Lumbar disc bulges are very common. Most people will develop one or more in their adult life, and often they won’t even know they have one. Because of this, they are sometimes referred to as “wrinkles of the spine”. In other words, they are a normal part of the aging process, and just like having wrinkles on your face doesn’t hurt, having a disc bulge doesn’t mean your back will hurt forever either. Yes, they most likely do hurt when they first happen, but then the pain goes away and as long as your flexibility, postural (core) control and strength returns, you will have a fully functional, pain-free, and strong back.
Anatomy
Your lumbar spine is made up of five vertebrae, that are a bit like cotton reels stacked on top of each other. Between the vertebrae are discs, which have a strong outer layer (annulus fibrosis), and a softer, shock-absorbing inner gel (nucleus pulposus). When the outer layer is injured and becomes inflamed, it can bulge outwards slightly because the inner gel pushes out where the tear has weakened the outer ring.
A quick note – lumbar disc bulges are sometimes referred to as a “slipped disc”. This is a factually incorrect and unhelpful term. Discs don’t slip out of position.
Symptoms
Lumbar disc bulges will cause low back pain that can be in the middle of your back, and more often to one side. The side the pain is on corresponds with the side the bulge is occurring on. The pain can also refer (travel) into the buttock on that side, and also down the back of the thigh - even all the way to the foot. Pins and needles or altered sensation can sometimes be present.
Pain from a lumbar disc bulge can be quite extreme. At first, it can be very distressing, and it can be hard if not impossible to stand straight. Some people have to crawl to furniture to pull themselves up. This can last for 2-3 days, and during this period it’s not worth seeking treatment, as the travel to and from the Physio will cause more pain and distress, and having hands-on treatment won’t lessen the pain.
However, with the right exercises and advice, pain from lumbar disc bulges will go down considerably at the three-day mark and resolve in two weeks. Stiffness and some soreness can last a few more weeks, but the immediate and severe pain won’t last if the sufferer has been diagnosed correctly and follows the right advice.
More severe disc bulges can “herniate”. This is where the inner gel squeezes out and “pinches” a nerve root (see the picture for this more severe version). Pain from this type of bulge can last for longer than two weeks, up to many months. It’s very important to note – if someone experiences pins and needles around their buttocks, can’t toilet because it feels like there’s no connection with their bowel or bladder, or have a floppy foot when they walk – they should present immediately to a hospital emergency department. Corrective surgery may be needed immediately to prevent permanent damage.
Crucially – there is no need for concern in the absence of these symptoms. A normal lumbar disc bulge as described above is very common, and with the right approach, the sufferer has a 100% resolution of the problem.
Physiotherapy Treatment
Physio treatment consists of the following:
Days 1-3
- Rest in bed and advice on analgesics
Days 3-14
- Resumption of normal activity – no resting in bed!
- Exercises to take the pressure off the disc bulge
- Hands-on treatment and exercises to restore flexibility to the legs and back
- Exercises to improve postural and core control of the back
- Advice to cease or modify certain activities at work and at home
- Advice to alter work station set-ups
Days 15+
- Flexibility, postural and core control exercise progressions
- Back and leg strengthening exercises commenced and progressed.
Successfully managing a lumbar disc bulge so that it doesn’t become a recurring problem incorporates strengthening the back to the point that it can handle anything it’s exposed to in work, home, and sporting life.
As well as physically strengthening the back, it’s paramount that the injured person has the knowledge and confidence that their back will fully heal. Amazingly, a negative mindset or belief that a person’s back pain will become an ongoing issue is the biggest predictor of an ongoing issue!
While everybody is different, there are a few exercises that are particularly helpful when dealing with lumbar disc bulges. If you’d like to see an example of the first best exercise to take the pressure off the disc (McKenzie extensions or cobras), improve the flexibility of the back (Lumbar rotations), and start working on postural or core control, check out our Instagram page.
If you are unsure about your pack pain - BOOK IN FOR A FREE INITIAL ASSESSMENT. Once the cause has been identified, a rehabilitation plan for you can be developed to get you back to your best.