Bulging and Herniated Disc: When a Spinal Disc Presses on a Nerve
If you’ve been told you have a bulging or herniated disc, you’re not alone. These are among the most common causes of back and leg pain.
A spinal disc acts as a cushion between the bones of your spine. When the outer layer weakens or tears, the disc can push outward and irritate nearby nerves causing pain, tingling, or weakness in the back or leg.
Understanding the Difference
Although often used interchangeably, bulging and herniated discs aren’t identical:
Bulging Disc
The disc extends beyond its normal boundary, but the outer layer (annulus fibrosus) remains intact.
Herniated Disc
The inner gel-like center (nucleus pulposus) breaks through the outer ring, pressing more directly on a nerve.
Both can irritate or compress spinal nerves, leading to similar symptoms, but herniations typically cause more intense nerve pain.
What Causes a Disc to Bulge or Herniate
Aging and Degeneration
Discs naturally lose water and elasticity.
Repetitive Lifting or Twisting.
Strain increases internal disc pressure.
Sudden Trauma
A fall or accident may rupture a weakened disc.
Poor Posture or Core Weakness
Long hours sitting or slouching add stress.
Genetic Factors
Some individuals have weaker connective tissue or early disc degeneration.
Common Symptoms
Symptoms depend on which disc and nerve root are involved. Typical features include:
Localized low back or neck pain
Shooting pain down the leg (sciatica) or arm
Numbness or tingling in the limb
Muscle weakness (trouble lifting the foot or gripping objects)
Pain worse with sitting, coughing, or bending forward
Common Symptoms
Symptoms depend on which disc and nerve root are involved. Typical features include:
Localized low back or neck pain
Shooting pain down the leg (sciatica) or arm
Numbness or tingling in the limb
Muscle weakness (trouble lifting the foot or gripping objects)
Pain worse with sitting, coughing, or bending forward
Where It Occurs
Most herniations happen in the lumbar spine (L4–L5 or L5–S1), causing leg pain or weakness. Cervical herniations affect the neck and arms, while thoracic (mid-back) discs are less common.
How It’s Diagnosed
History and Physical Examination
Your physician evaluates how the pain began, what worsens or relieves it, and which movements trigger symptoms.
Neurologic testing identifies affected nerve roots based on reflexes, sensation, and muscle strength.
Imaging
MRI: best for seeing soft tissue and confirming nerve compression.
CT Scan: used when MRI is not possible or to view bone changes.
X-rays: show spinal alignment but not the discs themselves.
Diagnostic Nerve Block
Sometimes, an image-guided nerve root block confirms which disc is responsible for pain.
Risk Factors
Age between 30 and 60
Sedentary lifestyle or prolonged sitting
Obesity or heavy lifting
Smoking (reduces disc nutrition)
Prior disc injury or degeneration
Risk Factors
Age between 30 and 60
Sedentary lifestyle or prolonged sitting
Obesity or heavy lifting
Smoking (reduces disc nutrition)
Prior disc injury or degeneration
Low Back Frequently Asked Questions
01. What is a facet ablation (RFA), and how is it different from diagnostic blocks?
Answer: Blocks test the pain source; ablation stops the nerve signal.
A medial branch block temporarily numbs a spinal joint to confirm the pain generator. If it works, radiofrequency ablation (RFA) uses heat to deactivate that small nerve for 6–12 months. The joint stays stable, and pain often lessens dramatically.
Lumbar | Interventional Spine | RFA
02. How long does a radiofrequency ablation (RFA) last, and can it be repeated?
Answer: Relief often lasts 6–12 months and the procedure can be repeated safely.
After an RFA, the tiny sensory nerves that send pain signals grow back slowly. Many patients enjoy meaningful relief for 6 months to a year. If the pain returns, a repeat ablation can usually be performed using the same approach. Regular stretching and strengthening help extend the benefit. Lumbar | Cervical | Interventional Spine | RFA
03. Why does my low back hurt after sitting or long drives?
Answer: It’s usually from facet-joint stress or weak postural muscles.
Sitting flexes the lumbar spine and compresses facet joints and discs, especially if the core is de-conditioned. Over time, this posture leads to inflammation and stiffness. Supportive cushions, regular breaks, and targeted therapy for core and glute muscles often relieve symptoms.
Lumbar | Ergonomics | Rehab
04. What is a diagnostic discogram, and why is it rarely done now?
Answer: It injects dye into spinal discs to find the pain source but carries risks.
Discography involves pressurizing discs with contrast dye while monitoring pain response. It was once common before spine surgery but is now less used because it can worsen disc damage and cause infection. Modern MRI and targeted nerve blocks provide safer diagnostic insight.
