Diagnosis: Bulging disc (lumbar)
Presentation:
A bulging disc is a very common injury of the spine that can occur anywhere in the vertebral column, but most commonly in the lower back. It is sometimes called referred to by health professionals as a slipped disc or disc herniation. A bulging disc can occur suddenly and may also come on over time, sometimes people have no pain or problems at all with a bulging disc however it can also cause severe pain and disability in patients. People suffering from a lumbar bulging disc will have the most trouble with bending and picking things up, things like twisting can also be uncomfortable. People with bulging discs can often relieve some of their pain by lying down with their feet up and resting from activity.
A bulging disc can occur suddenly and may also come on over time. #performbetter @pogophysio Click To TweetCauses:
The disc is a specialised shock absorber that sits between the vertebrae of the spine, absorbing shock and providing some stability. The nucleus pulposus is the shock absorber part in the center of the disc which is made of different materials. In order to absorb shock, it has to squeeze and expand, in rare cases it can be damaged or “break”, in the time between the damage and it healing to a normal disc again the intervertebral disc is said to be “bulging”. This damage to the disc can be caused by a pre-existing weakness in the disc, or perhaps high forces being applied to the spine, a good example of a possible cause would be incorrectly lifting a heavy box with poor posture and muscular bracing causing a heavy force to injure the disc (Bogduk, 2012).
Diagnosis:
The bulging disc can be diagnosed in the physio clinic or with an MRI. At times MRI’s are not the greatest tool as they are too specific, as sometimes discs will look bulging on an MRI, but the patient has no pain from them and vice versa. The physio cannot truly know if the disc is bulging or not, however they can diagnose a “disc dysfunction” and find the cause of this dysfunction and treat accordingly.
Treatment:
Conservative treatment for the bulging disc has been proven to very effective. After diagnosis, 90% of patients with lumbar disc herniation will resolve their symptoms without any surgical or invasive intervention. The first stage of treatment is resting from aggravating/painful activity to allow the disc to heal, it is important to remember that most activities could potentially be uncomfortable and it is a good thing to push through that minor pain whilst it is very important to not damage the disc further in instances of major pain. It is important to exercise, be it walking, swimming or cycling, however things like lifting heavy weights are to be avoided. A physio can perform manual therapy which has been proven to be very effective in relieving painful systems. A patient will also undergo muscle strengthening and re-education program as the stabilising back muscles tend to switch off and weaken in the presence of pain (Weiner & Schoenfeld, 2010).
Daniel O’Connor
Student Physiotherapist
References
Bogduk, N. (2012). Clinical and Radiological Anatomy of the Lumbar Spine (5th ed., p. 19). London: Elsevier Health Sciences UK.
Weiner, B. & Schoenfeld, A. (2010). Treatment of lumbar disc herniation: Evidence-based practice. International Journal Of General Medicine, 3(1), 209.
