First off, what even is a disc bulge?
Disc bulge, herniated disc, slipped disc, ruptured disc, protruding disc, prolapse disc or if you really know your medical terms “herniated nucleus pulposus”! These are all different names for the same condition that we can see occur in your spine and most often your lumbar spine (low back). This is often something we hear and are immediately alarmed by and yet this is one of the most common conditions to affect the lower back.
Before continuing it is very important to recognise that in most people, low back pain is benign and represents a simple back sprain associated with a mechanical loading incident or a ‘pain flare’ associated with psychosocial or lifestyle stresses(O’Sullivan & Lin, 2014). Only 5-10% of those suffering with low back pain have a significant disc condition like that listed above.
Wait, do I need to get an X-ray or MRI?
It is important to have a professional decide whether imaging is necessary as often the results of imaging can be misleading. As they may be accurate when they align with symptoms, they do not show a strong relationship to symptoms persisting.
So called ‘abnormal’ findings on MRI in pain-free populations have been found to show disc degeneration in 91% of those imaged, disc bulges in 56%, and disc protrusions in 32%, annular tears in 38%. (McCullough et al., 2012). Meanwhile, we know the effect of seeing these results may have in worsening and ruminating symptoms.
So what do I do then?
Back pain is still highly debilitating and it is very important to seek out a physiotherapist for assessment and management of your symptoms. If diagnosed with a disc herniation it can be helpful to limit lifting anything heavier than 1.5-3kg and deep bends and twists for 2-3 weeks while the disc stabilizes. As pain settles, a graduated rehabilitation program needs to occur to normalize movement and return to activities of daily living. Including bending, lifting, twisting and all the movements we did prior.
Can I exercise or should I just rest?
Resting it completely often only worsens symptoms and provides only temporary relief. Undertaking aerobic exercise for 20 to 30 minutes each day that does not excessively increase pain (e.g. walking, cycling or swimming based on comfort and preference) is strongly encouraged. While pain is a helpful guide to what we are going through, it is not always accurate or means we are causing damage. The first step is to reduce (not stop) the exercise you already do and your physiotherapist can be an excellent guide to what that should be.
Wait, can a disc bulge even be serious?
Yes, but this is very rare. It can develop into cauda equina which is a condition marked by significant changes to bladder and/or bowel function and neural symptoms affecting the legs and specifically numbness in the ‘saddle’ region up and under. If this is present it is important to seek immediate medical attention from a doctor. To reiterate – it is highly rare; with it occurring in 0.3-0.6 per 100,000 population per year (Woodfield et al., 2022).
What will my life look like with a disc bulge?
Your back is a strong and robust structure, it is highly adaptable and capable of recovering well. Research has shown that there are high recovery rates (over 80%) and reduction of the herniation in most patients at 12 months follow up. (el Barzouhi et al., 2013). With proper management we should see a full return to previous levels of function.
What can a Physiotherapist do to help this?
Seeing Physiotherapist can be an excellent way to facilitate non-pharmaceutical pain relief. You can also receive further advice and education regarding your symptoms and how to modify your daily activities and work while you recover and long term build up not only your strength, but your confidence in your back again. As it is vital we address and break down negative beliefs about low back pain and return you to your life without limitation!
