Lumbar Disc Bulge

While patients with a lumbar disc bulge may experience a sudden onset of back pain during the causative activity, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning. Pain is typically felt in the lower back and may be located centrally, on one side or on both sides of the spine. The patient may experience pain radiating down the leg into the buttocks, thigh, lower leg or foot (sciatica). Muscle spasm, pins and needles, numbness or weakness may also be present. In some cases, patients may appear to stand with their spine noticeably out of alignment as a result of the disc bulge. Symptoms are generally exacerbated with activities involving lifting, bending forwards, prolonged sitting, or when moving from sitting to standing. Coughing, sneezing and twisting may also aggravate symptoms. Patients with a lumbar disc bulge often experience pain that is worse first thing in the morning.

How is it diagnosed?

A thorough subjective and objective examination from a chiroppractor is usually sufficient to diagnose a lumbar disc bulge. Investigations such as an MRI or CT scan may be required to confirm diagnosis.

How is it treated?

Most patients with a lumbar disc bulge heal quickly and have a full recovery with an appropriate treatment program. The initial goal of treatment is to push the bulging disc back into its original position and then keep it there so the torn connective tissue at the back of the disc can heal. The time it takes to push the disc back into its original position varies from person to person depending on their activities and compliance with chiropractic advice. Since certain activities push the disc out and others push the disc back in, the balance of these activities dictates recovery time. Activities typically pushing the disc out include: sitting, bending forwards, lifting, coughing and sneezing. Activities which help to push the disc back in include: walking (for periods of time that do not increase your back pain) and certain exercises.
Generally, sitting should be avoided. However, if inevitable, optimal sitting posture is vital to minimize stress on the disc. If you must sit, try to keep it to short periods of less than 10 – 15 minutes at a time and no more than 1-2 hours total for the day. Sitting slouched should be avoided as it places your lower back into its maximal bend, this will rapidly aggravate a lumbar disc bulge.

What is the prognosis?

In patients with the perfect balance of activities, the lumbar disc may be pushed into position in as little as three days. Typically, however, patients take approximately 2 to 3 weeks to push their disc back into position. Once the disc is in position, the patient should be pain free and have full movement. However, the torn connective tissue at the back of the disc only begins to heal from this point. It takes approximately six weeks of consistently keeping the disc as it should be to allow the torn tissue to heal to approximately 80% of its original strength.

What factors contribute to its development?

What treatments are involved?

What other interventions are there?

What exercises will help?

The lumbar spine consists of 5 bones known as vertebrae, each of which is separated by a disc. The disc comprises of several layers of strong connective tissue wrapping around the disc. In the middle of the disc lies a soft jelly-like substance which is capable of changing shape. When this jelly-like substance protrudes from the disc due to a tear in multiple layers of the connective tissue, this is known as a lumbar disc bulge.
To understand the mechanism of a lumbar disc bulge, it is useful to liken the disc to a vanilla slice. Imagine a vanilla slice wrapped in five layers of sandwich wrap. The top and bottom layers of pastry represent the vertebra (bones), the custard represents the jelly-like substance of the disc and the sandwich wrap represents the connective tissue around the disc. If you were now to pinch the front of that vanilla slice, you could imagine, the custard would squeeze towards the back of the vanilla slice and may tear two or three layers of sandwich wrap at the back of the vanilla slice. As a result the custard is no longer supported as effectively at the back of the vanilla slice and therefore bulges out at this location. In the disc, the situation is the same. Bending forward closes down the front of the disc, pushing the jelly-like substance within the disc towards the back. Overtime or suddenly, this may tear several layers of connective tissue at the back of the disc resulting in a disc bulge.

Lumbar disc bulges most commonly occur in those who are 20 to 50 years of age. The lowest disc of the spine (L5/S1) is most commonly affected with the disc above (L4/L5) the second most common.
There are three main activities in everyday life which typically cause lumbar disc bulges provided they are forceful, repetitive or prolonged enough. These include: bending forward, sitting down and lifting (especially in combination with twisting). Occasionally, lumbar disc bulges may occur following a trivial movement involving bending forward such as picking up a small object or sneezing. In these instances, the disc has normally been subject to repetitive or prolonged bending, sitting or lifting forces leading up to the incident.

Despite appropriate chiropractic treatment, a small percentage of lumbar disc bulges fail to improve and may require other intervention. This may include further investigations such as an X-ray, CT scan or MRI, pharmaceutical intervention, assessment from a specialist or sometimes surgery. Your chiropractor will let you know if this is required and will refer you to the appropriate medical authority if it is warranted clinically. When a loss of bowel or bladder control is present due to the disc bulge, this is considered a medical emergency and immediate surgical intervention is usually required.

Several factors may contribute to the development of a lumbar disc bulge. These need to be assessed and corrected with direction from your chiropractor and may include:
• poor core stability
• being overweight
• muscle tightness
• muscle weakness
• joint stiffness
• poor lifting technique
• poor posture
• a lifestyle involving large amounts of sitting, bending or lifting

Chiropractic for a lumbar disc bulge is key in ensuring an optimal outcome
Treatment may comprise:

soft tissue massage
mobilization
exercises
biomechanical correction
ergonomic advice

The following exercises are commonly prescribed to patients with a lumbar disc bulge. You should discuss the suitability of these exercises with your chiropractor prior to beginning them. Generally, they should be performed 5 times daily and only provided they do not cause or increase symptoms.

1) Prone Lying (figure 3) – Lying on your front on a comfortable flat surface. Stay in this position for 10-20 minutes at a time provided it does not increase your symptoms.

2) Elbow Prop (figure 4) – Begin lying on your front and slowly move up onto your elbows provided it does not increase your symptoms. Hold for 5 seconds and then return to lying flat. Repeat 10 times.

3) Lumbar Extension in Lying (figure 5) – Lying on your front with your hands in a push-up position, slowly arch your back, straightening your arms while leaving your hips on the ground. Go as far as you comfortably can without increasing your symptoms and then return back down. Repeat 10 times.

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