A bulging disc, also known as a herniated disc, is a common condition that occurs when the soft inner nucleus pulposus of an intervertebral disc pushes against the outer annulus fibrosus, causing the disc to bulge out beyond its normal boundaries. This can put pressure on the nerve roots in the spine and cause pain, numbness, tingling and weakness in the arms or legs. Many people wonder if a bulging disc is a lifelong condition or if it will eventually heal on its own. Here is a look at some of the key factors that determine whether a bulging disc is lifelong.
What Causes a Bulging Disc?
The discs between the vertebrae in the spine act as shock absorbers and allow flexibility. They have a gel-like center called the nucleus pulposus surrounded by tough rings of tissue called the annulus fibrosus. A bulging disc occurs when the nucleus pushes out through a weak spot or tear in the annulus. This most often happens due to wear and tear as we age but can also be brought on by injury or heavy lifting. Some risk factors include:
- Age – discs lose elasticity and become more prone to bulging over time.
- Genetics – some people inherit weaker connective tissues.
- Weight – excess weight puts more pressure on the discs.
- Occupation – jobs with frequent bending and lifting.
- Smoking – nicotine impedes blood flow to discs.
- Improper lifting or bending – can strain the discs.
- Previous back injury – increases risk of disc problems.
Disc degeneration from aging is the most common cause. As we get older, the discs dry out and lose strength. Bulging discs become more common over the age of 40 but can occur at any age.
Symptoms of a Bulging Disc
A bulging disc may not cause any symptoms at first. As it progresses, it can lead to:
- Lower back pain that may radiate into the buttocks and legs
- Sharp, shooting pain, numbness or tingling in the legs or arms (sciatica or radiculopathy)
- Muscle weakness in the legs or arms
- Reduced range of motion in the back
The specific symptoms depend on which disc is affected and whether the bulging disc is putting pressure on nerve roots. A lumbar disc (lower back) is more likely to compress the sciatic nerve and cause leg pain. A cervical disc (neck) is more likely to affect the arms.
Is a Bulging Disc Permanent?
For many people, a mild bulging disc may go away on its own over time. In one study, MRI scans showed that over a 10-year period, bulging discs resolved in 33% of asymptomatic cases (no pain or symptoms). Some discs showed signs of improvement after just 1 to 4 years.
However, once a disc has bulged and there is disc degeneration, it weakens that area permanently. People who have had a symptomatic bulging disc are at increased risk of re-injury at that same disc level. Even after successful treatment, a bulging disc can come back or gradually worsen over time.
Here are some key factors that affect whether a bulging disc is lifelong:
Severity of the Disc Bulge
The larger the disc bulge, the less likely it is to heal on its own. Small disc protrusions and contained disc bulges have the best chance of improving. Large, severe disc herniations that pinched the nerve are less likely to resolve without treatment.
Location and Impact on Nerves
Bulging discs in the lumbar (lower) spine tend to be more likely to heal than cervical (neck) disc bulges. If the bulging disc is compressing nerve roots, causing sciatica or radiculopathy symptoms down the arms or legs, this is less likely to improve spontaneously.
Age and Disc Degeneration
Younger individuals with healthy disc tissue often have the best prognosis. Their bulging disc may retract back into place over time. Older individuals with disc degeneration have poorer healing potential. The discs tend to bulge again.
Ongoing Aggravating Factors
Activities that aggravate the bulging disc like heavy lifting, sitting for long periods or bending may prevent healing. Smoking also impairs disc health. Removing aggravating factors improves the chance of the disc bulge regressing.
Treatment Received
Aggressive physical therapy, anti-inflammatory medications, epidural steroid injections and other treatments may help a bulging disc heal and shrink back into place. Surgery like a microdiscectomy may physically remove the portion of the disc that is bulging and compressing the nerves.
Overall, the prognosis for a bulging disc resolving on its own declines over time. Early treatment within the first 4-6 weeks offers the best chance of a bulging disc regressing and shrinking back into place.
Can a Bulging Disc Heal Without Surgery?
