Bulging or Herniated Discs
What are bulging or herniated discs?
Discs are small, round, filled cushions — almost like shock absorbers — that are found between each of the vertebrae (bones) in your spinal cord. The outside of the discs is tougher than the inside — think of a car’s tire that’s filled with a thick gel. When a disc “bulges,” it means that the disc has for some reason shifted out of position, and the gel-like substance inside it has, correspondingly, shifted position; rather than being evenly spread, it now lists to one side, putting pressure on one of the walls of the disc. When a disc is “herniated,” it means that the fluid inside has found a tiny crack in the tougher outside membrane and has started to leak out. Herniated discs are sometimes referred to as “slipped” or “ruptured.”
You may have a bulging or herniated disc and never know it. What happens sometimes, however, is that the affected disc impinges on a nerve. Most often, this will occur in the lumbar (lower) part of the back, where most of the weight of the upper body comes to bear. Sometimes, it happens in the cervical region, affecting the neck. It can also occur in the thoracic vicinity (in the middle of the back, opposite the chest), where its symptoms can be confused with chest or stomach pain.
If the impingement or pressure is in the lumbar vicinity, you might feel pain, tingling, or numbness in your buttocks or legs; if it is in the cervical region, these symptoms would be experienced in the neck, shoulders, and arms. In severe forms of either case, everyday motions would be difficult, and there might be bowel or bladder issues as well. And in critical cases, the bulging or herniated disc may affect the cauda equina nerve complex at the base of the spine. If this region gets pressured, or squeezed, your legs would be very weak or numb and incontinence can occur.
Discs are subject to the same wear and tear as the rest of the body, so it makes sense that these conditions would arise more as we get older. The discs lose their sponginess, becoming drier and less flexible; a slight injury, or even just the progression of regular motion, can cause a slippage or a tiny tear. Lifting heavy objects improperly — using your back, instead of your legs — can put added pressure on your discs; being overweight can do the same. Your occupation — if it is physical, involves lifting or twisting — can play a role, as does genetics.
“Most cases of pain that stems from a bulging or herniated disc respond well to conservative and non-invasive treatment,” says Christopher Castro DO, a physiatrist at The Orthopedic Institute of New Jersey (OINJ). “ You can try home remedies like over-the-counter pain relievers; simply avoiding positions in which you feel pain; and exercise. When your pain interferes with your daily life, or is constant, we can help. A physical exam will help determine the cause of the pain, and its location. If the condition is severe, there are other tests that can be done, such as x-rays, CT scans, MRIs, and something called a myelogram — an x-ray or CT scan that follows the electrical pulses from your nerve as it travels to see its effect on the spine. These can help plan the proper course of action.”
There are other classes of medication that might be prescribed. “Anticonvulsants can help with radiating pain,” says Michael Gutkin, MD, another physiatrist at OINJ. “Muscle relaxants can help if your condition is presenting with muscle spasms. There’s also the possibility of oral steroids or a cortisone injection, which can help reduce swelling and inflammation so that your range of movement can improve and you’ll have less pain.”
Dr. Gutkin continues, “Physical therapy can help as well. And if your bulging or herniated disc is affecting the cervical zone, a form of traction could also help: your head is pulled gently away from your neck to allow the bones to reposition. Even though it sounds unusual, this manipulation gives the small bones in the neck some space to spread.”
Surgery is rarely recommended in these cases, but a physical exam and evaluation will lead to the right diagnosis, a prerequisite for finding the best treatment plan.
Why Choose The Orthopedic Institute of New Jersey
At OINJ, board certified physicians work collaboratively to come up with the best solutions for you. Using innovative techniques and the most up-to-date research and technologies available, our specialists have one goal: to get you back into the best of orthopedic health. We work with each other, as well as with other partners in your care, to develop the treatment plan that will work for you.
Our multiple office locations that can be reached by one centralized call center make it easy to schedule and get to appointments, and we treat patients of all ages with injuries and orthopedic conditions of all kinds.
Christopher Castro, DO – Physiatrist
As a physiatrist, Dr. Castro has expertise in non-operative spinal care, interventional spine procedures, pain management, occupational medicine, and electrodiagnostic studies. Board certified by the American Board of Physical Medicine and Rehabilitation, Dr. Castro incorporates medications, therapies, injections and lifestyle changes to help his patients improve function.
Dr. Castro completed an advanced fellowship at University of Medicine and Dentistry of New Jersey (UMDNJ); held his residency at the Sinai Hospital Physical Medicine and Rehabilitation program in Baltimore; and received his medical degree from the New York College of Osteopathic Medicine. His undergraduate degree in chemistry was earned at Fairfield University in Connecticut.
Michael S. Gutkin, MD – Physiatrist
Dual board certified by the American Board of Physical Medicine and Rehabilitation in sports medicine as well as physical medicine and rehabilitation, Dr. Gutkin is a physiatrist whose areas of expertise include interventional spinal and joint injection, pain management, rehabilitation, and spinal injuries. He is a partner at The Orthopedic Institute of New Jersey.
Dr. Gutkin completed his residency at The Rusk Institute at NYU Medical Center, and received his medical degree from St. George’s University Medical School. His undergraduate degree in biology was earned at Ithaca College in New York.
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The Orthopedic Institute of New Jersey is a premier multi-disciplinary center offering complete orthopedic care, rehabilitation and pain management services to patients of all ages and activity levels using a customized treatment plan to fit individual needs.