Bulging Disc Explained: Causes, Posture Fixes, and Treatment Options — Dr. Manish Kothari, Jaslok Hospital

Back pain is one of the most common complaints people bring to a doctor — and a "bulging disc" is often the culprit found on an MRI report, though few people understand what it actually means. In this episode of Just Health for the People, a public health awareness initiative by Jaslok Hospital, host Jitendra Hariyan speaks with Dr. Manish Kothari, a renowned spine surgeon and specialist in endoscopic spine surgery, about the causes, warning signs, and treatment of bulging discs.

Dr. Kothari brings extensive experience in advanced spine surgery techniques from the UK and has contributed to numerous national and international research publications and book chapters.

Understanding Spine Anatomy: What Is a Disc?

The human spine is made up of bones called vertebrae, stacked like bricks in a wall. Between each vertebra sits a disc — a flexible structure that acts like a shock absorber, giving the spine both movement and cushioning. Structurally, a disc resembles a jelly donut: a soft, jelly-like center called the nucleus pulposus, surrounded by a tougher outer layer called the annulus fibrosus.

As we age — particularly after 30 — the outer annulus becomes tougher while the inner jelly material gradually decreases. This is typically a slow, natural process the body adapts to. However, when this wear and tear happens too quickly, or when a tear develops in the outer layer, problems begin. A bulging disc occurs when minor tears accumulate over time, causing the outer layer to spread outward — similar to an old sofa cushion that has flattened and spread after years of use.

What Causes a Disc to Bulge?

While disc bulging is part of the normal aging process for everyone, several factors can accelerate or worsen it:

• Genetics — plays a significant role, though it's not the only factor
• Smoking — reduces blood supply to the disc, significantly increasing the risk of early degenerative or ruptured discs
• Being overweight — adds excess load beyond the spine's structural capacity
• Poor posture — modern sedentary lifestyles weaken the core muscles that act as internal support for the spine, leading to asymmetric loading and increased risk of tears

Does a Bulging Disc Always Cause Pain?

Not necessarily. Dr. Kothari notes that the vast majority of people with a bulging disc — likely more than 95–98% — experience no symptoms at all, as it's often simply part of normal aging. This is precisely why Jaslok Hospital does not recommend preventive MRIs for people without symptoms — MRI is an extremely sensitive test, and scanning without a clear indication often uncovers incidental findings that cause unnecessary worry without requiring treatment.

How Office Posture Damages the Spine

Dr. Kothari explains that prolonged poor sitting posture significantly increases pressure on spinal discs. To put this in perspective, using standing pressure as a baseline of 100:

• Sitting with good posture: pressure increases to approximately 125
• Sitting with poor posture: pressure increases to approximately 175
• Sitting while bending forward: pressure increases to approximately 225

This dramatic increase especially when sustained for hours, accelerates disc degeneration through asymmetric pressure the spine isn't designed to handle.

The Correct Way to Sit at a Desk

• Use a proper office chair that fully supports your entire back, from the lower back up to the upper back
• Avoid sliding forward in your chair — consciously correct your posture whenever you notice yourself slouching
• Prefer a desktop over a laptop; if using a laptop, use a stand so your gaze remains level rather than looking downward
• Keep your work desk close enough that you're not reaching forward — arms relaxed and supported by armrests
• Stand up and stretch every 45 minutes — take a short walk, get some fresh air, and return

Why Working From Home Is Often Worse for the Spine

Somewhat counterintuitively, Dr. Kothari notes that work-from-home setups often cause more back problems than the office. Without the structure of a proper office chair, people tend to sit on beds, floors, dining chairs, or plastic chairs that lack proper back support — and the natural discipline of "sitting at a desk to work" is often lost entirely. Adding cushions doesn't solve the underlying issue; maintaining good posture through active muscle engagement is what genuinely helps.

Protecting Your Spine While Commuting

For those using public transport:

• Use a bag with both shoulder straps rather than a single-sided bag, to keep weight distribution symmetric
• If sitting for extended periods, try to stand and move around after about an hour

For driving, the same back-support principle applies avoid letting a gap form between your back and the seat's backrest; your entire back, from neck to lower back, should stay supported.

