In order for the spine to perform optimally, it has to be able to maintain its natural curvatures and alignment, and the discs that sit between adjacent vertebrae play a role in that. While most bulging discs occur in the lower back, the neck can also be affected, and if left untreated, a bulging disc can progress to a herniated disc.
The intervertebral discs consist of two main parts, a gel-like interior nucleus and a durable and tough outer annulus. When the disc changes shape and bulges out at the sides, it can cause nerve compression. Treatment will be driven by causation and involve restoring disc health and function.
Exploring some basic spinal anatomy will help us get a better understanding of the spine and how the discs facilitate its optimal function.
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A healthy spine is naturally curved at each of the spine’s main sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).
The spine’s natural curvatures and alignment make it stronger, more flexible, and better able to absorb/distribute mechanical stress.
When a spine loses one or more of its healthy curves, its biomechanics are disrupted, and functional deficits can develop.
Intervertebral discs separate the vertebrae (bones of the spine), and these discs are an integral part of the spine’s ability to maintain its natural curves and alignment.
So what are the intervertebral discs, and what makes them so important?
The discs of the spine sit between adjacent vertebrae, providing the spine with structure as the vertebrae attach to them.
They also provide cushioning between vertebrae to prevent the generation of friction and increase wear and tear on the vertebrae.
While a single disc on its own can’t facilitate a wide range of spinal motion, when they combine forces, the discs can facilitate a range of spinal flexibility.
In addition, the discs act as shock absorbers, ensuring that stress from impact and movement is evenly distributed along the spine, so the integrity of each individual section is preserved.
As the spine and brain work in tandem to form the body’s central nervous system (CNS), the spine and its intervertebral discs also help protect the brain and important organs, which is why spinal conditions can cause a variety of symptoms felt throughout the body.
As the spine is one structure, the health of each curve and section is dependent upon the others.
So what about the structure of the discs themselves? What are they made of?
Intervertebral Disc Structure
As mentioned, the spinal discs have two main parts: a soft gel-like interior called the nucleus and a tough, durable outer layer called the annulus.
Both the inner nucleus and the outer annulus contain water, collagen, and proteoglycans (PGs), but the disc’s inner nucleus contains the most concentrated amount.
Collagen is known as the body’s glue. Holding its joints and structures together and keeping the discs hydrated is important because if a disc loses excess fluid, known as disc desiccation, it’s vulnerable to a variety of conditions, including degenerative disc disease.
The level of PGs is important because they attract and hold water, helping to maintain a consistent fluid level within the discs.
The challenge of maintaining optimal disc function is that they are the largest structures within the body without their own vascular supply; this means there is no direct path in and out of the discs for absorbing important oxygen/nutrients and eliminating waste.
Instead, the discs rely on a healthy blood supply along their margins, as by a process similar to osmosis, they absorb important nutrients needed for cellular repair and restoration from their surroundings.
When we’re born, the spinal discs are made up of approximately 80 percent water, but as we age, and particularly as natural age-related spinal degeneration comes into play, this level decreases over time.
In order to avoid disc desiccation (excessive fluid loss), staying hydrated and maintaining good circulation is key.
So what happens when a healthy disc becomes a bulging disc?
Partially due to the avascular nature of the intervertebral discs, and also due to the many important functions they perform, the discs are generally the first spinal structures to experience degenerative changes.
It’s also important to understand that disc degeneration doesn’t happen overnight; it takes place over time, and in addition to natural age-related spinal degeneration, certain lifestyle choices can exacerbate the rate of spinal deterioration.
Carrying excess weight, for example, puts excess strain on the back, and its individual structures, including the discs, and as the very design of the spine is based on movement, leading a sedentary lifestyle is in opposition to that, not to mention doesn’t facilitate good circulation: something essential to the health of the discs because of their avascular nature.
Chronic poor posture can also be damaging to the spine, particularly to the cervical spine, as modern issues like tech neck strain the neck, and its surrounding muscles, as they struggle to support the increasing weight of the head caused by the forward shift in posture.
In addition, repeatedly lifting heavy objects incorrectly can strain the spine and increase the risk of injury.
Smoking is another lifestyle choice that can have negative effects on the spinal discs because it doesn’t facilitate optimal hydration and actually contributes to disc desiccation.
