Disc herniation versus Disc Bulge

What is the difference between a disc herniation and disc bulge

You just received your MRI results and it says that you have a disc herniation or disc bulge. I’m sure this might be worrisome to you. So what does this mean? 

First of all, these terms are often used interchangeably but, in reality, there is a difference between the two.

Anatomy of the disc

https://youtu.be/pDGXX5OwQ2Y

The discs are spacers found between two vertebrae.  They are responsible for movement between the vertebrae; flexion, extension, rotations and lateral bending. 

They are made up of the following parts

  1. Annulus fibrosus – It consists of strong fibrous layers of criss-crossing fibers that firmly attach to the vertebrae above and below.  It is responsible for holding the two vertebrae together and pressurizing the inside of the disc.
  2. Nucleus pulposus.  This is found in the inner core of the disc. It is of jelly-like consistency.  The nucleus really likes water.  It absorbs water when we lay down. This is why we are taller in the morning. That excess water is squished out when we stand up and move around. 

Disc herniation

As you bend forward the pressure on the front of the disc causes the jelly like nucleus pulposus to creep backwards.  With repetitive flexion or flexion and rotation activities fissures can form  and the layers of connective tissue can separate in the annulus fibrosus (known as delamination). The nucleus can then work it’s way down these fissures.  Over time these cracks and fissures can extend out to the periphery of the disc which causes the nucleus to herniate out into the space where the nerves/spinal cord are located.  This is a disc herniation.

Think of it like a jelly filled donut.  Take a bite on one side of the donut and the pressure squirts the jelly out the hold.  If the hole for the jelly wasn’t there the jelly would be contained and not squirt out. 

Interestingly though, when it comes to an intervertebral disc, vertical pressure down on the disc won’t cause the jelly to herniate out but bending forward can.

Disc bulge 

Disc bulges are typically age related.  As we age, the discs have less ability to hold onto water. Less water causes the disc to decrease in height and bulge outwards. 

Think of this like a deflated tire. When a tire’s pressure is less than optimal the  car will sit lower and sides of the tire will bulge out.  If the bulge projects backwards towards the spinal cord. 

Both of these situations may cause back pain when there is nerve irritation (due to chemical irritation or physical compression).  But at the same time, there are numerous people walking around right now with disc herniations or bulges who experience no pain at all.  Their herniations or bulges may be of similar size and shape as yours. So what this means is your disc herniations or bulges may just be incidental findings. 

Be aware that most disc issues get better. Even the worst disc herniations resolve; as a matter of fact they are the most likely to resolve. 

So what can you do? 

Be assessed by a chiropractor, athletic therapist or other professional who can determine what factors aggravate or relieve you.  Seek someone who gets you active, guides you towards self care and makes lifestyle modifications  to manage pain and return you to an active healthy life.

14 Essential Tips for Healthy Eating

I must admit eating properly all the time is difficult. We don’t have the time, we are in a rush, healthy food is expensive, or we don’t know what foods are good for us. healthy food. These are all excuses that we are used to giving or hearing.

Throughout my years in health care as a Chiropractor, Athletic Therapist and a Strength and Conditioning Specialist, these are the top tips, in no particular order, which I have found to be excellent pearls of wisdom. I have simplified the tips because it is better to keep your diet simple than complex. Remember; do not get caught up with the fads at the time. Keep it simple. Do your best to follow the Canada food guide.

Incorporating these healthy eating tips will help you achieve better health. To accomplish these tips you must pre-plan and know what and when you are going to be eating. Take a day or two each week to prepare your food for the week and freeze what you can. This simplifies your week. It also means that when you are hungry you can quickly grab something from the freezer and heat it up. That means that it will take you 2 minutes rather than 20 minutes to prepare your food for that meal. Plus you won’t have to do as many dishes either.

If you find that purchasing healthy food is too expensive try purchasing your food when it is on sale and stock up on it. The cost of eating unhealthy food may end up being more expensive when you have to start paying for that medication to help lower your high blood pressure or high cholesterol. Take time and plan ahead with your purchasing. Remember, without a plan failure will happen.

Here are my favorite tips that I like to give to my patients.

  1. Eat slowly
  2. Eat to 80% full
  3. A regular meal pattern including breakfast consumption, consuming a higher proportion of energy early in the day, reduced meal frequency (i.e., 2⁻3 meals/day), and regular fasting periods may provide physiological benefits such as reduced inflammation, improved circadian rhythm, increased autophagy and stress resistance, and modulation of the gut microbiota.
  4. Eat one to two servings of vegetables or fruit on each meal. Pick from all the different colors available. Consider supplementing with a “Greens” product.
  5. Drink plenty or water or green tea approximately 8 cups a day. Avoid fruit juices and other sugar filled beverages.
  6. Minimize the consumption of simple/refined sugar and starchy foods until after moderate to strenuous exercise
  7. Eat a “complete protein” at each meal such as egg, milk, poultry, beans, fish etc.
  8. Consume essential fatty acids daily (Omega 3s) such as fish or fish oil supplements.
  9. Have a Multi-vitamin daily
  10. Choose whole foods rather than processed foods
  11. Choose whole foods that are high in fibre
  12. Chose whole grains as opposed to whole wheat.
  13. Avoid foods that are fried or contain trans fatty acids, hydrogenated or partially hydrogenated oils.
  14. Don’t worry about cheating every once in awhile.

