This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
Although people often refer to a disc bulge as a slipped disc, the disc doesn’t actually slip out of place. Rather, the terms bulge, protrusion or herniation means that the material at the centre of the disc has squeezed out of its normal space. This condition usually affects people aged 30-40.
Intervertebral discs separate your spinal bones – the vertebrae. They are made of connective tissue which is the material that holds the living cells of the body together, and are made of 2 parts. The centre, called the nucleus, is a spongy gel-like substance which can move. It provides most of the disc’s ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Healthy discs work like shock absorbers to cushion the spine. They protect the spine against the daily pull of gravity, and also during strenuous activities that put strong forces on the spine such as jumping, running and lifting.
Bulging occurs when the nucleus pushes backwards, and puts pressure at the back of the disc, causing it to bulge backward. This causes pain in the disc as it stresses the back of the annulus and if the bulge is large it may put pressure on the nerves. Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand this pressure. However, vigorous repetitive bending, twisting, lifting or prolonged sitting can put more pressure backwards on the disc than it is able to absorb. This can cause tearing at the back of the annulus which allows the nucleus to partially push through the annulus, causing pain, possible nerve compression (sciatica) and other problems.
At first, you may only experience a dull pain centred in the low back that comes and goes over a period of a few years. This is mainly from small tears in the annulus. A larger disc bulge may cause immediate back pain, and also may cause sharp pain that shoots from your back down part or all of your leg. This is commonly called “sciatica” and comes from nerves in your spine being squashed. As well as pain, you may feel numbness, pins-and-needles or weakness. These are signs that you really need to get treatment ASAP because possible nerve damage can result, and in some cases this may be permanent.
If a disc bulge is left untreated, symptoms will continue to persist. If the bulge is pressing on a nerve and treatment is delayed the nerve may not fully recover or can take a lot longer to recover than if treatment is commenced promptly. This may result in weakness in your legs, or altered sensation such as pins-andneedles or numbness. People with disc bulges also alter their posture to help with the pain. Without treatment these postures become habit and eventually lead to long term postural changes. These changes increase the risk of other structures being damaged as the change in posture causes changes in pressure to other areas of the body that are not strong enough to handle these changes.
Depending on the history and severity of the disc bulge, recovery can range from 6 weeks to several months. Receiving treatment promptly when symptoms appear will reduce the recovery period.
Your physio has been extensively trained to thoroughly assess and diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Reducing the inflammation associated with a disc bulge can help to take away that initial ‘throbbing’ pain many clients describe. By reducing inflammation your physiotherapist is able to work a lot more intensively on your back in restoring any lost movement you may have developed or continued discomfort you are having.
Lumbar disc bulges result in the joints and vertebra in your back becoming less mobile leading to stiffness and restricted movement. Without correcting this joint stiffness you will not regain your full range of movement, making a return to your normal lifestyle difficult. Without treating the stiff joints the risk of reinjuring your back is increased as the body will have to compensate in other areas to avoid the stiff segments.
Your physio may use techniques including stretches, muscle and soft-tissue releases, and specific exercises to help regain your flexibility.
Some movement patterns predispose you to having initial, perisiting or recurrent disc problems. Correcting these is essential if you are to achieve lasting recovery and freedom from pain.
As well as some incorrect movement patterns increasing your risk of having disc injuries, your body often changes the way it moves to compensate for the pain produced by the disc problem. Although this can be helpful initially, in the long term it can be very detrimental. These ‘new’ postures can become habit and hard to change. They can lead to increased loading of other weaker structures and this increases the risk of injury to other areas of your back and to other parts of your body.
This is one of the most important steps to ensuring full recovery from a lumbar disc bulge. Restabilising means re-training the muscles in your body that help to keep your spine strong and stable. Research has shown that your stabiliser muscles are the first muscles to switch off when you get back pain. If these muscles switch off and are not properly re-trained they lose their conditioning, become smaller and weaker, and your chance of a full recovery is limited. By re-stabilising your spine you are able to move more efficiently and the risk of re-injury is greatly reduced.
Techniques your physio may use to help re-stabilise your spine include Clinical Pilates, Exercise Physiology, light functional strengthening, swiss-ball exercises and a specific core strength program.
Once you are familiar with the exercises required to restabilise your spine your physio will then progress you to more advanced exercises specifically aimed at your activity or sport of interest. For muscle strengthening to be effective the muscles need to be strengthened in the specific way to how they will be used during your daily activities. This phase involves building your spinal strength to comfortably handle the heavier loading and fatiguing demands of sport and exercise.
Many clients find that seeing one of our Exercise Physiologists, Strength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your spinal strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.