When disc experiences degenerative changes, desiccation is often a factor, and as this involves the disc becoming dehydrated, it changes shape. Its inner nucleus pushes out against the annulus, which then bulges outwards around its perimeter (think of a marshmallow being squished between two cookies). Still, as this isn’t normal, the bulging disc is then encroaching on its surroundings.
As the bulging disc is introducing uneven pressure to its surroundings, this most often has a degree of nerve involvement, and nerve compression can cause a wide range of symptoms felt throughout the body.
A bulging disc can happen in any of the spinal sections, but the most common location is in the lumbar spine.
This is because the vertebrae and discs of the lower back have to support the weight of the spinal sections above, the trunk, and it’s the lumbar spine that feels the effects/strain of bending, twisting, and lifting.
In addition to the thoracic spine, a bulging disc can also develop in the cervical spine, and in addition to maintaining a healthy degree of cervical lordosis, the neck has the added responsibility of supporting the weight of the head.
As mentioned, the neck consists of the first seven vertebrae that start at the base of the skull and extend to the first vertebral body of the thoracic spine.
As mentioned, the cervical spine is in charge of facilitating a healthy degree of cervical lordosis, and this is the neck’s healthy curve that bends inward towards the body’s center.
When a disc is bulging, it can be asymptomatic, or it can produce a range of symptoms:
When a disc is bulging, there are a number of important patient/condition characteristics that will factor into how symptomatic the bulging disc will be.
Patient age and overall health, severity, location, and causation all factor into how a person experiences life with a bulging disc.
While each case is unique, when a disc is bulging in the neck, the aforementioned symptoms tend to be more confined to the upper body, just as a disc that’s bulging in the lower back is going to affect the lower body.
So what are the treatment options for a bulging disc in the neck?
Here at the Scoliosis Reduction Center, treatment is driven by a condition’s underlying cause, which is the difference between treating a symptom, or the condition itself.
When it comes to a bulging disc, I want to restore as much function as possible, prevent further damage, and address any related areas of spinal subluxation.
Once I have comprehensively assessed a bulging disc and determined its underlying cause, I can craft a customized treatment plan accordingly.
Through a conservative chiropractic-centered treatment approach, I integrate multiple condition-specific treatment modalities like chiropractic care, in-office therapy, and custom-prescribed home exercises.
I can also apply hot/cold therapy when beneficial for pain management, and as a chiropractor, I treat the spine in its entirety to improve its overall health, biomechanics, and function.
My assessment-diagnostic process can include orthopedic and neurological testing to gauge the level of reflex response, brain-body communication, muscle strength, and nerve sensation.
I can also tell a lot about a condition by a patient’s gait, balance, movement, and overall posture, and when necessary, I can order an X-ray to confirm a diagnosis and really see what’s going on in and around the spine.
I use a variety of chiropractic techniques to assess whether or not there are any areas of joint dysfunction or restricted movement along the spine, as this could account for the underlying disc degeneration, or be caused by it.
Through a variety of gentle/precise chiropractic adjustments, I can work towards repositioning vertebrae that are affected by the bulging disc. This takes the pressure off the disc structures, facilitating the nucleus's return to its central position inside the annulus, rather than projecting outwards, causing the bulge, and compressing nearby nerves.
A number of other techniques like flexion-distraction therapy and manipulation under anesthesia (MUA) can help to improve the health of the discs and their surroundings.
A variety of physical therapy exercises and stretches can also help increase core and spinal strength, so the pressure is taken off the discs, and improved circulation means the disc has much-needed oxygen/nutrients accessible in its surroundings.
Bulging disc symptoms & treatment will be case-specific and shaped by important patient/condition variables such as patient age, disc location, severity, and causation.
Once I have determined the underlying cause of the bulging disc, I can apply proactive treatment in an effort to preserve the disc’s function, and prevent further damage, such as disc herniation.
A herniated disc occurs when the bulging disc causes a tear in the outer annulus, through which the inner nucleus pushes through.
Here at the Scoliosis Reduction Center, I integrate multiple treatment disciplines such as chiropractic care, in-office therapy, and custom-prescribed home exercises to work towards preserving disc function, preventing further damage, and addressing any areas of spinal subluxation.
