Disc protrusion from A to Z: How to cure? (physio advice)

You have had back pain for a while, and have seen a doctor who prescribed an MRI. In the imaging report, the radiologist mentions a disc protrusion. We talk about median, paramedian, bilateral, posterior, posteromedial, circumferential, L4-L5, L5-S1 protrusion… what complicated and frightening terms!

Is that bad ? Does it heal well? What is the healing time? Can a disc protrusion disappear? And first of all, what exactly is a disc protrusion?

In this article written by a physiotherapist, we cover everything you need to know about disc protrusion, with an emphasis on simple and practical concepts. You will leave with a better understanding of your condition, as well as tools to help you treat your symptoms.

What is a disc protrusion?

Impossible to make you understand what a disc protrusion is without making a short anatomy lesson. As the protrusion involves the intervertebral discs, let's start by identifying the main structures that are part of the spine:

The spine (or spine) is composed of superimposed vertebrae. In the lumbar region (lower back), there are 5 vertebrae called L1, L2, L3, L4, and L5. Note that the spine ends with the sacred, this triangular bone also composed of 5 welded vertebrae (S1, S2, S3, S4 and S5).

Between each vertebra, there is an intervertebral disc. For example, the disc located between the L4 and L5 vertebrae is called the L4-L5 disc. The L5-S1 disc, for its part, is located between the last lumbar vertebra (L5) and the first sacral vertebra (S1).

In summary, intervertebral discs are structures located between 2 consecutive vertebrae. When we study the composition of these discs, we see that they resemble pads. More specifically, they are composed of a gelatinous core (Nucleus pulposus) in the central region, surrounded by a fibrous ring (Annulus fibrosus).

Role of intervertebral discs

But what are the intervertebral discs for? Their roles include:

The separation of the vertebrae from the spine
Shock absorption during movements involving impact (walking, running, jumping, etc.)
The distribution of pressures thanks to the gelatinous core
Mobility between the vertebrae

To better understand the definition of disc protrusion, and its link with your symptoms, let's return to the anatomy of the intervertebral disc as such.

As mentioned, it is composed of a gelatinous core which is surrounded by a fibrous ring. What you have to remember is that the gelatinous nucleus can move inside the disc.

To better understand :
The best analogy to understand this phenomenon is the image of a donut filled with cream. The cream can be compared to the gelatinous core, while the donut itself is the fibrous structure. In this context, it is easy to understand that the cream can move inside the donut depending on the pressures generated around the donut.

Similarly, the gelatinous nucleus can move inside the disc. He can even pushing on the edges of the annulus fibrosus and "distorting" the structure of the disc. This is exactly what happens following a disc protrusion.

To conclude: A disc protrusion refers to a protrusion of the disc due to pressure from the gelatinous nucleus on the annulus fibrosis. Obviously, this deformation of the disc can protrude towards the nerve channels, and put additional pressure on the surrounding structures.

What is the difference with a herniated disc?

Let's go back to our analogy to appreciate the difference between protrusion and herniated disc. We mentioned that the cream growing on the edges of the donut was the equivalent of a disc protrusion. The problem is that the cream can also come out of the donut if the pressure applied is strong enough.

In the case of a herniated disc, the gelatinous nucleus pierces the fibers of the ring which surrounds it, which creates a sliding of the disc towards the spinal canal. Depending on the degree of damage, disc herniation can be classified into several types:

Disc bulge

This is another name to qualify the disc protrusion. As a reminder, the disc is deformed, but the gelatinous nucleus has not yet pierced the fibrous ring. Note that a protrusion can sometimes evolve into a herniated disc, if the pressure exerted by the gelatinous core is significant enough and pierces the fibrous ring.

Disc extrustion

In the case of a disc extrusion, the hernia has pierced the annulus fibrosis, but the protruding section of the gelatinous nucleus remains in contact with the rest of the gelatinous nucleus present in the intervertebral disc.

Disc sequestration

Here, the breakage is so great that the protruding part of the nucleus is no longer in contact with the rest of the intervertebral disc.

If you want to know more about herniated disc and its management, consult the following article:

Herniated disc from A to Z: Better understand your diagnosis (symptoms and causes)

How to diagnose a disc protrusion?

If you are reading these lines, it is probably because you spent a medical imaging indicating one (or more!) disc protrusion(s) in your lumbar region.

