A new client sat on my bench last month holding her phone out to me. On the screen was her MRI report, and she had highlighted one line: "disc bulge at L4-L5." She had read it as a verdict. In her mind, her back was damaged, the damage was permanent, and the best she could hope for was to manage it. I hear a version of that story most weeks. So here is what that line actually means, from 25 years of working with backs in Honolulu, most of them after the scan had already scared the person half to death.
Between each pair of vertebrae in your spine sits a disc. Think of it as a small, tough cushion: a firm outer ring of fibrous layers around a softer center. Its job is to absorb load and let the spine bend and twist. Discs are not fragile. They are built to carry you for a lifetime.
A bulge means the outer ring has spread slightly beyond its normal edge, usually evenly around the rim, the way a tire bulges a little under the weight of a car. That is different from a herniation, where the inner material pushes out in one focused spot through a weak point or tear in the ring. Your radiologist uses those words precisely, so look at which one is on your report. Most of the reports I see say bulge.
Here is what changed how I read these reports. Researchers have scanned the spines of adults who have no back pain at all, people who were not patients, just volunteers. A large share of them had bulging discs. In a 2015 review that pooled those studies, about 30 percent of pain-free 20-year-olds had a disc bulge, and by age 80 it was about 84 percent. Disc degeneration, the other phrase that frightens people, showed up in pain-free spines even more often: 37 percent at 20, 96 percent at 80.
Read that again with your own report in your hand. The bulge is not rare. It is close to normal wear, like gray hair or lines around the eyes. Plenty of people are walking around Honolulu today with the exact finding you have, and their backs feel fine.
That does not mean your pain is imaginary. It means the bulge alone does not explain it. Something is loading that disc harder than it was built for, and the scan cannot show you what.
Because of what the rest of your body stopped doing. Your spine was never meant to carry load by itself. It was meant to sit on top of hips that rotate, glutes that fire, and a mid-back that turns. When those three go quiet, every bend, twist and lift gets borrowed from the lumbar spine, and the discs at L4-L5 and L5-S1 take the bill.
In my studio the pattern is the same almost every time. The hips have lost rotation, usually from years of sitting and driving. The glutes have switched off, so the small muscles of the lower back are doing a job they were never built for. The mid-back has stiffened up from the desk and the phone. The disc is the place where it hurts. It is almost never the place where the problem starts.
That is good news, even if it does not feel like it yet. A disc you cannot change. Hips, glutes and a stiff mid-back you can.
I have been where you are. A car rear-ended me at a stoplight 25 years ago, and the next morning I could not bend over to get the milk out of the refrigerator. My scans showed degenerative disc disorder and bulging discs. A surgeon offered me an operation with a 30 percent chance of success. I did not take it. I found the research on fascia, the web of connective tissue that holds the whole body together, built a sequence around it, and fixed my own back. I never had the surgery, and I still have not needed it. The discs are presumably still bulging. They just are not being asked to do the hips' job anymore.
Keep it. It is useful information, and your doctor needed it to rule out the things that do need a surgeon. But treat it as a photograph, not a sentence. The scan shows the structure. It cannot show the load, and the load is what hurts.
A few things do need a physician first, today, not a trainer: numbness that is spreading, weakness in a leg that is getting worse, any change in bladder or bowel control, or pain that started with a fall or an accident in the last few days. Get those checked. Once you are cleared to exercise, the work is finding where the load is going wrong and fixing that. I work alongside your doctor, never instead of one.
In my movement screen I put your body through tests you are supposed to fail, and every one you fail shows me where your spine is picking up a job that belongs to something else. You leave knowing where your pain actually comes from, whether we ever work together or not. Bring the MRI if you like. I will read it with you, and then I will show you what it cannot see.
If you want the longer version first, I wrote a free five-page guide, Why Your Lower Back Pain Keeps Coming Back. No email required.
- Dan
A free 20-minute Movement Screen at my private studio in Nuuanu. You leave with answers either way.
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