What is a Bulging Disc?
A bulging disc injury is a common spine injury sustained to your spine’s intervertebral disc. It can occur in your lumbar spine (lower back), thoracic spine (upper and mid-back) or your cervical spine (neck).
A bulging disc can commonly be referred to as a slipped disc or a protruding disc. However, when the disc bulge is significant enough for the disc nucleus to come out of the annulus, it is known as a herniated disc. See diagram.
How do we get it?
Lumbar disc herniation generally occurs between the ages of 30 and 50 and is associated with smoking, lack of exercise, poor nutrition, repetitive stress, poor posture, pregnancy, aging, incorrect body mechanics and may also be due to genetic defects.The most common discs affected are L4-5 disc, compressing the L5 spinal nerve root and L5-S1 disc compressing the S1 spinal nerve root.
What are the causes?
- Bulging disc herniation often occurs during aging where degenerative changes occur. Reduced hydration of the nucleus pulposus is one of these changes and reduces the ability of the disc to distribute load evenly.
- The herniated disc may lead to narrowing of the spinal canal leading to spinal stenosis. Due to discs typically herniating posterolaterally, lateral canal stenosis is more common. The excessive pressure on exiting spinal nerves causes numbness, tingling and/or weakness in the associated nerve distribution. This most commonly occurs in the L5 and S1 spinal nerve distributions following an L5-S1 or L4-5 disc herniation.
- Sciatica is a common result of a herniated lumbar disc where the sciatic nerve (L4-S3) is compromised causing shooting pain, weakness, numbness and tingling in the buttock, down the back of the leg and to the ankle/foot. Motor weakness and reflex changes may also be involved. NOTE: neurological deficit helps distinguish radiculopathy from referred pain.
How long does it last?
The location, number of discs affected, severity, degree of neurological involvement, type of treatment and the patient’s response to treatment will influence the prognosis. 90% of lumbar disc herniation is resolved following conservative treatment with only 10% of people still experiencing sufficient pain after 6 weeks to consider surgery. The herniated portion of the disc tends to regress with complete resolution after six months in two-thirds of people.
What do I do when I have it?
Most minor and moderately bulging disc injuries are treated conservatively without the need for surgery. In order to allow the torn fibres of the annulus to heal and the disc bulge to resolve fully, your bulging disc treatment is centred on encouraging the fluid to return and remain in the centre of the disc. This keeps the torn fibres closer to one another and the structure of the annulus as normal as possible.
By maintain the disc fluid in the central position that you intend it to stay, you are helping Mother Nature to lay down its scar tissue optimally for an excellent long-term solution. Please remember that scar tissue formation will take at least six weeks, so the longer that you avoid aggravating postures the better!
PHASE I – Pain Relief & Protection
Managing your pain is usually the main reason that you seek treatment for a bulging disc. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. Inflammation is the main short-term reason for why you have suddenly developed bulging disc symptoms. It best reduced via ice therapy and techniques or exercises that unload the inflammed structures.
Your osteopath will use an array of treatment tools to reduce your pain and inflammation. These include ice, dry needling, manipulation, unloading taping techniques, soft tissue massage and temporary use of a back brace. Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
PHASE II – Bulging Disc Exercises
As your pain and inflammation settle, your osteopath will turn their attention to restoring your normal joint alignment and range of motion, muscle length and resting tension, muscle strength and endurance.
Your osteopath will commence you on a lower abdominal and core stability program to facilitate your important muscles that dynamically control and stabilise your spine.
Researchers have discovered the importance of your back and abdominal core muscle recruitment patterns. A normal order of deep, then intermediate and finally superficial muscle firing patterns is normally required for pain-free backs. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
Your osteopath may recommend a stretching program or a remedial massage to address your tight or shortened muscles. Below are some beginner disc relief exercises. Perform 3 sets 8-10 reps, holding end range for 2- 3 seconds. Please ask your osteo for further advice.
PHASE III – Restoring Full Function
As your back’s dynamic control improves, your osteopath will turn their attention to restoring your normal pelvic and spine alignment and its range of motion during more stressful body positions and postures. They’ll also work on your outer core and leg muscle power.
Depending on your chosen work, sport or activities of daily living, your osteopath will aim to restore your function to safely allow you to return to your desired activities. Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some, it is simply to walk around the block. Others may wish to run a marathon.
PHASE IV – Preventing a Recurrence
Back pain does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and core muscle exercises. You should continue a version of these exercises routinely a few times per week. Your osteopath will assist you in identifying the best exercises for you to continue indefinitely.
In addition to your muscle control, your osteopath will assess your spine and pelvis biomechanics and correct any defects. It may be as simple as providing you with adjacent muscle exercises or some foot orthotics from a podiatrist to address any biomechanical faults in the legs or feet.
General exercise is an important component to successfully preventing a recurrence. Your osteopath may recommend pilates, yoga, swimming, walking, hydrotherapy or a gym program to assist you in the long-term.
Fine tuning and maintenance of your back stability and function are best achieved by addressing any deficits and learning self-management techniques.
Body & Health Creation services:
North Melbourne osteopath
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Article by Dr. Robert Amato
Osteopath | Director