Care Plan
First steps to consider
- Mild to moderate symptoms—like back pain, some leg pain, and numbness and tingling in your leg—can often be treated at home.
- Try changing your activities, resting, and taking ibuprofen (Advil) for 1–2 weeks.
When you may need a provider
- Severe back pain that does not start to get better after a few days of bed rest and NSAIDs.
- Symptoms don't improve after 6–8 weeks.
Emergency Care
Call 911 or go to the ER if you have any of the following symptoms:
- Loss of bowel or bladder control
- Difficulty walking
- Numbness around your inner thighs
The spine is made up of bony vertebrae and flat, rubbery discs that act as cushioning shock absorbers when the spine moves and bends. Each disc consists of a rubbery outer ring and a softer, gel-like inside.
Bulging discs (also called slipped discs) happen when the tough outer ring is weakened, and the inner gel material squirts out. The bulge can press on nerves, causing pain, tingling, or numbness in your legs or arms.
The most common place to have a bulging disc is at the very bottom of the spine (where it meets the tailbone). Bulging discs can also happen in the neck.
Dr. Rx
Back pain and back problems are incredibly common. It is estimated that at least 90% of people will experience some type of back or neck problem in their lifetime. —Dr. Ben Schwartz
Bulging discs can be small and cause no to minimal symptoms or can be large (called a herniated disc). Large bulges can place pressure on the spinal cord or on the nerves that run off the spinal cord and into the arms and legs.
A bulging disc usually improves with rest, ice, and taking pain medications. But, in some cases, bulging of a disc can worsen and become a herniated disc.
Symptoms
You may get numbness or tingling in the arms or legs, depending on which discs are affected. In some cases, you may have weakness in the muscles.
While the bulges occur in the back or neck, you may not have pain directly in those areas.
Pain from disc bulges often shoots from the back into the buttocks, thigh, lower leg, or even as far down as the foot. Pain from a disc bulge in the neck shoots into the arm.
Sometimes a bulging disc doesn't cause any symptoms. Symptoms usually occur if the bulge is big enough to put pressure on the spinal cord or nerves that run into the arms and legs.
Pro Tip
Many patients are surprised to learn that, even though they don’t have neck or back pain, that’s where the problem starts. The bulges place pressure on nerves as they run off of the spinal cord and into the arm or leg. —Dr. Schwartz
Main symptoms
- Numbness or tingling in the arm or leg
- Arm or leg weakness
- Pain that shoots into the arm or leg
Other symptoms you may have
- Back or neck pain
- Loss of bowel or bladder control
- Numbness in the groin (called saddle anesthesia)
Bulging disc in the neck
Bulging discs can also happen at the top of your spinal cord in the neck. They can cause neck pain but they more commonly cause nerve pain that shoots into the arm. The pain is usually a lightning or burning sensation and reaches all the way down to the fingers.
Some people feel stiffness in their neck muscles or shooting pain when twisting or bending the neck. The risk of bulging discs in the neck increases as we get older. Certain jobs that require a lot of overhead work and looking up may increase the risk of neck disc problems.
Causes
Bulging discs can develop if you use poor technique when lifting heavy objects. This can place excess stress on the disc and cause the gel material to squirt out.
Disc bulges are also a common part of the normal aging process. As we get older, water can leak out of the discs and cause them to flatten and bulge. The discs can also become more brittle or weaker as we age and more likely to tear or weaken.
In rare cases, sudden pressure can cause the gel material to burst through a weakened part of the disc and lead to bulges. Smoking is thought to damage the blood flow to the discs which can also cause weakening that increases the risk of bulging.
Risk factors
- Using poor body mechanics when lifting
- Smoking
- Excess body weight
- Age
- Repetitive lifting, pushing, pulling, twisting, and bending
Preventative tips
- Use proper lifting technique
- Stop smoking
- Avoid repetitive lifting, pushing, pulling, twisting, and bending
- Keep the core muscles strong
- Maintain a healthy weight
Pro Tip
Another thing to keep in mind is that disc bulges often don’t cause any symptoms. One study showed that many patients without symptoms have evidence of disc bulging on MRI tests. —Dr. Schwartz
When to call the doctor
Most people start to feel relief when avoiding activities or motions that cause the pain, and taking anti-inflammatory medications such as NSAIDs, and ice or heat.
Contact your doctor if you have severe pain or weakness that makes it difficult to walk, put weight on the arm or leg, or move your neck. Disc bulges are usually treated by orthopedic or neurosurgical spine specialists. Special tests such as an MRI may be needed in cases of extreme weakness or if the symptoms do not improve after 4 to 6 weeks of rest and at-home treatment.
Bulging discs usually do not require emergency treatment. But in rare cases, large disc bulges can place severe pressure on the spinal cord. This pressure can cause a problem called “cauda equina” syndrome, which is an emergency.
Symptoms of cauda equina syndrome include difficulty walking, numbness in the groin, and loss of bowel or bladder control. Cauda equina syndrome requires emergency surgery.
Treatment
Most bulging discs heal on their own with at-home therapies. This includes rest, avoiding activities like lifting and bending, regular use of NSAIDs, and applying ice or heat. In many cases, symptoms improve after 3 to 7 days, although it may take longer for symptoms to go away completely (up to 6 to 12 weeks).
Although the pain can be intense at first and numbness or weakness can be worrisome, these symptoms usually improve without the need for medical treatment like surgery. Your doctor may recommend physical therapy if your pain isn’t that bad. A physical therapist will focus on strengthening your core (abdominal, low back, and hip muscles).
For severe symptoms, a short course of oral steroid pills can help reduce inflammation. Occasionally, steroid injections in the back may be recommended to reduce inflammation around the nerves.
Medication
- NSAIDs—over-the-counter ibuprofen (Advil), naproxen (Aleve), or prescription versions
- Prescription oral steroids—prednisone, Medrol
- Muscle relaxers—used for short period of time for spasm
Surgery
Surgery for disc herniation is rarely required but may be recommended when pain has not improved after about 6 weeks of non-surgical treatment or if there is severe weakness.
Disc herniation surgery involves removing the bulging area of disc to remove pressure from the nerves and spinal cord (called a discectomy).
Emergency surgery is needed if diagnosed with cauda equina, a rare situation. The bulging disc is removed to relieve pressure on the spinal cord. Most patients feel better once the pressure has been relieved from the nerve. However, it can take weeks to months for all of the symptoms (including weakness) to go away.
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If you’ve had a disc bulge, follow up with your doctor in 4 to 6 weeks, unless symptoms are not improving or have worsened. Do not wait to contact your doctor if symptoms are getting worse, including progressive weakness or increasing pain or numbness. Though it can take 6 to 12 weeks for symptoms to completely go away.
Follow up after surgery typically occurs 2 weeks after the procedure to make sure the incision is healing as expected and to make sure symptoms are improving.
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