In this article, we are going to find out more about another painful condition leading to back pain, namely ‘disc protrusion’. We will also be comparing the differences of disc protrusion with other interchangeable terms disk bulging, disk herniation and disk prolapse.
Without further due, let’s dig down to disc protrusion to understand what it really means.
What is Disc Protrusion?
The protrusion means a bulge or prominence. In fact, disc protrusion is distension or protrusion of the fibrous ring that surrounds the intervertebral discs due to their flattening or bulging when weakened.
To better understand, it must be remembered that a fibrous structure present between the vertebrae, called intervertebral disks, forms and connects the entire length of the spine.
What are the intervertebral discs?
These discs serve as shock absorbents assisting in absorbing impact from spinal movements and ensuring mobility between each vertebra. Intervertebral discs are formed by fibrous rings (Annulus Fibrosus in the picture) that surround a pulpous nucleus (Pulposus Nucleus in the picture) that contains a kind of semi-fluid gel inside it, making up 40% to 60% of the disk.
What makes a disc to bulge and protrude?
Normally, the spine suffers from continuous pressure against the disc, which due to natural aging and wear and tear of the movements eventually weakens and loses its shape and height.
Thus, this disc wear eventually weakens the fibrous ring so that it cannot fully grasp the contents of its nucleus, displacing the disc from its original location and pushing the ring that surrounds the entire structure causing dilation (expansion). It is this dilation, in fact, that forms the bulge or bulge called the disc protrusion.
This disc protrusion, in turn, is pressed against the spine and reaches the ligaments and other structures located around the protruding disc, such as the nerve roots.
Symptoms of a protruded disc
For this reason, the most common symptoms are a pain in the affected spine region, tingling, numbness and weakening.
However, disk protrusion only generates pain when it compresses nerve endings near the medullary canal (Central Canal of the spine).
Difference Between Disc Bulge vs Protrusion
A bulge of the disc is characterized by a deformation of the ring where the disc is not necessarily herniated (see below what I mean by a disc herniation). When a disc enlarges or prolapses outwardly, the core presses against the disc wall, but the material is still contained in the disc without tightening the ring.
Additionally, a disc bulge can cause as many complications as a disc herniation where the spinal disc can still push against the spinal canal and its other structures without breaking the open disc.
The disk remains intact except that a small bubble appears attached to the disk.
In a protrusion, the disc has bulged, but its content (pulpus nucleus) is contained by the fibrous ring, while in an extruded hernia, there is damage to the fibrous ring and extravasation of the disc material into the vertebral canal, with a greater chance of compression of neural structures. Therefore, extruded hernias tend to cause more symptoms than protrusions, which can often be mere examination findings and not the true cause of pain.
Difference between disc protrusion vs disc herniation
Given now you have a better understanding what’s disc protrusion is, let’s jump directly to find out more about disc herniation.
In this case, the disc may open, causing the internal fluid to force the nerves around the spine. For some, surgically replacing the affected disc with an artificial one may be a viable treatment option.
Pains and symptoms caused by a herniated disk are common problems for some adults. As you know, the spine is made up of many different anatomical structures, including muscles, bones, ligaments and joints. Individually these structures have nerve endings that can create excruciating pain when they pushed aside by the herniation.
Tip: Excruciating back pain could be due to Kidney Pain too.
Difference between disc protrusion vs disc prolapse
Given now you have a better understanding what’s disc protrusion is, let’s jump directly to find out more about disc prolapse.
What is Disc Prolapse?
Prolapse is a popular medical condition that occurs when structures are intended to hold organs in their specific place to stretch or weaken, causing those organs to literally “fall apart out of place”. For example, the term ‘prolapse’ is also being used to define heart valve diseases (prolapse of mitral valve), the prolapse of the rectum (the end portion of the digestive track), or herniations of spinal discs (e.g. prolapse of the lumbar disk).
In women, prolapse of the pelvic organs is a common medical problem that rises when normal vaginal sustenance is missing, resulting in a drop of one or a few structures located at/near pelvic cavity (e.g. bladder, cervix, urethra or vagina). The reasons for such a prolapse are many (multifactorial), although, ‘fundamentally speaking’, the primarily cause of prolapse is the loss of support sustained by a complex mismatch between the musculature of the pelvic, the prolapsing structure (e.g. vagina) and the connective tissues in the sourounding.
In the context of the spine, lumbar disc prolapse is a common condition.
What is Lumbar Disc Prolapse?
Prolapse of the lumbar disc, which is also called the lumber slipped disc, is the reason for about 5% of total lower back pains, but is the the most popular cause resulting pain due to nerve root compression or sciatica.
Pressure caused on one or a few nerve roots contributing to the sciatic nerve lead to a serve form of lower back pain. These patients could also experiance numbness, tingling, a “pins and needles” feeling and also weakness of muscles in the entire lower body.
Disc herniation results when fibrous ring ruptures open or crack, and then due to the escape of the nucleus pulposus from its original location. Given lumbar vertebrae are relatively flexible, the intervertebral discs between those lumbar discs are particularly at a high risk to prolapse because this lower region of the spinal column carries a lot of body-weight and reasonably supports most of our movements.
Tip: Here are the all causes for Upper Back Pain and Lower Back Pain.
