Dr. Jeff Langmaid explains that a bulge is the disc pushing outside its normal boundary, while a herniation is the nucleus pulposus breaking through the annulus fibrosus. Many people over 50-60 have bulges or herniations without any pain. Symptoms only happen when disc material compresses spinal nerves, causing electric pain, numbness, or weakness.
Hi, my name is Dr. Jeff Langmaid and today I want to discuss the difference between a bulged and a herniated disc. If you've suffered from back pain and had an mri, maybe you've seen a chiropractor, a medical doctor, or a doctor of osteopathy, you may have heard that you have a bulging or herniated disc and that can be scary. We're going to talk a little bit about the anatomy, what the difference is, what it means, why you don't need to be scared, and even some things you can do to get on the road to recovery. So one thing that I've been asked hundreds of times by many, many patients is every time I have a bulge or a herniated disc, does it cause pain? The answer to that is no. You can have bulge and herniated discs and not have pain. As a matter of fact, most people walking around above 50 or 60 years old have multiple bulged or multiple herniated discs causing no pain whatsoever. So why do some cause pain? Quite often it's because that disc has touched upon the nerve. When the disc touches on the nerve, just like an electric current, it is going to light you up and let you know about it. And we'll talk about that in a moment. But first, let's look at a little bit of the anatomy of the spine so you can better understand what the difference is between a bulged and a herniated disc. This is a model or an example of your spine. Here are the front of your bones or vertebra, and in between resides the disc. The disc acts as a cushion in between the bones of your spine and it allows a variety of movements. Flexion, which is forward bending, extension, which is backward bending, and of course it allows rotation as well. So, so we have the front of the bones here and the disc in between. But running down the backside in this hole is perhaps the most important area. And out the sides, and those are your spinal nerves. Between every segment of your spine and behind every disc runs out the left and the right side, a set of spinal nerves. In your neck, these nerves run down into your shoulders, your arms and your hands. In your low back, these nerves run down into your buttocks, your hips and your legs, and of course your mid back or your thoracic spine. They come right around your chest cavity there, as you can probably already start to imagine. This is why if a nerve in your low back is aggravated, just like a telephone line going out to a different customer, the pain travels along that line. So an irritated Nerve in your low back can go right down into your buttocks, your hip, your leg, your foot, or your ankle, depending upon which specific level it is in your neck. The same thing holds true depending upon which level that irritation or that compression is happening. Depends upon which area of your arm shoulder may hurt. It also could be numbness and tingling. Those are the hallmarks of nerve pain. Electric like shocking pain and numbness, tingling. Some people even have a bit of weakness. But getting back to our original question, what's the difference between a bulge and a herniated disc? Well, a bulge disc is when the disc has pushed outside of the area it's supposed to be. That means the disc has pushed out from being directly underneath the bones. It's supposed to sit directly underneath those bones. But if it starts to have a hump on the front side or the backside, we often call that a bulge disc. Now, again, sometimes that bulge may be enough. It might have pushed out far enough to irritate and aggravate a nerve. At that point, you're going to feel pain. But that nerve also, or excuse me, that disc might not be pushing out that far. And if the disc does not push out far enough to touch on the nerve, you might be free and clear. How have a bulged disc and not even know about it? So what is a herniated disc in that case? Well, a herniated disc is when the inside or the middle portion of the disc, which we call the nucleus pulposus, has broken through and gotten towards the outside. So your disc is made up of two primary fibers, the outside, which is called the annulus fibrosis, and the inside, which is called the nucleus pulposus. And the outside is tough and like rubber. The inside is more like a crab meat consistency or a jelly consistency. And if there's a tear in the outside wall and the inside pushes through, that's often called a herniated disc. And we can see an example of that on this model right here. When I press down and in, you can see right on the backside, some of that jelly starts to come out the middle. That, that would be a great indication of a herniated disc getting into the canal and potentially even irritating a nerve. So if you have pain due to a bulge or a herniated disc, one of the best things that you can do is to decompress or take the pressure off that area. Whether that's hanging from a bar, whether that's having some traction, whether that's visiting a chiropractor or another doctor. You, those are a couple great things you can do, because once you take the pressure off that segment, sometimes that disc material will go back in on the inside, relieving your pain and saving you from having to go through a surgery. So that is the big differences between a bulge and a herniated disc.