Screen Time and Posture Tips for Children

With children increasingly using digital devices for schoolwork and entertainment, Dr. Kothari recommends:

• Prefer tablets over mobile phones for schoolwork and online classes
• Set devices on a proper stand at eye level, rather than having children look down at a device on a table — this helps prevent neck pain and also limits distracting use of the device

What Is Spondylosis? How the Body Naturally Compensates

As a disc undergoes wear and tear, the body attempts to compensate by toughening the annulus fibrosus and sometimes forming extra bone growth in the vertebrae — commonly seen on X-rays and referred to as spondylosis. This is generally a normal stabilizing response to minor spinal instability.

However, if left unchecked, these bony overgrowths (osteophytes) can narrow the spinal canal — the tunnel through which spinal nerves pass — leading to nerve compression, pain, and significant lifestyle limitations. This progression is why early corrective measures matter.

First Steps if You're Diagnosed With a Painful Bulging Disc

Dr. Kothari's approach begins with identifying and correcting contributing factors:

1. Address risk factors — smoking cessation, weight management, posture correction, and increased activity
2. Consistent exercise — research shows that the specific type of exercise matters less than doing something consistently every day, whether it's yoga, Pilates, Zumba, or Surya Namaskar

The Importance of Core Strengthening

"Core" refers to all the muscles surrounding the trunk of the body. Strengthening these muscles through planks, yoga, Pilates, or similar activities — provides crucial internal support for the spine. Dr. Kothari's key advice: find an exercise you genuinely enjoy, since consistency matters far more than the specific activity chosen.

When Is Endoscopic Spine Surgery Actually Needed?

Importantly, Dr. Kothari emphasizes that more than 99% of patients he sees are treated without surgery. Surgery is reserved for severe cases involving nerve damage or significant impact on a patient's ability to function and work.

What Is Endoscopic Spine Surgery?

Endoscopic surgery uses a small, pen-sized instrument inserted through a keyhole-sized incision. Lasers and specialized instruments pass through this scope to free compressed nerves and treat the bulging disc directly, allowing for quicker recovery while minimizing tissue damage.

Myth: You Can't Live an Active Life After Spine Surgery

This is a common misconception. Dr. Kothari notes that many of his patients have gone on to run marathons, engage in active gym routines, and even perform in multi-hour stage shows involving singing and dancing — provided the nerves are properly freed (through physiotherapy or surgery) and core exercises are maintained consistently afterward.

Spine Health Advice for Young Professionals (20s–30s)

Pain related to disc issues often starts subtly in a person's 20s and can become more significant by the 30s if left unaddressed. Dr. Kothari's advice for younger professionals:

• Avoid smoking, even under peer pressure
• Stay physically active with regular exercise, despite demanding work schedules
• Make time for your own wellbeing — even small, consistent efforts make a meaningful long-term difference

Running, Weightlifting, and Swimming: Are They Safe for the Spine?

All three activities are generally safe and beneficial when done correctly:

• Running: Low-impact activity actually improves disc nutrition, since discs lack direct blood supply and instead absorb nutrients through a compression-release cycle. Interestingly, running at a pace of around 7 (minutes per km context implied) with good-quality shoes has been shown to support disc health — while sitting continuously only compresses the disc without allowing this nutrient exchange.
• Weightlifting: Mild-to-moderate weightlifting, done under proper guidance, strengthens supporting muscles and benefits spinal health. Heavy lifting is more individually variable and should be approached cautiously.
• Swimming: Excellent for both the back and neck. However, if you already have a slip disc or herniation, it's best to let the back heal completely before learning to swim, rather than starting fresh while symptomatic.

Key Takeaways

A bulging disc is often a normal part of aging and doesn't always require treatment or even cause symptoms. However, lifestyle factors — particularly posture, smoking, weight, and physical activity — play a major role in whether disc wear and tear progresses to a painful, nerve-compressing condition. Most cases are effectively managed without surgery through posture correction and consistent core-strengthening exercise, with endoscopic spine surgery reserved for the small percentage of severe cases requiring nerve decompression.

This article is based on an episode of Just Health for the People, a public health awareness initiative by Jaslok Hospital, featuring Dr. Manish Kothari, spine surgeon and specialist in endoscopic spine surgery. Watch the full video here: Bulging Disc Explained by Dr. Manish Kothari

For consultation regarding back pain, bulging discs, or spine health, please reach out to Jaslok Hospital's Department of Spine Surgery.