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 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. They 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. The mild-moderate-severe disc bulges through to complete disc rupture and herniation of the nucleus through the annular wall.
The disc centre, the fluid component, or disc nucleus, is like the caramel inside a chocolate bar. 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’s 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 spinal discs’ posterior fibrocartilage (or annulus). Over time, this leads to inadequate 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, low 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.
It would be best to 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., motor vehicle accidents. 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 a disc injury. You should always lift any amount of weight using the correct postural lifting principles. Using unsafe lifting techniques, such as bending forward and pulling with your back, may result in sudden and unexpected disc loading.
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 factors such as excess abdominal fat, poor core stability, reduced limb strength, and the nature of occupation (e.g., heavy physical load versus light or no physical pressure).
Overall, genetic factors are mild to moderate contributing factors 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. They will base your diagnosis upon 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 identify your spinal disc injury’s extent 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 usually resolves 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 annulus’ structure as healthy as possible.
Your physiotherapist will advise you on the best positions to stay in and potentially tape or brace your spine. They’ll also explain to you the postures to avoid, which can be detrimental to your recovery.
Maintaining the disc fluid in the central position you intend to stay in, you help Mother Nature 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 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 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 superficial muscle firing patterns are typically required to prevent back pain. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises 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 daily living activities, 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.
Your physiotherapist will assess your spine and pelvis biomechanics and correct any defects in addition to your muscle control. 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
Your 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 maintaining your back stability and function are best achieved by addressing 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. It would be best if you went 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 than 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 are most likely to be rehabilitated 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 that you may need emergency surgery if you have severe symptoms such as bowel or bladder dysfunction or extreme muscle weakness. Please head straight to an emergency department.
Common Lower Back Pain Causes
The following conditions may cause lower back pain.
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
- Side Strain
- Back Stress Fracture
- Scheuermann's Disease
- Spinal Stenosis
- Stress Fracture Spine (Cricket Bowlers)
Back Joint Injuries
Youth Spinal Pain
Teenager Neck & Back Pain
Teenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control.
The competitive athlete and most individuals who exercise regularly or maintain fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Your physiotherapist can assist in the resolution of any deficits in this area.
Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.
Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these types of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor.
What is Back Muscle Pain?
Back muscle pain or its aliases: pulled back muscle, back muscle spasm, torn back muscle or back muscle strain, is very common. Back muscle pain is the most common source of back pain. The good news is that it is also one of the quickest to heal and rehabilitate.
What Causes Back Muscle Pain?
Most causes of low back pain are muscle, ligament or joint-related. Commonly, these muscular strains, ligament sprains and joint dysfunction arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes.
The causes of pure back pain are numerous but roughly fall into the following categories.
Back Muscle Strains
Muscle pain is the most common source of back pain. Muscle fatigue, excessive loads or poor lifting or sitting postures are the most common problems.
Inefficient, weak, or back muscles that lack endurance or normal contraction timing can lead to reduced joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.
Poor posture, when sitting, standing and lifting at work, can place unnecessary stress upon your spine. With muscle fatigue or overstretching, your ligaments and discs can stretch, and this puts spinal joint muscles and nerves under pain-causing pressure or strain, which results in back pain.
Ligaments are the durable, fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling, muscular spasm and pain.
Awkward lifting, sports injuries and motor vehicle accidents are prevalent causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.
What are the Symptoms of Back Muscle Pain?
Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain.
Typical back muscle pain symptoms include:
- Localised back pain, with no radiation into your buttock or leg.
- Back muscle tenderness and spasm.
- Protective back stiffness.
- Sudden back pain onset.
You will usually feel better when resting and may find a change of position painful, e.g. sit to stand, rolling in bed, walking or bending.
How is Back Muscle Pain Diagnosed?
Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries will show similar symptoms. In general, it doesn't significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains are similar. Most spinal practitioners refer to both injuries as a category called a "Back Strain" or "Musculoligamentous Strain".
X-rays and CT scans do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to determine the muscle or ligament structures injured.
What is Back Muscle Pain Treatment?
Seek a Professional Diagnosis!
A spinal healthcare practitioner, such as your physiotherapist, should thoroughly; examine you to exclude more severe sources of back pain.
