The Bulging Disc Conundrum
Note: anything written in this article IS NOT PROFESSIONAL MEDICAL ADVICE. It is just my perspective based on research and dealing with back pain myself. Please do your own research as well and consult medical professionals.
This bad boy is an MRI of somebody with bulging and herniated discs. Many people who suffer from back pain end up getting an MRI done on their thoracic and lumbar area and find that they do have a bulging disc, but in this article, I want to explore how the bulging disc diagnosis can be incredibly misleading, including stories from my own journey of dealing with and ending back pain.
My Story
I used to do powerlifting, which is the sport of trying to move as much weight as possible on the benchpress, squat, and deadlift. It started off as an innocent task; I just wanted to get better physical fitness and improve my strength. But quickly, it became a dangerous obsession of trying to keep increasing my maxes without much regard for safety and mobility. I was pretty good at it too, being able to put more weight on the bar nearly every time I went to the gym. However, my lack of foresight caught up to me on the day I tried a mock powerlifting meet, where I hit over 400 lbs on the squat and deadlift. The triumph of moving more than 2.5 times my bodyweight on each of these lifts was quickly overshadowed by a new back pain that would debilitate my lifting progress for the next 8 months.
From August of 2017 to December, I struggled to decrease this back pain and get back to powerlifting. Physical therapy was largely ineffective initially, and ultimately an MRI showed that I had 3 bulging discs in my lower back. I soon realized that I would have to put powerlifting on indefinite hold and that I would have to spend a long time rehabbing my back so I could get back to lifting even the lighter weights.
I entered physical therapy again with the idea of fixing bulging discs to reduce my back pain. I tried PT for a few months and had a slight reduction in back pain, but around March, I started experiencing intense leg and hip pains that debilitated me. Worst of all, my back pain returned. Thus began months of research into musculoskeletal issues and physical therapy. This involved reading countless articles, books on anatomy and movement, and talking with a lot of people about musculoskeletal issues and chronic pain.
Finally in the past few months, I’ve managed to get rid of my back pain, and my leg and hip issues are on the road to recovery as well. Physical therapy has helped a lot, mostly because I’m now seeing a physical therapist who understands that my entire body isn’t functioning correctly and causing back and leg pain. Also, reading about and understanding the nature of pain and muscular issues has greatly helped. But I think the biggest thing that got me over my back pain was understanding the nature of the pain, specifically whether the bulging discs were actually causing me pain.
Is it really a bulging disc causing your back pain?
One of the worst things about getting an MRI done on your back and receiving the bulging disc diagnosis is that you can be misled into thinking that your back pain is actually caused by the bulging disc. Many doctors will hear “back pain”, get the MRI done, and then simply say that any low back pain is caused by that disc, but the truth is that your specific back pain symptoms may not match the kind of pain a disc bulge causes.
It’s good to understand why a bulging/herniated disc causes pain in the first place. What happens is that the disc begins compressing a nerve, which causes symptoms such as numbness, weakness, and tingling along with pain. Often times, it’s accompanied by sciatica, which is a sharp nerve pain that originates in the lower back and radiates down the leg, due to compression of the sciatic nerve [1]. What’s key to understand is that not all bulges cause this kind of pain. In fact, a large amount of the asymptomatic population has been shown to have MRIs that would indicate something off about the discs. The proportion of the population that is asymptomatic but has disc degeneration increases with age as well [2].
If you’re not getting the numbness, weakness, and tingling in your back, you probably don’t have a bulging disc. This is what I came to realize a few months back, and it was a sign that I needed to change my approach to fixing my back. I also changed my physical therapist, who didn’t question whether the bulging discs were the cause of my pain.
Naturally, you’ll end up asking what ACTUALLY is causing your back pain. Unfortunately, diagnosing the nature of a person’s back pain is an incredibly complicated process. For some it can be due to poor bracing mechanics, while for others it can be largely due to poor thoracic spine mobility, and then others can have some different problem. The main take away here is to free yourself from the procrustean bed of “bulging discs” that a lot of doctors have put your low back pain in.