05. Why do some people have chronic back pain even after “successful” fusion surgery?
Answer: Adjacent levels often wear out faster.
Spinal fusion stabilizes one level but transfers stress to the discs and joints above and below, leading to adjacent segment disease. Scar tissue, muscle atrophy, and nerve irritation can also persist. Nonsurgical options like PRP or radiofrequency treatment can help preserve the surrounding spine.
Lumbar | Post-Surgery | Interventional Spine
06. What are “adjacent segment disease” and “hardware failure” after spine surgery?
Answer: They mean nearby levels or implants break down over time.
After fusion, joints next to the fused area compensate by moving more, sometimes developing arthritis or stress fractures. Hardware fatigue or loosening can also occur years later. Regular imaging helps detect changes early; pain-management injections or strengthening programs can often delay revision surgery.
Lumbar | Cervical | Post-Surgery | Spine Degeneration
07. How do you tell if leg pain is from the back or from a knee or hip problem?
Answer: Back-related pain travels below the knee; joint pain usually stays local.
Nerve compression in the spine typically causes sharp, shooting pain that radiates past the knee or into the foot. Hip or knee arthritis usually creates aching localized pain or stiffness without tingling. Imaging and physical-exam maneuvers help determine whether the source is spinal, joint, or both.
Diagnostics | Lumbar | Hip | Knee
08. What is an epidural steroid injection and what does it do?
Answer: It delivers anti-inflammatory medicine around pinched nerves.
Guided by X-ray, a thin needle places medication into the epidural space of the spine. The steroid reduces swelling around irritated nerves from a herniated disc or arthritis. Relief may last weeks to months and can allow better participation in physical therapy.
Interventional Spine | Epidural | Lumbar | Cervical
09. What are red-flag symptoms that spine pain is not just mechanical?
Answer: Fever, unexplained weight loss, numbness, or bladder issues.
Warning signs include constant pain at rest, night sweats, progressive weakness, loss of control of urine or stool, or recent infection. These could signal infection, tumor, or severe nerve compression and need emergency evaluation.
Safety | Lumbar | Cervical | Emergency
10. How long should I wait before considering spine surgery?
Answer: Only after conservative care has clearly failed and red flags are excluded.
Most mechanical back or neck pain improves with guided injections, therapy, or biologic repair within 3–6 months. Surgery is reserved for progressive weakness, structural instability, or nerve compression causing loss of function. A second opinion is always appropriate before proceeding.
Lumbar | Cervical | Surgery Decision
11. What is a “facet joint,” and why can it cause back or neck pain?
Answer: It’s a small stabilizing joint behind each vertebra that can become arthritic.
Facet joints allow bending and twisting. With aging or injury, they may develop arthritis and inflammation that causes sharp localized pain, often worse when leaning backward or standing long periods. Facet injections or RFA can calm these joints for months at a time.
Lumbar | Cervical | Anatomy | Interventional Spine
12. When should I seek emergency care after a neck or back injury?
Answer: Sudden weakness, numbness, fever, or bladder/bowel changes.
Go to the ER immediately for severe pain with loss of strength, incontinence, high fever, or trauma with head injury. These could indicate nerve or spinal-cord compression, infection, or fracture. Early treatment prevents permanent damage.
Cervical | Lumbar | Emergency | Safety
13. What is a “nerve root block,” and how is it different from an epidural?
Answer: A nerve-root block targets one specific nerve, while an epidural bathes several.
A selective nerve-root block (SNRB) uses live X-ray to deliver medication directly around one irritated spinal nerve. It helps confirm which nerve causes the pain and can calm inflammation at that precise level. Epidural injections are broader, covering multiple nerves at once.
14. How can I tell if my hip pain is coming from the joint or my back?
Answer: Hip arthritis hurts in the groin; back problems radiate to the leg.
Hip joint disease often causes deep aching in the groin or front thigh, worse with walking or stairs. Lumbar nerve compression tends to cause burning or tingling down the leg. Diagnostic injections into the hip or spine can confirm the true source.
Hip | Lumbar | Diagnostics | Joint Pain
15. Can regenerative medicine help spine patients who already have hardware or fusions?
Answer: Yes, but injections are placed around not into the fused levels.
PRP and bone-marrow concentrate can reduce inflammation in joints and ligaments next to a fusion where new pain develops. These procedures don’t interact with the hardware itself. Most patients benefit from improved flexibility and less reliance on pain medication.
Spine | Post-Surgery | Orthobiologics | Interventional Spine
When to See a Specialist
If pain radiates down your leg or arm, causes numbness, or limits daily activity, an evaluation can pinpoint whether a disc is responsible.
Prompt diagnosis helps prevent nerve damage and chronic pain.
Minimally invasive spine & joint care.
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