Back Slipped Disc
Bulged Disc, Disc Herniation, Disc Rupture
Your back may suffer an injury to the intervertebral disc that can have numerous terms describing mild to severe disc injuries. This article will hopefully explain the differences between the various descriptions used to variations of disc injuries.
What is a Bulging Disc?
A bulging disc injury is a common spine injury sustained to your spine’s intervertebral disc. It can occur in your lumbar spine (lower back), thoracic spine (upper and mid-back) or your cervical spine (neck).
A bulging disc commonly describes a slipped disc or a protruding disc. However, when the disc bulge is significant enough for the disc nucleus to come out of the annulus, it is known as a herniated disc. See diagram.
What is a Spinal Disc?
Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs.
The outer section of the spinal disc is the annulus. It consists of multi-directional fibrocartilaginous fibre layers. That are all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus.
The degree of spinal disc injury varies considerably from mild disc strains or internal derangements, mild-moderate-severe disc bulges through to complete disc rupture and herniation of the nucleus through the annular wall.
The fluid component, or disc nucleus, in the disc centre, is like the caramel inside a bar of chocolate. It usually moves within the annulus, adjusting to the pressures placed on your spine.
However, if you injure the annulus, the wall weakens, and the nucleus can press outwards on the weakened disc wall, causing your disc to bulge outwards.
A disc bulge (commonly referred to as slipped disc) can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs.
What Causes a Bulging Disc?
When a bulging disc, disc herniation or disc rupture occurs, it is typically due to either:
- a pre-existing weakness in the annulus, or
- a sudden increase in pressure through the disc causing fibres of the annulus to tear.
You can group the causes of a spinal disc injury under three headings:
1. Accumulated Microtrauma
Repeated microtrauma over an extended period can lead to disc injury. The best example of accumulated micro trauma is poor posture.
Poor posture when sitting, standing and working, stresses your spine. Sustaining a slouching or forward bending of your spine leads to overstretching and weakness of the posterior fibrocartilage (or annulus) of the spinal discs. Over time, this leads to poor disc integrity and displacement of the disc nucleus fluid posteriorly. This displacement places your spinal joints and nerves under pain-causing pressure.
Your aim to continually maintain a good position includes regular postural change.
During your initial efforts to retrain a good posture, poor muscle endurance and posture awareness predisposes you to sag back into your old habits. In these instances, it is useful to note that supportive posture devices such as a lumbar roll, Basset spine support, kinesio taping or a back brace are available to help you maintain a lordotic curve to your lumbar spine during this transition phase.
You should regularly alter any sustained posture to allow your spine to move and remain healthy.
2. Sudden Unexpected Load
Sudden unexpected load to the intervertebral discs can also occur in traumatic situations, e.g. a motor vehicle accident. This excessive load may occur due to the nature of the sudden forces exerted through your body at the time of impact, and your body attempts to repel those forces.
Unexpected load or torsion of a disc can result in tearing of the annulus fibres and hence a disc injury. You should always lift any amount of weight using the correct postural lifting principles. Using poor lifting techniques, such as bending forward and pulling with your back may result in sudden and unexpected loading of the disc.
Ask your physiotherapist about these principles.
3. Genetic Factors
Spinal disc injury does have a genetic predisposition. The deficiencies discovered include a lesser tissue density and increased elastin component of the fibrocartilaginous fibres. These make up the annulus of the intervertebral disc. Other factors that may play a role could be environmental – such as excess abdominal fat, poor core stability, reduced lower limb strength, nature of occupation (e.g., heavy physical load versus light or no physical pressure).
Overall, genetic factors are mild to a moderate contributing factor in disc injuries, and if one does sustain a disc injury, it is rarely ‘genetic’. And you can’t change your genetics. All you can do is be more diligent in your back injury prevention.
Bulging Disc Symptoms
A bulging disc injury is suspected when your back pain is aggravated by:
- forward bending
- coughing or sneezing
Sciatica, leg pain, pins and needles, numbness or weakness, are commonly associated with more severe disc pathologies.
Altered bladder and bowel function can indicate a severe disc pathology, which should prompt immediate medical assessment.
How is a Bulging Disc Diagnosed?
Your physiotherapist or doctor will suspect a spinal disc injury based on the history of your injury and your symptom behaviour. Your physiotherapist will perform clinical tests to confirm a spinal disc injury and detect if you have any signs of nerve compression. The most accurate diagnostic tests to confirm the extent of your spinal disc injury are MRI and CT scans.
MRI scans often identify a disc bulge. X-rays do not show acute disc bulging. However, X-rays can show signs of chronic disc injury such as degenerative disc disease and disc narrowing.
Bulging Disc Treatment
Most minor and moderately bulging disc injuries are treated conservatively without the need for surgery. Torn fibres of the annulus will heal and the disc bulge to usually resolve fully. While this occurs, your bulging disc treatment centres on encouraging the fluid to return and remain in the centre of the disc. This rehabilitation keeps the torn fibres closer to one another and the structure of the annulus as healthy as possible.
Your physiotherapist will advise you on the best positions to stay in and may tape or brace your spine. They’ll also explain to you the postures to avoid, which can be detrimental to your recovery.
By maintain the disc fluid in the central position that you intend it to stay, you are helping Mother Nature to lay down its scar tissue optimally for an excellent long-term solution. Please remember that scar tissue formation will take at least six weeks, so the longer that you avoid aggravating postures, the better!
