Treatment of Lumbar Disc Bulges
What is a Disk Bulge?
A bulging disc, also sometimes referred to as a slipped disc or protruding disc, is an injury to your intervertebral disc, a complex cartilage structure between the bony segments of your spine. A disc bulge occurs when trauma or repetitive stress causes the soft more fluid inner portion of the disc to press against the strong outer layer containing it. If the force is high or applied long enough it will create a bulge. A disc bulge is more common in the lower back (Lumbar Spine), but can occur anywhere in the spine, including your neck (cervical). If the disk bugle is progresses and the outer layer of the disc starts to rupture it is referred to as a herniated disc.
What does a Lumbar Disc do?
Lumbar intervertebral discs serve many purposes. One being, they are shock absorbers that sit in between the bones that make up the lower part of your spine. Discs have a unique architecture that evenly distribute pressure to absorb the impact of the body’s movement and daily stresses, while at the same time allows the spine to have mobility. The disc is made of a tough outer layer called the annulus fibrosus and a gel like middle called the nucleus pulposus. A helpful analogy is to think of the discs as miniature jelly doughnut, with the dough being the annulus fibrosus, and the jelly inner being the nucleus pulposus. The annulus fibrosus is innervated which means that there are nerve endings that can sense pain while the nucleus is not. Adjacent to the disc are spinal nerve roots that exit the spinal canal in between the vertebrae/disc and spinal joints and form the nerves that travel down to innervate the legs. Sometimes, if the disc bulges or herniates, it can compress a nerve root which is why disc injury symptoms can be felt in the lower body.
How do Discs Bulge?
Trauma or repetitive stress can start to push the jelly towards the back and sides of the disc and the dough starts to weaken. Prolonged sitting, lifting, twisting and bending and any combination are common stresses that will wear down the Annulus. Eventually, even a simple activity such as picking up a pen can cause the jelly to bulge out into the weakened dough. Since the outer dough is innervated pain can start to be felt. Pain can also be brought on by the chemical reaction that occurs when the jelly material comes in contact with the outside environment. The nerve root can be irritated or compressed by inflammation that develops as a result of the bulging disc.
What is the Difference Between a Disc Bulge and a Herniation?
Discs can be often be described as protruding, bulging, prolapsed, sequestered or herniated which can be confusing to patients. Generally, when the jelly has been moved into the outer dough but it still contained within the dough it is called a bulge while if the jelly has broken through the dough into the surrounding area it is called a herniation.
What are Possible Symptoms of a Disc Bulge?
- Acute sharp pain in the low back that can travel down into the hip, leg, even into the foot.
- Pain typically is on one side but can be variable with the pain location.
- Pain with prolonged sitting
- Difficulty Bending forward
- Burning, Numbness, pins and needles, and/or weakness into the leg or foot
- Standing shifted to one side or inability to fully straighten spine
- Pain with a cough or sneeze
It is important to note that disc bulges are quite common and will often not cause any pain. Studies demonstrate that a large number of healthy young adults without any back pain have one or more bulging discs visible on MRI.
It is also important to note that if you are experiencing severe symptoms in both legs, changes in going to the bathroom or numbness around your anus, seeking urgent medical assessment right away could prevent long term injury.
Who Gets Disc Bulges?
A disc bulge can happen to anyone but they are more common in people who weight lift, prolonged poor sitting posture or who have physical labor jobs with repetitive motion.
How Can I Prevent a Lumbar Disc Bulge?
- Posture: Sitting in a slouched position puts pressure on the front part of the doughnut pushing the jelly towards the back. Sit with a lumbar roll or lumbar support to ensure your low back maintains a natural arch while sitting and your pelvis does not roll back.
- Keep Moving: Our bodies are designed to move. Studies show that on average people maximally flex (bend forward) 50 times a day and maximally extend (arch backwards) an average of 0 times a day. So, make sure that you keep moving in all directions. If you are sitting for a while stand up, take a walk, stretch out.
- Core Strength: A strong core helps support the low back. Incorporate a core strengthening program into your exercise or workout routine.
