Often times, clients come in reporting a disc bulge or herniation in the lower back or
November 15, 2022
Often times, clients come in reporting a disc bulge or herniation in the lower back or neck, which may have been confirmed on a scan. Disc herniations do not necessarily manifest in back pain, however this is commonly the case which drives an individual to be referred for an MRI. Receiving the diagnosis of a disc bulge is not the end of the world, nor does it mean you can’t return to sport or physical activity. This article aims to clear up misunderstandings about disc bulges, and how Physio and Chiro can help disc herniations heal.
Discs are a type of soft tissue that sit in between the vertebrae of your spine. Their primary function is mechanical, since the continually transfer stresses generated by body weight and muscle activity across the spinal column. They make approximately one-third of the spinal column's height, and are major joints of the spine. They also allow bending, flexion, and torsion of the spine. (1)
A disc bulge however, occurs when the supportive structure of an intervertebral disc has been compromised, which can potentially cause the disc itself to press against and compress the nerve root. This nerve compression cau cause back pain, spasms, cramping, shooting pain, sciatica, numbness, pins and needles, or pain down your legs or arms.
The four stages of a disc herniation are: 1) disc protrusion 2) prolapsed disc 3) disc extrusion 4) sequestered disc. Although these stages can sound scary, most people are able to heal from the pain with conservative treatment such as Physiotherapy and Chiropractic, including the final sequestration stage. (2) It is also worth noting that it is common to have a disc bulge yet remain asymptomatic. In a study conducted by Nakashima et. al (2015) on 1211 healthy individuals (between the ages of 20-70 years), they found that 87u.6% of the subjects presented with disc bulge despite being asymptomatic. (3)
With the appropriate treatment and rehabilitation, most people can return to their pre-injury activity. Depending on an individual’s presentation, certain exercises may need to be reduced to allow the pain to improve, such as sit-ups, deadlifts and squats. However, McKenzie method exercises can actually help drive the pressure of the disc forward to pull the disc material back into the disc. It is not uncommon for disc bulges to resolve after appropriate rest and rehab.
The majority of individuals with a disc herniation do not require surgery. The symptoms of radiculopathy improve in approximately 9 out of 10 people with time, conservative treatment such as physiotherapy or chiropractic, and NSAIDS (non-steroidal anti-inflammatory drugs). Physiotherapy and Chiropractic will involve a thorough assessment to determine the affected vertebral level or levels, biomechanical dysfunctions, core strength and lifestyle factors that may have contributed to this condition. Our treatment then involves taking pressure off the affected disc by releasing compressive muscle spasms, gentle traction of the spine, and joint mobilisation/manipulation as required. Appropriate strength and stretching exercise are also added, depending on the biomechanical presentation of the individual.