This article will explore the physiotherapy treatment options for bulging discs.
First it helps to understand the anatomy of the spinal disc..
What is a Spinal Disc?
Spinal discs are the shock absorbing rings of fibrocartilage and glycoprotein that separate the vertebral bones.
They allow movement at each spinal level, and help to create enough room for the major spinal nerves to exit from the spinal canal (just behind the discs) and travel to your limbs.
The disc has an outer layer called the annulus fibrosus. The annulus is made up of several layers of fibres that are densely packed to create a wall around the inner part of the disc.
The inner part is called the nucleus pulposus and is a jelly-like glycoprotein. It is similar to the caramel inside a chocolate. It normally moves within the annulus adjusting to pressures that are placed on your spine.
What is a Bulging Disc?
Injuries to the disc occur when the annulus fibrosus (outside) is impacted (the wall of the chocolate weakens) and the nucleus (caramel) can press outwards on the weakened disc wall. This is referred to as a bulging disc.
This ‘buldge’ can potentially press against or irritate the nerve where it exits from the spine.
What are the common Symptoms?
Typical symptoms of a bulging disc can include:
- Back pain
- Pins and needles
- Or pain in the legs
Usually, pain is aggravated by: sitting, forward bending, coughing or sneezing, lifting.
What Causes a Bulging Disc?
Injury to the disc is typically due to either:
- A pre-existing weakness in the annulus.
- Accumulated microtrauma: for eg poor posture – sustaining a forward bend of the spine can lead to overstretching and weakness of the posterior walls of the discs. Over time this can lead to poor disc integrity and displacement of the fluid posteriorly.
- A sudden increase in load: eg poor lifting technique can exert pressure through the disc causing fibres of the annulus to tear.
How to Treat Spinal Disc Injuries?
Most minor and moderately bulging disc injuries are treated conservatively without the need for surgery.
Conservative treatment is centred on encouraging the fluid to return and remain in the centre of the disc. This keeps the torn fibres of the annulus closer to one another, promoting healing. Physiotherapy programs include:
Avoid Aggravating Positions
- Adopting positions that help to maintain the disc fluid in the central position allows scar tissue to be laid down at the healing site. Aggravating positions disrupt this process!
- Safe postures and physiotherapy taping can assist with this.
Pain Relief and protection
- Reduction in pain is best achieved through reduction in inflammation. Inflammation around the site is the main short-term reason for the sudden development of disc symptoms.
- Soft tissue massage, ice, electrotherapy, dry needling, traction and unloading taping techniques are examples of physiotherapy techniques used.
- As pain and inflammation settles, restoring your normal range of motion, muscle length, strength and endurance becomes of vital importance.
- The deep lower abdominal muscles dynamically control and stabilise the spine. Therefore, their correction functioning is a significant facilitator for pain-free back movement. A graduated exercise program incorporating core strengthening and lower back and gluteal stretching is the best approach.
Restoring Full function
- The focus then turns to more functional and stressful body positions and postures. Each person is different, and in accordance to their goals, outer core and leg strengthening exercises can be used to return you safely to your desired activities.