Many people with a bulging disc improve significantly without needing surgery. Here are some conservative treatment options:
- Rest – Avoid strenuous activities that aggravate the bulging disc. Take frequent breaks if sitting.
- Ice/Heat – Use cold packs or heating pads to help manage pain and inflammation.
- Medications – Over-the-counter anti-inflammatories like ibuprofen can ease pain. Some doctors prescribe muscle relaxers or stronger prescription pain medication for short-term relief.
- Physical Therapy – Stretching, gentle exercises and modalities like ultrasound may help strengthen the back and reduce bulging.
- Epidural Steroid Injections – Corticosteroid anti-inflammatory medication injected into the epidural space can temporarily shrink inflammation of a bulging disc.
- Spinal Decompression – A traction device gently pulls and releases the spine to take pressure off the discs and nerve roots.
- Alternative Therapies – Massage, acupuncture and spinal manipulation may promote healing.
These conservative treatments allow the bulging disc to potentially heal and shrink back into place over 4-6 weeks. But if the bulging disc does not improve and continues causing significant pain and neurological symptoms, surgery may be recommended.
When Is Surgery Needed for a Bulging Disc?
Surgery for a bulging disc may be considered if:
- Severe or worsening pain, numbness/tingling down the arms/legs persists despite 6 weeks of aggressive conservative treatment
- There is progressive muscle weakness or wasting from nerve compression
- The bulging disc is significantly impacting daily function and quality of life
- Cauda equina syndrome with loss of bowel/bladder control develops (surgical emergency)
The most common surgery is a discectomy or microdiscectomy. This involves surgically removing the portion of the bulging disc that is putting pressure on the nerve. This decompresses the nerve and can provide rapid relief of sciatica or arm/leg radiculopathy caused by the bulging disc.
Patients undergoing discectomy for a lumbar disc herniation experienced significant improvements in pain, function and quality of life at both short-term and long-term follow ups. While re-herniation is possible in about 5-15% of cases, most patients do not require additional surgery. Microdiscectomy has high success rates of around 90% for appropriate candidates.
Home and Lifestyle Changes for a Bulging Disc
Along with medical treatment, making certain home and lifestyle modifications can help manage a bulging disc:
- Use good posture and body mechanics during daily activities.
- Limit sitting and take regular stretch breaks if you must sit for prolonged periods.
- Sleep on your side with a pillow between your knees.
- Avoid lifting over 10 lbs. Let your legs do the work.
- Wear flat supportive shoes and avoid high heels.
- Manage your weight to avoid excess pressure on the spine.
- Quit smoking to maximize disc health and healing potential.
- Use analgesic creams like capsaicin cream for temporary pain relief.
- Try yoga, tai chi, qigong or other gentle stretching activities.
Making these changes to relieve pressure on the spine may help manage bulging disc discomfort and prevent the disc from worsening over time.
Outlook for Bulging Discs
The prognosis for a bulging disc depends on its severity, location, age of the patient and whether aggravating factors can be removed. Mild bulging discs in younger patients without nerve compression have the best chance of resolving. More severe, chronic bulging discs in older patients tend to persist and are less likely to heal on their own without treatment.
Proper early treatment and lifestyle changes can help many bulging discs improve over time. But some bulging discs do remain lifelong once disc degeneration sets in. It’s important to see your doctor if back pain, sciatica or other symptoms of a bulging disc develop so proper treatment can begin quickly for the best outcome.
Conclusion
A bulging disc results when an intervertebral disc weakens and the nucleus pushes out. Mild cases may heal over time with conservative treatment but more severe bulging discs often persist, especially in older individuals with disc degeneration. Aggressive physical therapy, anti-inflammatory medications, injections and spinal decompression may help some bulging discs shrink back into place and prevent the need for surgery. Patients who have aggravating factors, severe pain/ weakness or who do not improve with conservative treatment may require surgery like a microdiscectomy for lasting relief. With early proper care, many patients with a bulging disc can avoid lifelong discomfort. But in certain cases, a symptomatic bulging disc does remain a chronic condition requiring ongoing management.
