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

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

Is that bad ? Does it heal well? What is the healing time? Can a disc protrusion disappear? And above all, what exactly is a disc protrusion? We often hear about the herniated disc, this diagnosis which makes more than one tremble (as can be seen in several back pain forums).

In the following article, 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.

Definition

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 vertebrae superimposed. 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 vertebrate, there is a intervertebral disc. For example, the L4-L5 disc is the disc located between the L4 and L5 vertebrae. The L5-S1 disc, on the other hand, is located between the last lumbar vertebra (L5) and the first sacral vertebra (S1).

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

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

Role of intervertebral discs 

  • 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 go back 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 must be remembered is that the gelatinous nucleus can move inside the disc.

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. 

The difference with 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:

Camber:

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.

Extrude: 

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.

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:

RECOMMENDED FOR YOU:  Protrusive Disc Disease: Definition and Management

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.

Disc protrusion and back pain (symptoms)

I will need ALL your concentration for the rest of this article. Indeed, what I am about to tell you is of paramount 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 were ever gradual, your body may have adapted to the protrusion caused by the disc protrusion. Also, since the pain is often the result of nerve irritation, your disc protrusion may not cause symptoms, simply because it does not come into contact with a nerve or nerve root and 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 earlier that the health 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. Above all, this evaluation makes it possible to identify muscle 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 trained therapist may 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 (kinesitherapy or physiotherapy)

-Meditation techniques

-Breathing techniques

-Yoga and/or Pilates

- Weight loss

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:

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Anodyne® Posture Shirt – Women | Back & Shoulder Posture Corrector | Posture Corrector Tee Shirt | Reduces pain and tension | Medically Tested and Approved | Medium – White
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Everlasting Comfort Lumbar Support - Lumbar Pillow for Desk, Office Chair or Car Seat - Memory Foam Back Cushion - Black
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  • ✔️Against back pain: Most chairs do not support the back, which causes tension. Ergonomic cushion supports upper, middle and lower back for complete comfort
  • ✔️Breathable Cover: The chair cushion features a breathable mesh cover that allows air to circulate, preventing heat build-up. Finally enjoy a perfectly fresh seat all day long

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ALDOM Muscle Massage Gun Massage Device Deep Muscle Massager with 30 Adjustable Levels 6 Massage Heads and LCD Display Relieve Aches and Stiffness
  • 30 LEVELS Massage Gun:ALDOM massage gun Choose the speed and massage heads that best suit your needs can quickly eliminate lactic acid produced after exercise, and for everyday relieve muscle pain, back and neck aches and stiffness, greatly reducing the time muscle recovery.
  • Long Battery Life: Equipped with high quality battery, the muscle massager can keep working about 6-8 hours after charging, while the cooling system can effectively remove excess heat, if the battery is low, there will be a red prompt.
  • Less than 45 dB Ultra Low Noise: ALDOM muscle massager gun which features high performance and low noise. features advanced technology and high-torque non-brushed electric motor, Featuring the high-precision mold which tightly connects the machine head and the body, The high-torque motor rotates 1800-4800 times per minute and achieves your tissue to loosen the fascia (connective tissue)

Last updated on 2024-03-15 / Affiliate links / Images from the Amazon Partners API

ECODE Vertebral and lumbar decompressor axial stretching LUMBA PLUS ECO-852
  • LUMBA +: Uses the neurovertebral decompression technique recognized by INSERM, practiced in osteopathy practices and recognized by the Association of Exclusive Osteopaths. Neurovertebral decompression is a surgical or non-surgical procedure that aims to release pressure on the spinal cord or spinal nerves
  • Neurovertebral decompression is a key element in the treatment of back pain such as herniated discs, bulging discs, sciatic pain, disc degeneration and osteoarthritis. Vertebral decompression is a principle increasingly used in the treatment of back pain (nerve sciatica stuck, disc pinching, scoliosis, compression of the vertebrae or low back pain).
  • Let's discover the technique of spinal decompression and see together its effects by stretching against sciatica. Principle of vertebral decompression Vertebral (or neurovertebral) decompression is a gentle treatment used in the event of sciatic nerve stuck, herniated disc or in case of disc pinching.

