Back pain is by far the most common musculoskeletal ailment in the United States. As a physical therapist, I frequently have patients tell me they were told they have a bulging disc and assume that is the cause of their pain. A disc bulge can certainly cause pain, and it can sometimes be quite severe. However, research would actually suggest that most people dealing with back pain are more likely experiencing symptoms due to something else in their back, and a bulging disc may just be a coincidental finding. Let’s take a look at what current evidence says!
First, we need to discuss what a bulging disc is. In our spine we have 7 vertebrae in our cervical spine (neck), 12 in the thoracic spine (mid back), and 5 in the lumbar spine (low back). In between each of those vertebrae is a disc. This disc acts as a cushion to absorb impact and allows more flexibility through our spine.
You may have heard it described as a jelly donut. Although this metaphor describes the shape, it poorly misleads the structure. I don’t know about you, but every jelly donut I have had that was worth a darn was nice and soft and doughy. The fibrous layer of the discs in your spine are actually quite sturdy and are likely not going to rip open if you stand up a little too quickly one day. All that to say, your back is not some fragile structure waiting to burst forth jelly.
When these discs do become damaged, there are three main ways it can present. One is a bulge, which is simply the disc sticking out a little more than usual. Another is a herniation, in which the disc rips and the contents start to spill out. The third is a sequestration, in which a piece of the disc or internal material separates from the disc entirely.
So do bulging discs cause pain? Well, yes and no. Research shows that a lot of people without back pain have bulging discs. One study found that among a group of 98 people who did not have back pain, 52% had one or more bulges, and 38% had two or more. (1) Another study found that disc bulges in asymptomatic people were present about 20% of the time in younger people and 75% in people over 70. (2)
This illustrates a very important concept when understanding how our body works: pain is much less about what is physically and anatomically happening in our body and more about what our nervous system is doing. All pain is communicated through our nervous system, and there are all kinds of things in our back that can communicate via this system, whether or not there is actually something damaged.
Another important thing to understand is that pain perception is not proportionate to the severity of the injury. Some people have a torn rotator cuff or ACL and feel no pain. Other people come into the clinic with a kinked neck from sleeping on it funny and are in excruciating pain. There is no specific standardized measure to determine the severity of an injury based on its pain level. This is also illustrated in the previously mentioned research showing that there are a lot of people with bulging discs that have no pain.
This is both frustrating and liberating. I personally look at it as encouraging. Many people, myself included, will experience fairly severe back pain at some point. When this happens, it is hard not to assume there is something seriously wrong because the pain is so intense. I try to encourage my patients, and myself at times, that although the pain is intense, it is likely not a serious injury and will resolve.
Now, disc bulges do happen in weird ways sometimes, and they can be painful. A good percentage of people with disc bulges do have back pain (2), but we don’t have a reliable way of knowing if the disc is the true source of pain. From a treatment standpoint, our focus should be more on fixing movement quality than what is anatomically happening in the spine.
Many people with low back pain have more muscle-based issues. This can result from several different factors, but if your back does not move well, is stiff, or does not have proper stability, your muscles are going to be talking to you! This will be the case regardless of whether you have a bulge or any other kind of finding on an imaging report.
It is also important to note that disc herniations (when the disc actually tears open) typically resolve over time. It is estimated that around 85-90% of disc herniations resolve in 6-12 weeks. (5) Albeit a herniation is different than a bulging disc, it shows that our body is resilient and at times better able to repair itself than we may think. In the same study they also mention that most bulging discs are found coincidentally and not usually the cause of the back pain for which people seek imaging. (5)
If you are someone who has been told you have a disc bulge and have been concerned or believe your back pain is related to it, I hope this article gives you some hope and peace of mind. Disc bulges can certainly cause pain at times, but are commonly the scapegoat for medical professionals to blame for someone’s pain.
If you are dealing with back pain, I encourage you to find a physical therapist you trust and schedule an evaluation with them. It can be a daunting thing, but your pain can get better! One of the big steps to regaining your pain free life is having an understanding of how God made your body, and I hope this article helps you with that!
References
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69-73. doi:10.1056/NEJM199407143310201
Brinjikji W, Diehn FE, Jarvik JG, et al. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-2399. doi:10.3174/ajnr.A4498
Lucas JW, Connor EM, Bose J. Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019. NCHS Data Brief. 2021;(415):1-8.
GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316-e329. Published 2023 May 22. doi:10.1016/S2665-9913(23)00098-X
Al Qaraghli MI, De Jesus O. Lumbar Disc Herniation. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Related Posts