PHASE I – Pain Relief & Protection
Managing your pain is usually the main reason that you seek treatment for a bulging disc. In truth, it was the final symptom that you developed and should be the first symptom to improve.
You are managing your inflammation. Inflammation is the primary short-term reason for why you have suddenly developed bulging disc symptoms. It best reduced via ice therapy and techniques or exercises that unload the inflamed structures.
Your physiotherapist will use an array of treatment tools. They aim to reduce your pain and inflammation. These treatment modalities may include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage, gentle exercise and temporary use of a back brace. Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
PHASE II – Bulging Disc Exercises
As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal joint alignment and range of motion, muscle length and resting tension, muscle strength and endurance.
Your physiotherapist will commence you on a lower abdominal and core stability program to facilitate your important muscles that dynamically control and stabilise your spine.
Researchers have discovered the importance of your back and abdominal core muscle recruitment patterns. Standard recruitment order of your deeper muscles, then intermediate and finally, superficial muscle firing patterns are typically required to prevent back pain. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you, specific to your needs.
Your physiotherapist may recommend a stretching program or a remedial massage to address your tight or shortened muscles. Please ask your physio for their advice.
PHASE III – Restoring Full Function
As your back’s dynamic control improves, your physiotherapist will turn their attention to restoring your normal pelvic and spine alignment and its range of motion during more stressful body positions and postures. They’ll also work on your outer core and leg muscle power.
Depending on your chosen work, sport or activities of daily living, your physiotherapist will aim to restore your function to allow you to return to your desired activities safely. Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some, it is merely to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.
PHASE IV – Preventing a Recurrence
Back pain does tend to return. The main reason back pain recurs is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and core muscle exercises. You should continue a version of these exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best activities for you to continue indefinitely.
In addition to your muscle control, your physiotherapist will assess your spine and pelvis biomechanics and correct any defects. It may be as simple as providing you with adjacent muscle exercises or some foot orthotics to address any biomechanical faults in the legs or feet.
General exercise is a vital component to successfully preventing a recurrence. Your physiotherapist may recommend pilates, yoga, swimming, walking, hydrotherapy or a gym program. These modalities all appear to help back pain. Exercise will assist your back pain relief in the long-term.
Bulging Disc Exercises
You physiotherapist will prescribe the best bulging disc exercises. They will consider your disc bulge location, size, neurological symptoms and the acuteness of your symptoms. Please follow their recommendations as they guide you from back pain and back towards your healthy life.
Fine-tuning and maintenance of your back stability and function are best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.
Bulging Disc Recovery Time
Unfortunately, bulging disc injuries are usually not a quick fix. Most bulging disc injuries do take several weeks, or even months, to settle.
Bulging discs will also remain weak and vulnerable for at least six weeks, sometimes longer. However, the good news is that most bulging disc injuries will not remain painful for that period. These lingering back sufferers tend to be inadequately managed disc injuries in the early phase.
The best thing you can do for a suspected bulging disc is to seek professional advice. After your assessment, your back physiotherapist or doctor will be able to provide you with what they would anticipate is your bulging disc recovery time.
What Happens if a Bulging Disc Goes Untreated?
Even if you don’t seek professional treatment, nature will naturally attempt to heal your bulging disc. While professional spinal care may fast-track your recovery, most instances of mild bulging discs will heal naturally and may not require treatment. However, patients suffering from a bulging disc commonly seek quicker pain relief. In these instances, please seek out the professional advice of your trusted spinal healthcare practitioner.
When is a Professional Opinion Recommended for Bulging Disc?
1. Loss of Bladder or Bowel Function. There are some bulging disc cases where professional care is essential. In some cases, such as when you lose bowel or bladder control, it is deemed an emergency, and you may require immediate surgery. These bulges usually are very significant and affect your nerve control involving your bladder or bowels. You should go straight to your nearest emergency department in these instances.
2. Weakness in your limb muscles is a significant concern. If you experience arm, hand, leg or foot weakness, please seek prompt medical assessment.
3. The reduced or altered sensation is your next priority. Mild disc bulges can reduce your ability to feel things touching you, e.g. numbness or pins and needles. If you experience any of the above symptoms, you should seek professional assistance.
4. Referred Pain. Pain in your limbs, e.g. legs (sciatica) or arms (brachialgia) is usually a more significant injury that when experiencing only spinal pain. We recommend that you seek the professional advice of your trusted spinal care practitioner.
5. Spinal Pain. Interestingly, if you are only experiencing spinal pain, bulging discs are generally mild injuries and the most likely to rehabilitate quickly. Please adhere to low disc pressure postures and exercise accordingly. If in doubt, please seek professional advice.
Spinal Disc Surgery
Surgery is occasionally required. Surgery is an option when a conservative (non-operative) approach does not settle your leg pain. While surgery is usually a last resort, an exception is emergency decompression. Surgical decompression occurs when severe nerve compression is affecting the function of your bowel or bladder. Or, if you experience significant muscle weakness, e.g. foot slap or drop.
Persisting symptoms over six months may require the attention of a surgeon who specialises in treating back pain and sciatica. Please remember, if you have severe symptoms such as bowel or bladder dysfunction or extreme muscle weakness, you may require emergency surgery. Please head straight to an emergency department.