If you’re reading this because you’re in pain from a bulging or herniated disc, we’re sorry.

Orthopedic spine surgeon Dr. Scott Nimmons of Novant Health Brain & Spine Surgery - Kimel Park shares what recovery looks like, how long it takes and what might help you make it through.

He also shares some good news: Most people with this problem don’t require surgery.

Here’s more from Nimmons.

Herniated disc vs. bulging disc

What is a herniated disc?

In between the bones that stack on top one another in your spine, you have 23 discs that work as shock absorbers.

They’re made of a jelly-like substance called collagen. As we age, that substance begins drying out, causing the discs to degenerate and become less supportive.

Sometimes there can be a tear in the disc’s outer layer because of degeneration or injury. When this happens, some of that damaged disc substance can leak or push out, putting pressure on the nerves or on the spinal cord. This is called a herniated disc. Some people call it a “slipped” disc, although that’s not a medical term.

Is there a difference between a herniated disc and a bulging disc?

In a herniated disc, the outer layer of the disc tears. In a bulging disc, the disc flattens and “bulges” into a space where it shouldn’t be, but the outer layer of the disc stays intact.

A herniated disc typically involves more inflammation than a bulging disc does. There’s inflammation from the rupture itself, and then there’s also an inflammatory response to the disc substance that’s pushing into the nerve.

Both disc problems can put pressure on a nearby nerve and cause discomfort, but if a patient comes in describing intense pain, it’s more often a herniated disc than a bulging disc.

It’s also relatively common to see that a patient has both a herniated disc and a bulging disc, or multiple bulging discs.

What are the symptoms of a herniated disc?

Symptoms will depend on which disc herniated and which nerve it’s pressing on. Each nerve follows a different pattern, and a lot of times doctors can tell where the damaged disc might be based on your symptoms and an exam, even if we haven’t gotten imaging yet.

With a herniated disc, patients say they have shooting pain down their arm or leg, numbness, tingling, electric shock-like sensations or sometimes even weakness. Some patients say they have sciatica — nerve pain running from the lower back down to the leg.

This pain can either come on suddenly or it can be more insidious and gradual. The slower onset typically affects people in their late 50s and early 60s. But I see it in younger people too, especially if they’ve had an injury to a disc or some kind of trauma like a car accident.

When should I get help, and where should I go first if I think I have a herniated or bulging disc?

Your primary care provider is typically very well equipped to help you manage your symptoms for the first few weeks, and can escalate you to a spine specialist if needed based on your symptoms.

If your pain suddenly gets much worse, reach out to your primary care provider. And if you notice bowel or bladder changes, have a sudden onset of weakness or feel numb in your groin or inner thighs, go to the emergency room.

Treatment and recovery from herniated or bulging discs

Do herniated discs ever get better on their own?

Most of the time, the body can take care of this problem on its own. Roughly 90% of the time the body reabsorbs the disc material and the inflammation around the nerve calms down. Most people are feeling better within six to eight weeks.

What can I do to help with the pain from a herniated or bulging disc?

As doctors, our job is to help you manage symptoms while the disc takes care of itself.

In those first weeks, we often use anti-inflammatory medications or a steroid to address the inflammation. We may also prescribe nerve pain medications or muscle relaxers. The goal is to help you get through the worst part of the pain.

During this time, limit activities that flare your pain, but don’t go on bedrest either. Most doctors will tell you to walk if you’re able to.

You may be sent to physical therapy. This doesn’t always mean that you’re doing workouts — sometimes the therapist helps with massage or other techniques that can help manage your pain. Other times they’ll give you gentle exercises to improve your range of motion and help to stabilize the spine.

If medications and physical therapy haven’t helped, or if your pain is too unmanageable for you to complete physical therapy, injections can be useful. We can use them as a treatment to help patients feel better (called a “therapeutic injection”). Injections can also help us figure out which nerve is causing the pain (called a “diagnostic injection”) and whether it’s likely to improve without surgery.

What happens if the herniated or bulging disc doesn’t get better with rest and pain medication?

Typically, a herniated disc gets better on its own within six to eight weeks, but the likelihood of it getting better on its own goes down after that.

If you’ve had symptoms longer than that and it’s not getting any better, it’s time to seek care from an expert who may talk with you about imaging, injections and surgery. I think it’s helpful to understand that most people with this problem won’t ultimately require surgery — surgery is our last resort.

What does surgery for a herniated or bulging disc look like?

The way we get the nerve to feel better is by taking pressure off of it, reducing inflammation and allowing it to heal.

A minimally invasive surgery called a lumbar microdiscectomy is the most common procedure for a herniated disc in the lower back. It can often result in a significant improvement in pain.

In this surgery, the patient is put under general anesthesia. We use imaging to guide us to where the nerve is being compressed, shave away a small portion of bone in the spine so we can access the disc herniation, gently push the nerves to the side, pull the disc fragment away so it’s not pushing on the nerve anymore, then close up the skin again. The procedure is over within 30 to 90 minutes, and recovery takes about six to eight weeks.

If the herniated disc is in your neck, we may need to do a more complex procedure, like an anterior cervical discectomy with fusion (ACDF surgery), but just because you have a disc herniation doesn’t mean you need fusion surgery.

Disc pain is treatable

If you’re dealing with disc pain, here’s my message: Very reliably, people will experience resolution of their pain — especially pain going into the arm or leg.

There are treatments that are very effective for this problem, and you don’t have to suffer in silence. Come in and let us help you. We have lots of tools — and not all of them are surgery.