How can you actually figure out how to treat your low back pain then? I’ve got some recommendations which will be largely holistic. Very few specifics to be found here unfortunately.
What do I recommend?
First of all, if you haven’t gone through extensive physical therapy and are on track to get surgery, I’d recommend trying more physical therapy before the surgery. The reason I say this is because physical therapists can often fix a problem of low back pain and save you from having to go through spinal surgery. In fact, your PT may just show you that your low back pain is not due to bulging discs. You should be able to have an extensive discussion with your PT about what the nature of the pain is. If you question them on their treatment based on information you have through your own research, they should be open to having a discussion about their approach. If your PT refuses to discuss the pain in depth (very uncommon) or doesn’t want you questioning their approach (a bit more common), then you should find a new PT. Also, if your PT doesn’t address your low back pain on a systematic level and attributes it to one cause, such tight hamstrings, they likely aren’t doing a thorough evaluation and you should find a new PT.
If you do decide to go the surgery route though, absolutely do not get a spinal fusion. There has been research done which shows spinal fusions are ineffective for reducing low back pain and often times result in the patient needing to undergo surgery again [3]. Please check the book in the citation for a more in depth discussion as to why spinal fusion is ineffective (I’d also recommend that book if you’re considering getting another surgery or have friends/family about to undergo surgery). Outside of spinal fusion, if all other methods of conservative treatment have failed and it looks like you need to undergo spinal surgery, please make sure you do thorough research on who will be operating on you, and don’t be afraid to get second or third opinions.
As for how to do your own research, I would suggest staying away from sites like WebMD or other general health sites. They’re not effective in providing useful and actionable information. There’s one book which I’d highly recommend, Becoming a Supple Leopard by Kelly Starret. Read the first few sections to learn proper bracing mechanics and understand proper movement mechanics. I’ve also included some Youtube videos at the bottom that I’ve found to be incredibly helpful in understanding what injury recovery is like.
For specific exercises, every individual will have a very unique routine that needs to be done. However, there are almost always a few fundamental movements that are done. These include the McGill big 3 and the cat camel stretch. It’s worth starting with these initially and then adding on new stretches/exercises you get from a PT or research and then seeing what helps you over time.
There’s also a mental aspect to pain that needs to be addressed. The nature of pain is complicated and would require an entire book to be discussed effectively, but my recommendation is to understand that pain is not always indicative of tissue damage. You need to remember that smart movement brings healing (by smart movement, I mean movement that doesn’t cross far into the pain threshold but pushes you to become mobile again). Also, meditation is incredibly beneficial. Outside from the immense amount of non-athletic reasons to meditate, it also allows you to better understand how your mind reacts to feeling pain. A lot of suffering that is caused by low back pain is mental, in that you begin to develop negative feelings such as despair and fear, and the metacognitive skills developed from meditation are key to breaking through these feelings.
Conclusions
Don’t think of your MRI as conclusive. It’s worth doing your own research and tracking your own pain, seeing what causes flair ups and what makes your back feel good. It’s also worth trying out a variety of professionals and getting their opinions before taking the plunge into back surgery. Ultimately, your back can get better, and it’s very likely that back surgery for a bulging disc is not required for that. If you have questions on back pain or anything I’ve written in this article, please feel free to reach out.
Youtube Videos
- https://www.youtube.com/watch?v=g4xkVHu8xDk
- https://www.youtube.com/watch?v=iaV5R9ugQEE
- https://www.youtube.com/watch?v=dtL0NaPoXfk
I want to note that all three of these videos are by lifters. I find that the best advice comes from people who have gotten injured and recovered a lot, as they’ve found systems that work very well for them. These three also have good explanations for why their recovery methods worked, and their advice has been echoed by many other professionals.
Citations
