Many new patients enter The Hart Wellness Center and say that they have bulging discs and that is the reason that they think have pain. Once people understand they have disc bulges they carry that subconsciously with them for the rest of their lives. Now, every time they feel an ache in their back it is because of those disc bulges right? While bulging discs can cause pain, they are not always the source of pain.
Let us start with first understanding what a disc is. An intervertebral disc is the cartilage cushion that separates your vertebrae (back bones). You have a total of 23 of these discs located from your neck to the bottom of your back. They act as shock absorbers for your spine so that your bones do not become overworked. As we age these shock absorbers begin to thin out due to the wear and tear we put on our body on a daily basis. This is natural aging that is completely normal. As these shock absorbers receive wear and tear our bones start to take on more force. This is one of the causes of arthritis. Our bones are overused and have to make up for our lack of ‘shock absorbers’.
As seen in the image above, quite a few things can happen to a disc. A bulging disc is when part of the disc is displaced backwards. If displaced far enough it turns into a herniation which is a common cause of low back pain or ‘sciatica.’ Disc bulges are minor changes seen with aging and overuse and can be present in many of the 23 total discs in our body. They are typically seen in the neck at the levels of C5-C6, C6-C7, and C7-T1. This is all in the lower area of your neck. They are not as common in the middle of your back and are prevalent in the low back at L4-L5 and L5-S1 which is down by our pelvis region.
The above statistics are from a research article in the American Journal of Neuroradiology. The main take away from this table is that starting at the age of 40, 50% or greater of those who are ASYMPTOMATIC have disc bulging. Next time you are at at the mall look at every 40+ year old person you see. At least half of them are walking around with a bulging disc and they are doing just fine. What this means is that having bulging discs is essentially normal. Tight muscles and joints that do not move properly are common in people 40+ and these could be other potential causes of pain. Just because an MRI reports says you have bulging discs does not mean that they are the reason your neck or back hurts. You can compare an MRI of 2 40 year olds; one who has low back pain and one that does not. It would not be out of the ordinary to see the healthy 40 year old have a worse looking MRI than the injured 40 year old. As a physician we are taught to treat the patient sitting directly in front of you, NOT the image (MRI, CT, X-Ray). If a patient has disc bulging on an MRI but have no pain at all…WHO CARES. The goal is to live your life pain free with or without disc bulges.