Treatments for Disc Prolapse
In most cases, symptoms experienced a disc prolapse can be controlled with a few simpler medical appraoch and lifestyle changes (such as pain medications, rest, physical therapy, exercise). Although, in most of cases surgical treatments are not necessary, sometimes surgery is carried out to provide faster and sustainable pain relief, for minority of people whose strugle with severs pain and reduled quality of life with a pain effecting their happiness.
Tip: Here are the Back Pain Treatment Options. There are a number of Natural Remedies For Chronic Back Pain too.
What is Intervertebral Disc Protrusion?
It is when the intervertebral discs separate and strugle to tolerate movements between the vertebral column. The discs have a soft spongy center and a comparabaly less-mobile wall containing 26 tissue layers.
In certainty, the terms slipped disc and disc protrusion are a ‘catch-all’ term approach to cover a number disc-related medical conditions where a part of the intervertebral disc wall has become bulged and weakened resulting a disrupted soft “Nucleus Pulposus” pushing towards into the spinal canal. The pressure caused by this compression irritates the descending or exiting nerves.
What is Foraminal Disc Protrusion?
Foraminal disc herniation fits under the acute radicular syndrome, producing more intense excruciating pain in the leg opposed to in the lower back. The pain originates from a disc rupture in the extracanalicular portion of the medullary/central canal (within borders of the pedicles) which leads to compression of the emerging spinal nerve roots. That is, for example, a foraminal disc between L4 (lumber 4 vertebrae) and L5 (lumbar 5 vertebrae) causing tension on the L4 spinal nerve root.
The extraforaminal herniation is located laterally to the pedicle.
Tip: Here is our popular article about all the possible Causes for a Leg Pain. You should not ignore the Night Leg Pain, Back of the Leg Pain, Upper Leg Pain, Groin Pain, Calf Pain or the Foot Pain.
What is Disc Protrusion with Annular Tear?
The Annular cleft is a type of discogenic condition that affects the spine. It usually occurs when the fibers that make up the hard outer lining of the intervertebral disk (called the fibrous ring) break or split apart.
The annular fissure is also called the annular tear, although there are differences between the two terms.
Note that “ring tear” is not a standard term that doctors used to describe or diagnose this condition. The reason is that in general English, the word “tear” suggests that some kind of trauma leads to the separation or rupture of the fibers. While an annular tear may be due to a single injury, more often than not, long-term wear is the culprit. In fact, tears are most often the result of age-related degenerative changes that occur in the disk and spine.
These types of changes can lead to further degeneration in other areas of the vertebral joint. This means that wear as a cause of annular cracking it’s largely about everyday life and living habits – the way you sit, stay, walk up and downstairs, etc. – activities you don’t pay attention to and what you do on autopilot, so to speak.
When we fail to pay attention to how we perform the movement, less-than-ideal habits can, over time, set the stage for an annular tear.
If correcting your habits so you can avoid an annular tear looks like a mountain to climb, I have good news for you: with a little effort, poor posture, body mechanics and muscle imbalance (usually things that are subtle but long-term spinal destruction habits) can be broadly corrected.
In other words, working for a more balanced posture and body alignment can help you prevent and / or manage your risk of an annular tear or tear. Things you can try to help include: yoga classes, Tai Chi or Pilates, strength training using fitness (which is imperative, otherwise strength training can actually contribute to spinal problems in some cases)
Tip: If you use a wheelchair, follow this Guide on How to Choose a Cushion. By the way, Roho Cushion can be an interesting choice.
Tip: Yoga, Tai Chi and Pilates are ones of the Best Exercises for Diabetes too. They can even help you to Manage Hypertension.
What are the causes of Disc Protrusion?
Unfortunately, disc protrusion is directly associated with the body’s natural aging, consequently due to joint wear and degeneration over the years.
Therefore, living and moving is your main cause. However, the people most susceptible to early disk protrusion are those who often repeatedly and continuously overload the spine (e.g. manual workers and high-performance athletes).
Risk groups for disc protrusion
Other at-risk groups include smokers, people with sedentary lifestyles, and patients with a family history of the disease.
Some other factors common to other spinal problems, such as poor posture, overweight, genetic disposition, may also contribute to the emergence of disc protrusion.
Main causes of disk protrusion
Thus, the leading causes of disk protrusion may be as follows:
- Aging (so, we all are at risk)
- Excessive and frequent heavy lifting (lifting, pulling, pushing, loading)
- Spine overload (excessive exercise or weight)
- Intense physical exercise without professional guidance
- Bad posture or static
- Long term exposure to direct vibrations in the spine
- Repetitive movements such as tilting and turning the trunk
- Heavy and repetitive physical work
- Some professions such as driving for long periods, bricklayer, loader, etc
- Accidents or trauma
- Psychological and psychosocial issues.
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Treatment for Disc Protrusion
Treatment depends on the severity of the disc protrusion, the region where it occurs and the discomfort it causes. It can be done with exercise, physiotherapy or ingestion of analgesic drugs.
If treatment is not sufficient to relieve discomfort, your doctor may recommend stronger medications such as muscle relaxants to ease muscle tension and opioids, gabapentin or duloxetine, to relieve pain.
The doctor may also recommend surgery if symptoms do not improve or if the disc bulging is compromising muscle function. In most cases, surgery involves removing the damaged portion of the disc and, in more severe cases, the disc may be replaced with a prosthesis or the doctor may choose to merge the two vertebrae between which the bulging disk is located.
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