LOW BACK PAIN - DISC BULGES

(Herniated disc, prolapsed disc, ruptured disc, disc protrusion, disc disease, disc degeneration, degenerative disc disease)

Disc bulges are a common cause of back pain in the adult population. This can be caused by an acute traumatic incident or wear and tear on the disc over time. An intervertebral disc sits between each vertebrae of the spine. The disc is made of an outer strong fibrous ring (annulus fibrosis) and an inner softer core (nucleus pulposes). The core changes shape during movement to absorb shock forces. If the outer layer becomes torn, the jelly-like core can protrude outside, causing a disc bulge.

As the lower levels of the spine carry a heavier load than the upper ones, they undergo more stress. Hence the lowest disc of the spine (L5/S1) is most commonly affected with the disc above (L4/L5) the second most common.

Causes of a lumbar disc bulge

A traumatic incident such as a motor vehicle accident or lifting a heavy object may forcefully cause a disc bulge. However, most disc bulges are an accumulation of repetitive, forceful or prolonged stressors over time causing delayed inflammatory disc pathologies. These stressors include

• Bending forward
• Prolonged sitting in a poor posture 
• Lifting and/or twisting

Interestingly, some patients can get a disc bulge following a minor movement such as bending to pick up a piece of paper or sneezing. In these instances, the disc has normally been subject to repetitive or prolonged bending, sitting or lifting forces leading up to the incident.

Other causes of disc bulges include:

• Poor core stability to support the lumbar spine
• A sedentary lifestyle causing muscle weakness and tightness
• Being overweight
• Poor lifting technique
• Poor posture

Signs and symptoms of a lumbar disc bulge

Acute disc bulge patients commonly complain of:

• Sudden onset of severe back or leg pain
• Very limited back movement
• Pain with coughing, sneezing, sitting to standing
• Occasionally, listing their posture to one side

 Delayed inflammatory onset disc bulge patients commonly complain of:

• Gradual or delayed onset of diffuse back or leg pain- generally the day after the aggravating activity
• Limited back movement
• Pain in the morning

 Both patients can complain of sciatica symptoms, especially if the disc is compressing on the nerves that exit at the vertebrae and go down the legs. These symptoms include pain, pins and needles, numbness or weakness typically going down one leg. In severe cases the sciatica symptoms can be present in both legs.

Diagnosis

A physioFIX physiotherapist can help diagnose a lumbar disc bulge based on your history, symptoms and presentation. Investigations such as x-rays, CT scans or MRI scans can sometimes be used to supplement a physiotherapy assessment.

Treatment for a lumbar disc bulge

The majority of lumbar disc bulge patients make a quick full recovery with appropriate physiotherapy and do not require surgery.

Firstly it is important to avoid any activities that aggravate your back pain, such as sitting, bending forwards and lifting. You should avoid sitting for more than 15 minutes at a time. If you do need to sit, sit with a good posture (see Tips for Healthy Computer Use). Typically, lying down with your back straight, small periods of standing and walking, and back stretches will help with your pain. Consult your doctor or pharmacist about pain relief medications if necessary. You can use a heat pack to help reduce muscle spasm. All these activities will help your body recovery and minimize further protrusion of the disc.

The following physiotherapy techniques can help with disc bulge:

• Gentle mobilizations of the lumbar spine
• Massage to reduce muscle spasm
• Stretches (commonly into back extension)
• Gentle mobilization exercises- knee rocking, knee to chest
• Electrotherapy
• Acupuncture
• Core stability strengthening including Pilates
• Hydrotherapy
• Postural taping
• Postural and activity advice

With appropriate physiotherapy, symptoms typically take 2-3 weeks to start to settle. However, it takes approximately 6 weeks for the damaged tissue to heal to about 80% of its original strength.

Other interventions for a Lumbar Disc Bulge

Despite appropriate physiotherapy management, some disc bulges fail to improve and may require other investigations and treatment. Generally it is advisable to attend at least 6 weeks of physiotherapy treatment before seeking specialist advice. However, if you experience constant prolonged or worsening severe pain symptoms limiting movement, loose bladder or bowel control, or have paraesthesia in your private areas due to your disc bulge, you may require emergency surgery.