What is a disc bulge, is it causing your pain and how can you fix it?
What is an intervertebral disc?
The intervertebral disc is a spongy tissue, which sits between each spinal vertebrae (see the picture below). It allows movement of the spine while also acting as a shock absorber.
What is a disc bulge (or herniation)?
A condition known as a disc bulge (also referred to as a 'slipped' disc) is when the soft, jelly-like contents inside the disc bulges or pushes towards its outer edges, sometimes causing back pain. This bulge can also press on a nerve causing nerve pain. The terms bulge and herniation are sometimes used interchangeably, however a herniation should be considered a more severe injury as the disc contents with a herniation push through the disc's the outer edges.
How do I know if the disc is the cause of my pain?
Although no test is 100% accurate, a thorough physiotherapy assessment can help to give a very good indication of the pain source. Your symptoms also provide clues as to whether the discs are the cause of your pain. Common symptoms can include:
Pain when bending forwards
Pain with prolonged sitting
Pain with lifting
Pain with coughing and sneezing
Pain and stiffness which is worse when first waking in the morning
Pain, tingling, numbness down the leg, indicating the possibility of a bulge or herniation pressing on a nerve
Not all disc bulges are painful!
While physiotherapy tests are helpful, scans (MRI or CT) can identify with good accuracy if a disc bulge exists. It is however very important to realise not all disc bulges or herniations are symptomatic! This raises the question of whether a scan is necessary- a discussion which you should have with an experienced physiotherapist. Note the following study by Boden and colleagues in 1990 to demonstrate my point.In a group of 67 people who had never had low back pain or sciatica, about one-third had substantial abnormality on MRI scans, including disc bulges and herniations. This shows us that just because a disc bulge or herniation is present, it does not always mean that there will be associated pain.
Other causes of low back pain to consider:
Ligaments (strong bands that link bones together)
Muscles (connect to the bones to move the joints)
Bone (provides structure from which the muscles attach and the joints are formed. Also protects the nerves exiting from the spinal cord)
Referred pain from the surrounding organs or arteries
Stress! Note that stress can exacerbate pain from a current or previous injury in a number of ways, including by making the surrounding nerves more sensitive.
Disc injuries in athletes
A great study was done by Wasserman and colleagues in 2017 investigating the lower backs of 100 athletes at the 2016 Beijing Olympics. MRI scans showed 52% had moderate to severe 'spinal disease' including moderate to severe degenerative disc changes with varying degrees of disc bulges and herniations. Weightlifting and aquatic diving had the highest incidence of low back pathology on MRI amongst competing athletes. This further demonstrates that not all disc bulges are symptomatic and it is possible to perform at the highest level with disc bulges and herniations!
If your disc IS the source of your pain, will it heal?
A disc bulge or herniation certainly can be a significant source of pain, particularly if it is pressing on a nerve. This is often referred to as 'sciatica', and can result in pain, tingling, numbness and weakness down the leg into the foot. If this is the cause of your pain, will the disc heal?
A study by Zhong and colleagues in 2017 showed 2/3rds of disc herniations will heal and reabsorb into the disc
A bulge or herniation can remain visible on a scan but become asymptomatic, meaning a much greater number than 2/3rds will recover with appropriate conservative (non-surgical) treatment
6 things you can do if you have back pain (with or without a symptomatic disc injury)
There are many things you can do to help reduce pain and encourage healing if you have a symptomatic disc injury, or any other low back injury. These include:
Finding and modifying any potentially aggravating activity. E.g. sitting or lifting with poor posture
Staying active. Appropriate, pain free movement and light physical activity will help with your recovery
Avoiding sustained postures, especially sitting! Sitting in one position, regardless of if your posture is perfect, for a long period of time (>20 minutes) without getting up and moving will be detrimental to your recovery
Improving the flexibility of tight and short muscles around your hips, legs and lower back
Improving the strength of weak muscles around your lower back/core, hips and legs
Improving your lower back control and awareness. Click here to find out about one great way you can improve your lower back awareness.
In many instances, an episode of low back pain will subside in time with appropriate rest, however if you are experiencing your first ever episode of back pain, or you have had repeated episodes and have never been assessed by an experienced physiotherapist to address the above mentioned factors, an assessment is certainly worthwhile to speed up your recovery and reduce the risk of recurrence! An assessment will identify which muscles are tight, short or weak, and specific exercises can then be prescribed to address these problems. You will also be coached on improving your posture and work ergonomics if relevant.
If you would like to speak to a physio at ProSport to organise an assessment, or to ask questions and discuss your particular problem, you can call us at 0415 889 903, send us an email at email@example.com or book online by clicking HERE. We are happy to have a no-obligation free discussion about your problem and how we can help you!