Dear Alice,

What is the difference between a slipped disc, a bulge in a lumbar disc, and a herniated disc?

I am (for the past two months) experiencing severe back pain which radiated down my left leg. My MRI results came back and the nurse from the office said I had "disc disease" and "degeneration" as well as a "slipped disc." The doctor called me later and told me I have a "bulge" and an "arthritic" spine condition.

I am trying to understand what the various terms mean (slipped vs. bulge vs. herniated). Could you tell me what the distinctions are?

Dear Reader,

All those terms can sure be confusing! Depending on who you ask, there is a slight distinction between these conditions, but they all can result in the experience of back pain caused by an issue with the discs in your spine. Your spine is a column of 33 small bones called vertebrae and between each is a small piece of disk-shaped cartilage. These discs act as a cushion and prevent the vertebrae from grinding against each other when you "do the twist" or any other movements that involve your back. To answer your question about the difference in these conditions, "bulging" discs are those that shift out of place and put pressure on the nerves in the spinal column. On the other hand, herniated/slipped/ruptured discs are those where the disc cracks or is damaged and the jelly-like fluid inside the disc leaks and irritates the nearby nerves. Disc degeneration refers to any back pain that result from discs that aren't functioning properly. This degeneration can sometimes cause discs to herniate or bulge and could be why you are hearing multiple terminologies from your health care providers.

To further your understanding, it’s helpful to know a bit more about the spine and how these conditions can occur over time. The discs between your vertebrae are made up of a tough outer layer that contains nerves and a soft, jelly-like inside layer. They work together to act as shock absorbers for all the movement and forces a person's body goes through. Over time, all of that strain and stress put on the back (lifting, bending, carrying the sofa up five flights of stairs, etc.) causes wear and tear on the discs and vertebrae. The discs, which are made up of 80 percent water, also dry out with age, making it more difficult for them to absorb shock. These factors make it more likely for your discs to degenerate. You may be able to reduce your risk of back pain by getting regular physical activity, practicing proper posture, and maintaining a healthy weight.

Interestingly, the conditions you’ve mentioned don't always cause symptoms; in fact bulging discs usually don't have symptoms. Herniated/slipped/ruptured discs are more likely to cause pain, tingling, or numbness in the leg, but, in some cases, there are no symptoms. Treatments for these conditions involve managing the pain and strengthening the muscles in the back until the pain subsides. Though it may feel like common sense to minimize movement in areas of the body that are painful, it's actually recommended that you continue being active when you have one of these back issues; this area has limited blood flow, but physical activity can increase the blood flow which helps the healing process. Some extreme cases may require physical therapy or surgery, but there isn't consistent evidence that particular treatments speed up the recovery time. If you start to experience numbness or weakness, loss of bladder or bowel control, or difficulty standing or walking as a result of your back pain, it’s wise to talk with your health care provider in the event that there may be complications that need to be addressed.

For more information about treatment and prevention of back pain and other issues related to disc disease, check out the following resources:

Regardless of the type of back injury, or the terminology that your health care providers use, it may be helpful to keep working with medical professionals to address your symptoms and work towards alleviating the ailment. Best of luck!

Alice!

Alice!

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