Numerous injuries can cause back pain, and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment aims to protect your damaged tissue while hastening your muscle and ligament healing and then look at strategies to prevent a recurrence.
Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.
How To Avoid Repeat Back Strain
While it is easier to understand that lifting a heavy load in an awkward position can cause back pain, it's harder to comprehend how a simple movement can hurt your back. Yes, it can happen by merely leaning forwards to pick up your teacup or when bending to brush your teeth! We do know that some people are vulnerable to repeated lower back sprains and strains.
The reason is poor local joint control. The main reason for this is inadequate or non-existent muscle activation of the deep core stability muscles. These muscles are small but are right next to the joint to control excessive slides and glides. When they don't work correctly, the joint can slide too far and strain its supporting ligaments. Ouch! That hurts.
The good news is You can easily correct poor core stability to prevent back pain. Don't hesitate to contact your physio for more information or to have your core activation accurately assessed.
High-risk factors of back pain include:
- sudden forceful movement
- lifting a heavy object
- twisting the back
- coughing or sneezing
- prolonged sitting with poor posture
Suffering Back Pain. What Should You Do?
While lower back pain is commonplace, the diagnosis of the cause of your back pain is specific to you, and therefore, the treatment or investigation pathway varies for each case.
A spinal health care professional can assist you with a prompt diagnosis, early referral, acute and chronic back pain relief, plus long-term self-management or back pain prevention strategies specific to you. You should feel confident that your practitioner has screened you for particular pathologies that require urgent medical attention. They should assess you for neurological deficits such as:
- loss of bowel or bladder function,
- leg muscle weakness,
- loss of sensation,
- diminished reflexes,
- and day-to-day operation.
A thorough assessment will determine whether you have radiculopathy or stenosis. This diagnosis is essential since treatment usually differs from NSLBP or radicular pain.
For specific recommendations, please consult a musculoskeletal physiotherapist or another spinal healthcare practitioner.
You probably already know that back pain has a nasty habit of returning within a few months of the initial injury. Research has shown that you have an 80% chance of recurring back pain within 12 months of the first episode. The good news is that you can reduce your chances significantly if you do the right thing early.
What Should You Do When You Suffer Back Pain?
The latest research recommends that you only spend a day or two resting in bed. More extended periods cause muscle weakness which ultimately makes repeat back pain more likely.
Ice or Heat?
We recommend ice treatment for 20 minutes every 2 or 3 hours for the first 48 hours. The ice should help reduce your pain, swelling and back spasms. After a few days, you are safe to use heat packs. We usually recommend avoiding heat (and heat rubs) in the first 48 hours. Heat packs encourage bleeding, which could be detrimental if used too early.
Should You Use a Back Brace?
A back brace can help you to get back on your feet or allow you to return to work sooner. We don't encourage long-term use because research has shown that your stomach and back muscles will weaken as you become reliant on the brace.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain relief in the form of paracetamol or an anti-inflammatory. You are best seeking their advice as certain drugs can interfere with other health conditions.
When Should You Commence Physio?
In severe cases, when the slightest movement causes unbelievable pain or spasm, it may be best to wait a day or two to start treatment. This delay will allow the majority of swelling to settle. Slight niggles or "my back feels out" sufferers can usually commence treatment (and maybe fixed) on the day of injury. If you are not sure what to do, please call us for advice. We'll happily guide you in your time of need.
What About Core Stability Training?
The current physiotherapy and fitness training trend is 'core stability training' (back and abdominal muscle control).
What If You Do Nothing?
"Back pain is something you could be suffering needlessly". Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome and the quicker you'll get back to living your life.
What Results Should You Expect from Physiotherapy?
Not only will your physio diagnose the cause of your pain and give you the "peace of mind" associated, but they'll also help you to:
- Relieve your pain quicker
- Cope better with your pain using proven strategies and tips
- Get you back to work and play quicker through faster healing rates.
- Loosen and strengthen your back with individually prescribed exercises
- Prevent future bouts of back pain via our holistic back pain management approach
Think about it. Back Pain is Something You Could be Suffering Needlessly.
Please use our expert advice to guide you out of pain quicker and for a lot longer.
If you have any questions regarding your back pain (or any other condition), please call us now to discuss your situation. You'll find our friendly staff happy to point you in the right direction.