- If you enjoy weight lifting (especially exercises like squats or deadlifts) it is very important that you use proper form, if you can’t use proper form with the weight you are lifting you greatly increase your risk of injury
Physiotherapist, Chiropractic, Massage or Sports Medicine Doctor Treatment of the Disc Bulge
If you suspect you have a disc bulge it is very important to see a physiotherapist, chiropractor or sports medicine doctor right away to get professionally diagnosed. Often through a clinical assessment your physiotherapist can find one simple specific exercise that can help push the ‘jelly’ back towards the middle of the disc. If you follow the exercise regimen and avoid activities that push the jelly towards the outside of the disc, pain can resolve quickly.
Once you are no longer in acute pain your therapist will teach you what exercises and lifestyle changes can be done to help prevent re-injury in the future. The most common predictor of back pain is previous incidents of back pain so it’s important to continue to practice what you have learned from your physiotherapist, chiropractor or sports medicine doctor.
Your therapist may also work with a Pilates instructor and Massage therapist to help with the recovery and prevention of disc bulge. Pilates can be used to help improve your core strength, form, and posture while exercising or performing daily activities, and massage can help relax tight muscles that are aggravating your disc bulge.
Best Exercises to Help with a Lumbar Disc Bulge
The best exercises to treat a disc bulge will depend on the location and severity of the bulge. You should see a physiotherapist, chiropractor or sports medicine doctor so they can prescribe exercises based on your specific disc bulge injury.
Lower back (lumbar spine) disc bulge exercises can include:
1. Repeated Extension in Lying (REIL)- this is a Mackenzie based exercise.
Lying on your stomach, arch your back (extension) by pushing up through your hands. While doing this keep your back relaxed and belly hanging towards the ground with gravity, achieve this with using just your arm strength. Only go as high as you need for pain relief.
HOLD 5 seconds, repeat 5-10 times, up to 5x/day depending on symptom severity.
Warning: DO NOT do this exercise if you are shifted or the pain that increases into the legs.
2. Bird-dog (Transverse Abdominis “Core” strengthening).
Position your body in 4-point kneeling by placing hands under shoulder and knees under hips. Set your spine to neutral by maintaining a normal lower back curve and also ensure your rib cage is higher than your shoulders by pushing the floor away. Draw tension around your core. Without moving your spine draw the opposite arm and leg off the ground, keep the weight even between your 2-points of contact (the other hand and leg).
HOLD 5 seconds, repeat 5-10x per side, up to 3x/day.
Warning: This is a more advanced exercise and should be done at a later stage of healing.
What Should be Avoided with a Disc Bulge
If suspect you have a disc bulge you should avoid the following activities.
- Bending forward
- Prolonged sitting
Again, it is important to be diagnosed by a heath care profession such as a physiotherapist, chiropractor, or sports medicine doctor in order to get information specific to your disc bulge injury.
How can I Treat my Lumbar Disc Bulge at Home?
If you have acute pain in your spine that you suspect may be a disk bulge you can try doing the following:
- Rest in a comfortable position, lying on stomach, flat on your back or on the side with a couple of pillow between your knees, and apply ice and/or heat intermittently 10 min on/off.
- If the pain is constant, take an over the counter anti-inflammatory medication, as prescribed by a pharmacist.
- Avoid any movement or position that makes the pain or leg symptoms worse. BUT do remain active with intermittent walking.
- Try some gentle breathing and abdominal tightening exercises
How Long Does It Take to Recover from Disc Bulge?
Recovery time will vary for every individual injury. If this is a reoccurrence, do not expect the pain to resolve as quickly as the first time.
Best case scenerio, recovery will take 6-8 weeks until you are back to your pre-injury lifestyle. This is if you are able to get control of your symptoms in the first few days by modifying your lifestyle, as well as seek medical care from your trusted physiotherapist, chiropractor or sports medicine doctor.
In more complex cases, it may take a 3-6 month to get back to your lifestyle and in the most severe cases you may have to modify your lifestyle long term and possibly require surgical intervention.
A disc bulge is a serious injury and if symptoms do not improve you should seek professional help from a physiotherapist, chiropractor, or sports medicine doctor who can give you a comprehensive treatment plan with exercises you can do at home. It is important that you follow the prescribed exercise routine as well as avoid doing activities that will make your disc bulge worse.
Please contact Rebalance Sports Medicine today and (416) 777-9999.
Bonnie Winship, Physiotherapist
Bonnie Winship is a registered physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.