Why a L4/L5 Disc Bulge May Not Be The Real Answer to your Low Back Pain

Introduction

If you’ve been told your low back pain is because of a “bulging disc at L4/L5”, you’re in good company. Many people believe that once an MRI shows a disc bulge, the problem is identified. Working at my downtown Toronto clinic, I hear it often: “Doctor, my MRI shows a bulge at L4/L5 — so that must be the cause of my pain, right?” But the truth is more nuanced. Imaging findings such as a disc bulge do not always correlate with symptoms—and using them as the sole answer can keep you stuck chasing treatments that don’t address the actual root cause.

In this post I’ll explain why a disc bulge is often a red herring, how it fits into our NeuroStructural Corrective Chiropactic framework, and what you can do in Toronto (desk-job posture, cycling in the Don Valley, etc) to move beyond it.

The Problem or Symptom

A: What is an L4/L5 disc bulge?‍

At the spinal level between the fourth and fifth lumbar vertebrae (L4/L5) the intervertebral disc can show a “bulge” on MRI—where the outer ring (annulus fibrosus) slightly extends beyond its normal boundary. Many clinicians and patients treat this as the cause of low back pain, nerve compression, or sciatica.

B: Why this assumption can mislead

Here are some important facts:

• Numerous studies show that imaging abnormalities (including disc bulges) are very common in people who have no back pain. For example, a systematic review found that disc bulge prevalence among asymptomatic (no back pain) individuals increased from ~30% at age 20 to ~84% by age 80.  
• In one famously cited study of 98 people without symptoms, 52% had at least one disc bulge on lumbar MRI.  
• A meta-analysis in younger adults (50 years or less) found the odds ratio (OR) for disc bulge in symptomatic vs asymptomatic was 7.54—but the prevalence in asymptomatic people was still significant.  
• A recent study found no meaningful correlation between MRI grades of disc bulge/foraminal stenosis and patient disability (Oswestry Disability Index).  
• Hence: finding a bulge doesn’t equal “your pain comes from the bulge”.
  

C: So what’s really going on when you feel low back pain?

Pain in the low back can be multifactorial — and symptoms might stem from:

• Nerve irritation from poor joint alignment, increased motion or instability
• Muscle imbalances, posture distortions, or pelvic/hip dysfunction
• Mechanical stress on the spine from repetitive movement (e.g., sitting long hours on Bay Street or cycling along the Don Valley Trail)
• Central nervous system sensitization (pain-processing changes from chronic low back pain)
• Functional changes in the spine (mobility loss, ligament or facet joint strain) rather than structural “damage” seen on imaging
  

In short: the disc bulge might be present, but it isn’t necessarily the driver of your pain.

Expert Insight (Dr. Krekora’s Perspective)

At my clinic — Toronto Top Chiropractor — we emphasise the NeuroStructural Corrective Process: identifying the root mechanical, neurological and functional causes of pain, rather than stopping at imaging findings.

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Here’s how I explain it:

1. Imaging = snapshot, not story
   An MRI gives us a static image of the spine—great for ruling out serious pathology (tumor, fracture, infection), but weak as a standalone explanation for pain. As research shows, disc bulges are common even in pain-free people.  
2. Symptom ≠ signature
   The fact that a disc bulge is present doesn’t mean it’s symptomatic. The key question: Is it the pain generator in your case? If you’re working long hours seated, cycling, or lifting kids in Toronto, the problem might be more biomechanical than “disc bulge”.
3. Focus on function & structure
   In our NeuroStructural framework we assess posture, spine alignment, joint motion, neurological function and corrective movement patterns. For example: if your pelvis is mis-aligned, hip flexors are tight, and spinal movement at multipe levels is restricted — the L4/L5 disc bulge becomes less relevant.
4. Tailored Corrective Chiropactic care plan
   Depending on your exam, we may combine chiropractic adjustments, neuro-functional acupuncture, posture re-education and mobility/strength work. Even if you have a bulge on your MRI, the goal isn’t to “fix the bulge” per se — it’s to restore optimal spine mechanics, reduce nerve pressure, and ease your pain so you can “feel strong, live to the fullest”.
5. Education matters
   I’ll often tell my patients: “Your MRI is a finding, not necessarily your problem.” Understanding this shifts mindset away from passive “fix my bulge” and toward active “let’s correct what’s under your control”.
   

How NeuroStructural Chiropactic Care Solves It

Step 1: Assess the whole spinal system

We don’t treat the MRI; we treat you. That means assessing: posture (desk vs active Toronto lifestyle), gait, hip and knee mechanics, spine motion segments, nerve-muscle actvaion, and functional movement patterns.

Step 2: Address root cause, not just symptom

If your L4/L5 disc bulge shows up but you still have pelvic tilt, glute and core weakness, poor joint motion and surrounding spinail nerve irritation — we fix the core problems. Over time this reduces compensatory stress on the disc, nerves and joints.

Step 3: Use targeted corrective therapies

• Chiropractic adjustments to restore alignment
• Neuro-functional acupuncture to calm nerve irritation and muscle tension/trigger points
• Posture and mobility training (especially for city-workers sitting 8+ hours)
• Education on ergonomics (Bay Street desk setup), movement breaks (Don Valley Trail cycling/lifestyle), core control
  

Step 4: Monitor progress beyond imaging

We track how you feel, how you move, your functional improvements—not just what your MRI says. Often we see pain drop, mobility improve and strength return without doing something “to the bulge”.

Step 5: Prevent future issues

Once we’ve stabilised your spine, we give you tools to maintain it: posture re-checks, mobility drills, regular spine tune-ups. The goal: “Ready to feel like you’re 25 again!”

Local Tips for Recovery and Maintenance (Toronto-Focused)

• Desk posture on Bay Street: Use a chair that supports slight lumbar curve, position monitor at eye level, take two minutes every hour to stand and extend your spine.
• Active commuting / Don Valley Trail rides: While cycling is great, avoid excessive forward hunch; engage core and stretch hip flexors afterward.
• Weekend Warrior caution: If you’re tackling stairs in the CN Tower or shovelling snow in Willowdale, warm up spine and hips first — lumbar discs hate sudden overload.
• Hydration and nutrition: Intervertebral discs need hydration for optimal function—stay well-hydrated (Toronto tap is fine) and limit prolonged sitting without breaks.
• Regular check-ins: Even if you feel pain-free, a quarterly alignment check at our Toronto clinic helps catch early shifts before they become symptoms.

Conclusion & CTA

So if your MRI says “L4/L5 disc bulge”, here’s what to remember:

• It may be relevant — but it’s not always the main reason you have pain.
• Many people with bulges never experience symptoms. Imaging often shows changes more than causes.
• At our Toronto clinic, our NeuroStructural Corrective Process helps you move beyond “the bulge” towards real alignment, mobility and strength.

Ready to stop chasing MRI reports and start correcting the root cause? Book your free 20-minute case review with me, Dr. Mateusz Krekora at Toronto Top Chiropractor—and let’s get you feeling like you’re 25 again.

This article is for informational purposes only and should not be taken as medical advice. Please consult a licensed chiropractor before starting any treatment.

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