Don’t try and do this all at once.  Take one tip and practice it for the next 3 weeks and then add another tip.

Original document was created  May 2010. Updated January 2 2020.

How do I cure a sore back?

I recently received a question from someone on Klout.com asking the question, “How do I “cure a sore back”. Here is my response:

“How do I cure a sore back?”

It’s a difficult question to answer since there are multiple reasons for someone to have a sore back. Factors that may influence your lower back soreness may be:

Postural Strain

Staying in a stationary position for extended periods of time. For example, sitting for long periods of time. This is called postural strain.  To help with this, taking mini breaks from that position may help. http://drnotley.com/protect-your-spine-mini-breaks/

Inappropriate movement habits

If you are an athlete or are active then looking at your technique may be needed. Simply having someone help with your technique may be all that you need to take the strain off your back and allow your soreness to improve. A wonderful exercise that may be great for conditioning, like the burpee, may be detrimental to your back if done improperly http://drnotley.com/burpees-and-back-pain-my-thoughts/

Deconditioning

If you are not very active then developing general conditioning may be what you need.  I often see those who have back pain and they are very deconditioned but once they start getting active their pains diminish.

TRX suspension trainer and back pain: challenging the spine

Back Strength: Four for the Core

Unaddressed old injuries

If you have other injuries or an old injury these should be addressed. For lower backs we often need to look at spine posture during the actively, as well, as how the looking at the mobility or stability of the hips, knees, ankles and feet. If there are problems in these areas they can put added stress on the spine and cause pain.   What you may need if these is the case is exercises that will aid in increasing mobility of joints or stability.

Suboptimal health habits

Smoking (http://drnotley.com/chronic-pain-and-cigarette-smoking/), stress, and nutrition (http://drnotley.com/understanding-essential-fatty-acids/) can also cause back pain among other health issues.

Help from a professional

 Above, I have discussed approaches that require an active approach on your part.  These are very important because you are taking control of your health/pain which is very effective but there are passive methods that can be beneficial in the process.  Here are some examples

Pain referring to the back

Back pain/soreness may be as a result of other internal problems. For example, women have sore backs as a result of their menstrual cycle. A number of internal organ problems can result in back soreness.  A rule of thumb is that if you can’t find a position  or treatment that gives you relief or that there are no movements that cause added soreness then seeking out a medical doctor is warranted.

Conclusion

This is a round about way of saying that there are numerous ways to help a sore back.

Dr Notley

P.S. This list may not be all inclusive. If this pain persists seek out a Chiropractor, Athletic therapist, Physiotherapist, acupuncturist, or medical doctor.

Why is your back stiffer in the morning?

You may have noticed when you wake up in the morning that your spine is more stiff than it was before you went to bed.

I’d like to explain why this happens.

Why is my back stiffer in the morning?

The intervertebral discs between our vertebrae are made up of  multiple, strong, fibrous layers called the annulus fibrosis. The annulus encases the nucleus pulposus which is a jelly like substance. This jelly substance is attracted to water.

When we wake up in the morning our spine is approximately 19mm longer than it is at the end of the day. This is because when laying down the force of gravity on our spine is less than the force of attraction of the water to the nucleus pulposus. Therefore, water is drawn into the intervertebral disc.

This increase in water in the discs reduces the ability of the spine to bend forward by between 5 and 6 degrees.  Bending stresses on the spine are increased by 300% and stress on the ligaments is increased 80%.

Sadly, the muscles don’t seem to compensate for this stiffness by restricting the lumbar spine’s bending range of motion.  Therefore, when we bend forward this increased stress on the spine increases our chance of aggravating or injuring our spine.

Thankfully, approximately 50% of increased disc height is reduced within the first hour of the day.

Should I workout in the morning?

Based on this information it is highly recommended that if you want to exercise avoid spinal based movements that involve flexing the spine or bending within the first hour.

For those with chronic lower back pain this advice holds true as well.  Do your best to minimize the amount of bending that you perform within the first hour of the day. Plan your day out, the night  before, so that the first parts of your day involve less bending and heavy lifting.  Later in the day these activities would be more appropriate.

Dr Notley

P.S. You can watch more videos on Instagram TV and Youtube