It's not uncommon in physiotherapy to have a patient come in, usually after an MRI, expressing a lot of concern over findings related to their spinal discs. Fortunately, and more often than not, it is never as bad as they think, and usually part of their session involves educating them on the situation and providing some peace of mind.
One reason for the unnecessary fear created by disc findings on MRIs is poor semantics. Even our choice of words, such as the term "slipped disc" can even make things sound much worse than they really are. Healthcare professionals do not always do the best when explaining these findings to patients, frequently confusing terminology, and inadvertently creating unnecessary fear, which in turn can negatively affect our perception of our body and sense of safety with movement and activity. This fear may cause more issues with pain and function than the disc issue itself. What if your disc issue really is more severe? In rare cases, surgery may be needed, but studies show that more serious disc injuries often actually reduce in size and heal better over time compared to the milder (and often asymptomatic) disc issues like a bulge or protrusion, likely due to an increased inflammatory response in the body. Note that not all inflammation is bad, as it plays an important role in tissue healing. As for the more minor disc issues, they still tend to do really well under the direction of a physiotherapist.
Before Reading On, the Most Important Thing You Should First Know
While these conditions may sound intimidating, remember that many people experience no symptoms from these disc issues, and often they're discovered incidentally during scans for other health concerns. In fact, in one study of people with no back pain, MRI revealed disc herniations in 20% of people under the age of 60. If you do have symptoms, they will vary depending on the location and size of the disc problem.
Remember, being diagnosed with a herniated disc does not mean that you're destined for surgery. Most cases can be managed with physiotherapy, which can help eliminate or reduce symptoms, improve mobility, strengthen your body, and promote good ergonomics to prevent further issues. I am always happy when I get to tell this to a concerned patient.
Your spine is strong, adaptable, and capable of healing, even in your later years. That said, every person and every spine is unique. Therefore, your treatment plan needs to be tailored to your specific needs and goals. This is why longer, one-on-one, and more detail-oriented physiotherapy sessions are where it’s at.
This guide will help you understand the differences between bulging, protruded, extruded, and sequestrated discs. We will focus on 'degenerative disc disease' in a later post.
Bulging Discs:
A bulging disc happens when the disc extends outside its usual location in the spine, pushing into the spinal canal. This bulging tends to occur in the disc's full circumference. It's important to note that a bulging disc is not the same as a herniated disc, and as mentioned, they are often asymptomatic, incidental findings on MRI. Research shows that only 13% of bulging discs will get smaller or improve over time, but worry not, these are the most easily managed disc issue.
Protruded Discs:
Protrusion is the next stage after bulging. When a disc protrudes, the outer layer of the disc (the annulus fibrosus) is still intact, but it bulges out where the layer is weakest. This is often caused by wear and tear or an injury that puts pressure on the disc, causing it to expand outwards. Research shows that 41% of protruded discs will get smaller if given time, and again, may not cause any symptoms at all, anyway.
Extruded Discs:
Extrusion occurs when the nucleus material of the disc pushes through the annulus fibrosus but still remains within the disc. It's like if the filling of a jelly doughnut squeezes out, but doesn't completely detach from the doughnut, but please do not think of your discs as being as delicate as a donut! Although initially quite painful and debilitating, up to 70% of extruded discs will improve and reduce in size as time goes on.
Sequestrated Discs:
A sequestrated disc is the most severe type of disc injury. This occurs when a piece of the nucleus material not only breaks through the annulus fibrosus but also separates (or sequestrates) from the main disc. As painful as this sounds, research shows that 96% of sequestrated discs improve and get smaller over time.
Need More Information?
This is just a short primer on understanding disc injuries, and by no means a comprehensive view of the topic. If you have any questions about these conditions and how they may be affected you, feel free to ask! Book an appointment today or get in touch by e-mail at mark@phyisobox.ca
Sources:
The probability of spontaneous regression of lumbar herniated disc: a systematic review, CC Chiu et al, Clinical Rehabilitation, 2015.
Systematic literature review of imaging features of spinal degeneration in asymptomatic populations, Brinjikji et al, American Journal of Neuroradiology, 2015.