needs to take place. By taking NSAIDS you are taking away that repair signal.
Is that a good idea?
I personally think not.
NSAIDS while handed out many times without a second thought by medical folks, patients need to keep in mind that they are not without their dangers.
Most common drugs prescribed.
NSAIDS (old & new) cause bleeding ulcers and cardiovascular “events”.(9)
Newer NSAIDS had a 4 to 5 fold increase of myocardial infarction compared to the older NSAIDS.(9)
Study on rats: After 14 days of “Celebrex” there was 32% less resistance to tension in ligaments; energy absorbed to failure was 41% less than if “Celebrex” was not given. (10)
Women taking NSAIDS 22 days per month had 86% increased risk of hypertension. “a substantial proportion of hypertension in the United States, and the associated morbidity and mortality". (11)
NSAIDS cause gastric ulcers and bleeding (12)
NSAIDs should be used only in patients who do not respond to other analgesics; the lowest possible doses should be used; and the least toxic NSAIDs should be selected. (12)
"The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain.(13)
1 L.G.F. Giles; R. Muller; and G.J. Winter; "Lumbosacral disc bulge or
protrusion suggested by lateral lumbosacral plain x-ray film";
Journal of Bone and Joint Surgery - British Volume,Vol 88-B, Issue
2 Ressell OJ, DC; “Disc regeneration is possible in spinal osteoarthritis”;
ICA Review of Chiropractic Mar-Apr 1989
4 Wallach DV Sc ND; "Dead Doctors Don’t Lie" (Audio)
5 Postacchini, Franco MD "Results of Surgery Compared With Conservative
Management for Lumbar Disc Herniations" Spine: 1 June 1996 - Volume 21 - Issue 11 - pp 1383-1387
6 Nelson C, DC,: Top Clin Chiro 1994;1(4):20-29
7 Seaman DC, MS DABCN,: JMPT 1999;22(7):460
9 Wiesel, MD:”Are drug companies shading the truth about Cox-2 inhibitors?"
10 Elder, MD: Am J Sports Med 2001; 29(6): 801-5
11 Archives of Internal Medicine Oct 28, 2002, 162:2204-8
12 "Risks of bleeding peptic ulcer associated with individual non-steroidal anti
inflammatory drugs." Lancet. 1994 Apr 30;343(8905):1075-8.
13 Dabbs et al "A risk assessment of cervical manipulation vs. NSAIDs for the
treatment of neck pain." http://www.ncbi.nlm.nih.gov/pubmed/8583176