Last updated on 2024-03-14 / Affiliate links / Images from the Amazon Partners API

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  • IMPROVE YOUR PERFORMANCE: Rolling the back roller over your muscles releases toxins, and increases the flow of blood and oxygen to the target area. Massage your muscles with our fitness roller before or after a workout to boost your performance, speed up your recovery time and protect you from injury.

Last updated on 2024-03-15 / Affiliate links / Images from the Amazon Partners API

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RECOMMENDED FOR YOU:  Protrusive Disc Disease: Definition and Management

List (non-exhaustive) of invasive treatments

Finally, invasive treatments are sometimes considered when the pain persists, and previous treatments have proven ineffective. In general, it is rare to resort to these methods in the case of disc protrusion. Anyway, it is advisable to consult your doctor who will be able to guide you in the process.

-Infiltrations

-surgery

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

  • 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.
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  • Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
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  • Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 
RECOMMENDED FOR YOU:  Protrusive Disc Disease: Definition and Management

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  • Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
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  • wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.
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Prognosis: The healing time of a disc protrusion

“Does it heal well, a disc protrusion?”

“Can a disc protrusion disappear?”

These are questions that I receive regularly, either in the clinic or via Internet users.

Sorry, but I'll go with the usual answer…it depends!

It depends on what ? From several factors. Yes, there are the physical factors that give us a clue about the prognosis. For example, a chronic back pain is more difficult to treat than a acute lumbago (especially if it is the first episode of back pain). Or, localized pain is usually easier to treat than low back pain radiating to both legs.

But besides the physical factors, know that the psychosocial factors are even more decisive in predicting the evolution of your back pain. Believe it or not, body mass (ie. your weight) is not always a risk factor for chronic back pain.

On the other hand, your job satisfaction is intrinsically linked to the risk of developing persistent lower back pain. Ditto for your family relationships. Not to mention your state of mind (stressdepression isolationEtc.).

In short, the risk of your disc protrusion turning into chronic pain is also related to your demographic, family or occupational situation…and not just your lumbar condition! Hard to believe, I know. But it is proven by several scientific studies!

L5-S1 disc protrusion, recognized as an occupational disease?

A disease is said to be occupational if it results from a direct exposure to a physical, chemical or biological hazard. It must also result from the conditions in which a worker exercises his professional activity, and must appear in one of the tables of the general or agricultural Social Security system.

The tables of occupational diseases 97 and 98 relate to back pain, and define a number of criteria which must all be met to allow recognition of the disease.

Here are the conditions that must be met for back pain to be recognized as an occupational disease:

  • It must be a chronic condition (defined by a duration of at least 3 months)
  • If the pain radiates into the leg: sciatica or radiculalgia femoral crural must be caused by a herniated disc with a topography consistent with the root involvement. For sciatica, the herniated disc must be level L4-L5 or L5-S1. For crural radiculalgia, the herniated disc must be level L2-L3, or L3-L4, or L4-L5.
  • The herniated disc must be explicitly qualified in the report of the radiological examination via a scanner ou IRM.
  • The duration of exposure to the risk is 5 years, and the period of coverage must be a maximum of 6 months.

It can therefore be seen that at present, the L5-S1 disc protrusion does not meet the above criteria, and therefore cannot be recognized as an occupational disease.

Are you looking for solutions to relieve your pain?

Discover the opinion of our team of health professionals on various products available on the market (posture, sleep, physical pain), as well as our recommendations.

Conclusion (and take home message!)

So much for the disc protrusion! If ever your doctor has given you this diagnosis by medical imaging, the first thing is to don't panic!

Already, it is not guaranteed that it is the protrusion that is responsible for your pain (a health professional will be able to confirm this). Then, we must not confuse protrusion and herniated disc, this diagnosis which makes more than one tremble.

As soon as serious damage is excluded, the prognosis is generally favorable in the presence of disc protrusion. However, it must be understood that the pain won't go away while remaining inactive.

Indeed, a proactive approach is THE solution of choice for those who wish to heal optimally, in addition to preventing recurrence of injury. Also be aware of the psychosocial factors that are intrinsically linked to your symptoms and your prognosis for recovery.

Among the treatments available are more natural or alternative techniques, and invasive methods are generally not necessary in the presence of disc protrusion. Be sure to find an experienced and trusted healthcare professional who will be your ally and your guide.

For a summary of the article, see the following infographic which offers 10 essential things to know after being diagnosed with a protruding disc: Click here.

Good recovery!

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