Low back: bulging and herniated discs

Early on in the cascade of spinal disease is the most famous of the spinal conditions; the dreaded "herniated disc". It tends to be the first severely painful condition that comes forth from a diseased spine. It also had the capability of cause irreversible nerve damage. It needs to be taken seriously. I will describe it in layman's terms.

Before the disc herniates, there usually is some quiet wear and tear and degradation of cartilagenous material, both with the disc and in the supportive fibers around the edges of the disc. This can happen slowly over years, and is sped up by tobacco use, bad genes, bad habits and physically abusing your back.

It manifests as back or leg pain, and it tends to be treated well with simple matters. Chemicals (drugs) can commonly reduce inflammation enough to make someone feel better. Spinal manipulation and realignment can decompress the disc, normalize the forces it is seeing and relieve much of the painful symptoms. Weight loss and physical therapy are highly beneficial. Spinal bracing can off-load some forces, restrict motion and provide pain relief.

You will hear words used to describe this point as "DDD" (degenerative disc disease), "dark disc disease" and "annular tears" of the disc. The overall alignment of the spine is typically maintained, as the so-called "tire" (disc) is usually only a little "low on air".

The moment of truth...this disc, which had been quietly aging inside your back, decides that it needs to shovel the driveway. Maybe the snowblower won't start. Maybe you bend over to pick up a toy off the floor. Maybe someone rear-ends you while you're stopped at the light.

Force turns into pressure, and the pressure pushes disc material towards the area of least resistance; that weakest spot in the annulus (sidewall of the disc) is now taken advantage of by the biomechanical forces applied to your spine. Commonly, this weak spot is behind the disc (posterior) and right next to the nerves running through your lumbar spine.

This weak spot can BULGE out. The metaphor is that of a "bubble" in the sidewall of your tire.

This weak spot can open up enough to let disc material HERNIATE out of the disc itself. The sidewall of your tire just blew out.

The common theme to both of the above events is the fact that there may now be a portion of the disc PHYSICALLY PRESSING BACK INTO THE NERVES. This is a distinct difference between the early stages of the disease process. What was once only chemical irritation is now both chemical and physical irritation on the surrounding nerves.

To be continued...