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.
There are three common terms used in disc injuries – disc bulge, protrusion and herniation. 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 between the ages of 30 and 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.
Bulges occur when the nucleus pushes backwards and puts pressure at the back of the disc, causing it to bulge backward. Usually the bulge will cause pain as it stresses the back of the disc and the surrounding layer of ligament. If the bulge is large it may put pressure on the nerves. Protrusion occurs when the nucleus puts more pressure backwards and tears some fibres of the annulus. The nucleus moves further backwards but not fully through the annulus. Herniation occurs when part of the nucleus squeezes out through the damaged annulus. This produces significant pain and often causes pressure on the nerve.
At first you may only experience a dull pain centred in the neck. This is mainly due to pressure on the annulus. Throbbing pain in the neck may be felt due to inflammation produced by the body in response to the disc bulge. A disc bulge can press against a spinal nerve, producing symptoms of nerve compression. This can include pain, pins-and-needles and numbness. Symptoms follow known patterns through the body and may be felt in the shoulder, arm, or even the fingers. More significant nerve pressure can cause a reduction in your reflexes, and the muscles that are supplied by that nerve may become weak.
If a disc bulge is left untreated, symptoms will continue to persist. If the disc is pressing on a nerve and treatment is delayed then more significant (and in some cases permanent) nerve damage can result. Early treatment is vital in these cases otherwise permanent damage is much more likely. In severe cases surgery may be required.
People with disc bulges also commonly alter their posture to help with the pain. These changes increase the likelihood of other structures being damaged as the change in posture causes changes in pressure to other areas of the body not used to handling such pressure.
Depending on the severity of the disc bulge recovery can range from 4 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 patients describe. By reducing inflammation your physiotherapist is able to work a lot more intensively on your neck to restore any lost movement you may have developed or continued discomfort you are having.
Techniques your physio may use to manage your inflammation include specific local massage and soft-tissue releases, joint mobilisations, postural correction techniques and occasionally traction. Taping can be used to help support muscles, and we may also suggest that you see your GP to receive a prescription for some antiinflammatory medication. We will also talk to you about activities to modify or avoid to help your pain settle as quickly as possible.
Cervical disc bulges result in the joints and vertebrae in your neck becoming less mobile leading to stiffness and restricted movement. Without correcting this joint stiffness you will not regain your full range of movement and a return to your normal lifestyle will be difficult. Without treating the less mobile joints, the risk of re-injuring your neck is increased as the body will have to compensate in other areas to avoid the stiff segments.
Techniques your physio may use to correct the joint stiffness and restricted range of motion include deeper joint mobilisations, stretching and soft tissue massage. You will also be guided through exercises for home and work to help you recover as fast as possible.
Your body often changes the way it moves to compensate for the pain produced by the disc bulge. Although this can be helpful in the short term, in the long term it can be very detrimental. It can lead to loading of other weaker structures not normally used to handling stress. This increases the risk of injury to other areas of your neck and to other parts of your body.
Techniques your physio may use to help re-educate your movement patterns include core stability exercises, stretching and postural control exercises. Your physio will often use video feedback or a mirror for these exercises to allow you to see how you should be performing the exercise and help you consistently perform them correctly. Hands-on treatment to fully restore your joint movement and muscle length will continue.
This is one of the most important steps to ensuring full recovery from a cervical 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 neck 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, deep neck flexor muscle retraining and exercise to build you core strength.
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.