What about my protruding or bulging disc?

It is one of the most infamous parts of the body as it is frequently blamed for severe and unpleasant low back pain (LBP). However, as discussed previously here, there is no evidence that discs or other anatomical features being out of alignment actually causes pain. Instead, pains such as LBP involve many factors and treatment should not focus purely on a single tissue such as a disc.

However, people continue to be sent for scans of their spine at an alarmingly high rate, and it is important therefore for these scans to be interpreted accurately. Things that can be seen on scans include various changes in the shape of lumbar discs, such as disc bulges and disc protrusions. This recent review of 14 studies highlighted some interesting facts about these changes in lumbar disc shape and structure. The results indicate that most of these changes in the disc shrink and/or disappear without the need for surgery, with almost half (43%) of these protrusions completely resolving. Bigger changes in the disc were usually actually more likely to resolve, such that having a large disc protrusion is not necessarily something to be concerned about. Finally – and this is often confusing for patients – whether a disc continued to look mis-shapen or not on a scan was not related to whether a person’s LBP improved or not.

This study reinforces other research which demonstrates that that pain is not due to changes in disc shape and structure as these are seen in many people without LBP, and whether they shrink or not doesn’t seem to matter in terms of LBP. Consequently, in the event of a person having LBP and a large disc bulge or protrusion, a wait and see approach where a comprehensive non-surgical rehabilitation programme is tried before considering surgery may be the best option.

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