What the words mean
Spinal discs sit between the vertebrae. Each has a tougher fibrous outer wall and a softer gel-like centre. Radiology reports describe several different things, and the terms are not interchangeable:
- Bulge: a broad, generalised extension of the disc wall beyond its normal margin. Extremely common, frequently unrelated to symptoms. See bulging discs below.
- Protrusion or herniation: a more focal displacement where inner material pushes into or through the outer layers.
- Extrusion: material has passed through the outer wall but remains connected to the disc.
- Sequestration: a fragment has separated entirely.
The finding is not automatically the cause
Disc changes are remarkably common in people with no pain whatsoever, and the proportion rises steadily with age. Which means a herniation on your scan may be the source of your symptoms, or may be an incidental finding that has been there for years. Matching the imaging to the clinical picture is the job, and treating a scan report without doing that is how people end up on the wrong plan.
What it usually feels like
In the low back: back pain that may be less prominent than the leg pain, with sharp or burning pain travelling into the buttock and down the leg, often past the knee — see sciatica. Typically worse sitting, worse with coughing or sneezing, sometimes with numbness or pins and needles in a defined patch.
In the neck: pain into the shoulder blade and down the arm, sometimes with numbness in particular fingers or weakness in a specific movement. See neck pain.
Same-day emergency care if you have
Loss of bladder or bowel control, numbness around the groin or inner thighs, or weakness in a limb that is getting worse. These can indicate cauda equina syndrome or significant cord involvement and need an emergency department, not an appointment.
The natural history is better than most people expect
The majority of disc herniations improve substantially with conservative care over weeks to months. Herniated material often shrinks over time, and repeat scans commonly show a smaller lesion than the original. Symptoms frequently improve well before anything changes on imaging, because a great deal of the pain comes from inflammation around the nerve root rather than from mechanical pressure alone.
Bulging discs: what can actually be done
Nothing pushes a disc back into place. But that is not the same as saying nothing can be done, and the realistic version is more useful than the marketing version. A bulge is the disc spreading slightly, rather than something breaking through it, and bulges show up routinely on scans of people who have never had back pain. Finding one does not establish that it is causing your symptoms.
Three things can be done, none of which involve repositioning anything:
- Reduce the irritation. Much of the pain in disc presentations comes from inflammation around the nerve root rather than mechanical pressure alone. That settles, and it can be helped to settle.
- Restore movement to what has stopped moving. Segments above and below an irritable level commonly stiffen up protectively, which increases the load on the level that is already unhappy.
- Change what the disc is being asked to carry. If your hips do not extend and your trunk does not share load, one lumbar segment keeps taking more than its share, and it will keep doing that after the current episode settles.
How we assess it
About 30 minutes: a full history, neurological testing across reflexes, power and sensation, nerve tension testing, and a segmental examination of how the region is moving and loading. Where imaging is warranted we have it on-site. If you already have a scan report, bring it, but expect us to examine you rather than treat the report.
What care might involve
Depending entirely on findings: adjustment using techniques suitable for an irritable spine (an irritable disc is not treated like a stiff facet joint, and low-force options are available), cold laser therapy, a structured course of spinal decompression where offloading the segment is appropriate, and rehabilitation to rebuild tolerance.
We cannot help a disc that has sequestered. Some presentations need medical or surgical review, and we will say so.