Currently there is only themedical imaging which is able to diagnose a disc protrusion. Moreover, a magnetic resonance (MRI) is able to clarify the level where the protrusion is, as well as other characteristics (such as nerve irritation, type, etc.).

In the office, a health professional can perform some clinical tests and put forward a hypothesis of disc damage.

Un neurological examination include reflexes, myotomes (strength and endurance of the lower limbs), dermatomes (sensitivity in the legs), or nerve stress tests (such as the Lasegue test or Leri).

However, these assessment tests have certain limitations that prevent an ultra-precise diagnosis from being made.

How does a disc protrusion manifest (symptoms)

I will need ANY your concentration for the rest of this article. Indeed, what I am about to tell you is of capital importance, and must be understood in order to avoid chronicization of your condition (in other words, the persistence of your pain over time).

Let's start with statistics which I hope will challenge your view of your condition:

In 20-year-olds with NO lower back pain, 29% had a disc protrusion.
In people aged 80, again WITHOUT back pain, 43% had a disc protrusion.

But then, you will ask me, what is the link between my disc protrusion and my back pain?

It's simple. If you have back pain and have been diagnosed with a protruding disc, it may be responsible for your pain. The symptoms often encountered are localized pain (it can sometimes radiate behind the thigh), augmented by sitting, bending forward, and heavy lifting.

But it is also possible that it is present long before the appearance of your symptoms, or that it is not nothing to do with your back pain!

Why ? Because the body has an extraordinary ability to adapt.

If the changes happened gradually, it is possible that your body has adapted to the protrusion caused by the disc protrusion.

Also, since pain is often the result of nerve irritation, it is possible that your disc protrusion does not create symptoms, simply because it does not come into contact with a nerve or nerve root and does not create an inflammatory process. .

Morality ? Disc protrusion can sometimes cause symptoms, while it is asymptomatic in some people. The most important thing is to correlate identified finds to imagery with clinical evaluation.

I mentioned previously that the healthcare professional could do certain clinical tests, and that these had flaws. On the other hand, they can help corroborate the diagnosis made by the radiologist following medical imaging.

And above all, this evaluation makes it possible to identify muscular and joint imbalances, in addition to eliminating potential serious damage of the spine.

Treatment: What to do?

Well, you've been diagnosed with a protruding disc, and your back is hurting. You may have learned by reading this article that the diagnosis of disc protrusion was not necessarily related to your symptoms. But you still have back pain.

What can you do to reduce your lower back pain and resume your activities?

Of course, consult a health professional will allow you to adapt the treatment according to your condition.

Generally, we start with conservative treatments aimed at relieving you, in addition to restoring your movements and maximizing your function.

A qualified therapist might use one of the following techniques to help you:

List (non-exhaustive) of conservative treatments

Heat and/or ice (video explanation)
Mckenzie method (video explanation)
Massage and mobilization of a qualified therapist
Joint manipulation
Therapeutic exercises (physiotherapy or physiotherapy)
Meditation techniques
Breathing techniques
Yoga and/or Pilates
Weight loss

A word about the exercise:
Adapted and progressive exercises could not only relieve your symptoms, but also prevent recurrence of injuries in the long term.

To benefit from our free “21 days against back pain” program adapted to disc protrusions, see the following page.

There are also alternative treatments used in the treatment of back pain (including disc protrusions). Although they demonstrate an absence of scientific evidence, they are often used, sometimes with success.

List (non-exhaustive) of alternative treatments

When conservative treatments do not work, many turn to alternative medicine. Although they are not supported by solid scientific evidence, we observe in some cases an improvement of the symptomatology thanks to the following approaches:

It is also possible to self-treat in the comfort of your own home by using certain anti-back pain accessories. However, it should be remembered that these tools generally provide temporary relief, and should be used sparingly.

Among the products recommended by our professionals, we have:

List (non-exhaustive) of invasive treatments

Finally, invasive treatments are sometimes considered when pain persists and previous treatments have proven ineffective.

In general, it is rare to resort to these methods in the case of disc protrusion. Regardless, you should consult your doctor who will be able to guide you through the process.

What about natural remedies?

Like accessories and anti-back pain products, natural products and grandmother's remedies are very popular with people suffering from back pain.

Often, these remedies include anti-inflammatory properties to relieve various body pains.

On the other hand, it should be noted that most of these natural products are not scientifically proven. It is therefore important to speak to your doctor before using them, particularly to avoid any interaction with your medications.

Natural remedies that may relieve symptoms include:

Turmeric

Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.