Article by John Miller
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.
What is a Spinal Disc?
Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies, while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs.
The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus.
The degree of spinal disc injury varies considerably from mild disc strains or internal derangments, mild-moderate-severe disc bulges through to complete disc rupture and herniation of the nucleus through the annular wall.
The fluid component, or disc nucleus, in the disc centre is like the caramel inside a chocolate. It normally moves within the annulus adjusting to the pressures placed on your spine.
However, if you injure the annulus, the wall weakens and the nucleus can press outwards on the weakened disc wall, causing your disc to bulge outwards.
A disc bulge (commonly referred to as slipped disc, can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain into your legs.
What Causes a Bulging Disc?
When a bulging disc, disc herniation or disc rupture occurs, it is typically due to either:
The causes of disc injury can be summarised under three headings:
1. Accumulated Microtrauma
Repeated microtrauma over an extended period can lead to disc injury. The best example of accumulated microtrauma is poor posture.
Poor posture when sitting, standing and working stresses your spine. Sustaining a slouching or forward bending of your spine leads to overstretching and weakness of the posterior fibrocartilage (or annulus) of the spinal discs. Over time, this leads to poor disc integrity and displacement of the disc nucleus fluid posteriorly. This places your spinal joints and nerves under pain-causing pressure.
To decrease the effect of poor posture on your spine it is important to continually attempt to a maintain a good posture or even better, regularly change your posture.
During your initial efforts to retrain a good posture, poor muscle endurance and posture awareness predisposes you to sag back into your old habits. In these instances, it is useful to note that supportive posture devices such as a lumbar roll, Basset spine support, kinesio taping or a back brace are available to help you maintain a lordotic curve to your lumbar spine during this transition phase.
Any sustained posture should be regularly altered to allow your spine to move and remain healthy.
2. Sudden Unexpected Load
Sudden unexpected load to the intervertebral discs can also occur in traumatic situations, ie: a motor vehicle accident. This may happen due to the nature of the sudden forces exerted through your body at the time of impact and your bodies attempt to repel those forces.
Unexpected load or torsion of a disc can result in tearing of the annulus fibres and hence a disc injury. You should always lift any amount of load using the correct postural lifting principles. Using poor lifting techniques, such as bending forward and pulling with your back may result in sudden and unexpected loading of the disc.
Ask your physiotherapist about these principles.
3. Genetic Factors
As with many conditions spinal disc injury is considered to have a genetic predisposition.
Those suggested to be susceptible are people who are known to have a lesser density of and increased elastin component of the fibrocartiliginous fibres, which make up the annulus of the intervertebral disc. Other factors that play a role are more environmental in nature – such as excessive abdominal fat, poor core stability, poor lower limb strength, nature of occupation (ie: heavy physical load versus light or no physical load).
Overall, genetic factors are a very minor contributing factor in disc injuries and if one does sustain a disc injury it can almost never be put down to ‘genetic factors’. And, let’s be honest, you can’t change your genetics. All you can do, is be more diligent in your back injury prevention.
Bulging Disc Symptoms
A bulging disc injury is suspected when your back pain is aggravated by:
Sciatica, leg pain, pins and needles, numbness or weakness are commonly associated with more severe disc pathologies.
Altered bladder and bowel function can indicate a severe disc pathology, which should prompt immediate medical assessment.
How is a Bulging Disc Diagnosed?
Your physiotherapist or doctor will suspect a spinal disc injury based on the history of your injury and your symptom behaviour. Your physiotherapist will perform clinical tests to confirm a spinal disc injury and detect if you have any signs of nerve compression. The most accurate diagnostic tests to confirm the extent of your spinal disc injury are MRI and CT scans.
In the MRI show, a disc bulge can be identified. X-rays do not show acute disc bulging. However, X-rays can show signs of chronic disc injury such as degenerative disc disease and disc narrowing.
Bulging Disc Treatment
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.
Your physiotherapist will advise you on the best positions to stay in and may tape or brace your spine. They’ll also explain to you the postures to avoid, which can be detrimental to your recovery.
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 deload the inflammed structures.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include: ice, electrotherapy, acupuncture, deloading 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 settles, your physiotherapist will turn their attention to restoring your normal joint alignment and range of motion, muscle length and resting tension, muscle strength and endurance.
Your physiotherapist 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 physiotherapist may recommend a stretching program or a remedial massage to address your tight or shortened muscles. Please ask your physio for their advice.
PHASE III - Restoring Full Function
As your back’s dynamic control improves, your physiotherapist 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 physiotherapist 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 be simply to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.
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 physiotherapist will assist you in identifying the best exercises for you to continue indefinitely.
In addition to your muscle control, your physiotherapist 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 to address any biomechanical faults in the legs or feet.
General exercise is an important component to successfully preventing a recurrence. Your physiotherapist 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 is best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.
What is the Prognosis for Spinal Disc Injury?
Unfortunately bulging disc injuries are usually not a quick fix. Most bulging disc injuries do take several weeks to settle.
They will also remain weak and vulnerable for at least six weeks, sometimes longer. However, the good news is that most bulging disc injuries will not remain painful for that time period - but some do - and these tend to be the disc injuries that are poorly managed in the early phase.
Spinal Disc Surgery
Surgery is occasionally required when your leg pain does not settle with a conservative (non-operative) approach.
Persisting symptoms over six months may require the attention of a surgeon who specialises in treating back pain and sciatica. If you have some severe symptoms such as bowel or bladder dysfunction or extreme muscle weakness you may require emergency surgery.
Please check with your physiotherapist or doctor for their professional opinion.
Common Bulging Disc Treatment Options
FAQs about Bulging Disc Injury
Helpful Products for Bulging Disc
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