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DEAR MAYO CLINIC: The bulging discs in several of my lower vertebrae have flattened out. I am told this occurs with age. In my case, this causes discomfort in my right hip area and affects how long I can comfortably walk. Are there options available to restore discs? If not, are there any other treatments for this?
ANSWER: You are correct that the discs in the low back change in appearance over time in almost all adults. This includes loss of disc height and loss of water content that makes the discs appear darker on an MRI scan. The discs also may bulge into the spinal canal. These changes often affect more than one disc.
Whether these disc changes, as seen on an MRI scan, have anything to do with your hip pain or back pain in general can be a challenging question. The fact that healthy adults without hip or back pain have the same changes suggests that, much of the time, these disc changes are not associated with pain.
In your case, without further evaluation, it’s not clear whether the bulging discs are causing your pain. The process of determining whether the discs are causing your hip pain would start with a face-to-face evaluation with your health care provider, along with a detailed back examination. There are several other structures in the low back, buttock and hip region that can cause hip pain. These structures are unrelated to age-related disc changes.
Most hip pain is related to muscle, tendon, joint or ligament issues, or to irritation or degeneration of the small fluid-filled sacs (bursa) that cushion the bones, tendons and muscles near your joints. Less frequently, nerve irritation at the spine can cause hip pain. A methodical health care provider usually can identify these problems with a thorough examination in addition to possibly other testing, such as X-rays, an electromyogram, a joint injection or a diagnostic nerve block.
Restoration of discs is an active area of research. Animal studies have shown that restoring disc height, water content and structure can occur with stem cell injections or injections of other products into the discs. Human studies are assessing whether these same changes can be achieved in people with back pain. Although many health care providers offer such treatments, injection of stem cells or other substances into the discs should only be done if you are a participant in a research study, because it is not yet known if the treatment is completely safe or effective.
At this time, the best management for chronic back pain, whether it’s from a painful disc or another source, is to get the muscles that support your low back as fit, functional and strong as possible. It’s also important to use proper body mechanics and care for your back. A physical therapist who specializes in spine care can create a physical therapy treatment plan to fit your needs.
In addition to physical therapy, the American College of Physicians recently published a guideline for chronic low back pain treatment, including other therapies to consider that are supported by solid scientific evidence. They include mindfulness-based stress reduction, multidisciplinary rehabilitation and acupuncture. There is less evidence but growing support for other treatments, such as biofeedback training, manipulation, yoga and tai chi therapy.
Though I cannot be more definitive regarding specific treatment for your problem until a diagnosis is made, realize that simple measures are almost always preferable to injections and surgery. These might include the use of heat, ice or pain creams for pain control. Stretches and over-the-counter agents, as well as modifying your activity to types of movement patterns that you tolerate best, typically are recommended as first-line pain treatments. — Dr. Randy Shelerud, Spine Center, Mayo Clinic, Rochester, Minnesota