By Adelaide Women's Physio | July 28, 2016
What is a lumbar disc?
The back consists of five bones called lumbar vertebrae which have a disc or shock absorbing cushion between the bones. The discs are composed of a fibrous outer layer (disc annulus) and a gel-like inner layer. This inner layer is referred to as the disc nucleus which has the ability to move similar to a thick fluid. The gel is important in adjusting to pressures occurring around the vertebral column or spine. Daily movements and postures place forces of many directions on the discs. Over time or with a sudden disruptive force, the fibrous disc wall can be weakened or damaged, allowing the gel substance to move outward from its central position. This can be referred to as a disc derangement or bulge and is a common condition presenting for physiotherapy assessment and treatment.
Defining lumbar disc bulges.
A lumbar disc bulge refers to the leak or prolapse of the gel substance through the fibrous disc wall, creating a bulge of the wall. The bulge is still contained by the weakened outer wall and can be commonly called a “protruding disc”. It is also often misleadingly called a “slipped disc”.
If the disc wall ruptures the gel substance can leak out of the disc wall and is now referred to as a “ruptured disc” or “herniated disc”.
These different degrees of lumbar disc injury result in various levels of tissue inflammation, muscle spasm, swelling, weakness, cramping, numbness, pins and needles, sciatica and loss of function. The different presentation of symptoms is often related to the amount of pressure or irritation affecting a spinal nerve leaving the spinal cord through the inter vertebral space (foramen) close to the disc.
What causes lumbar disc bulges?
Sometimes all it takes is a sudden, forceful movement (such as bending or lifting) to place too much strain on an already weakened outer disc wall. This may cause sudden back pain or referred buttock or leg pain.
Poor posture and repetitive movement patterns over long periods of time can place unnecessary stresses on the vertebral disc wall and annulus. Initially, the experience of low back stiffness or a niggly back comes and goes without too much concern. As time and life events progress, the back episodes often appear more often and become more severe.
Major traumatic situations such as a motor vehicle accident can place sudden forces on the body, with big loads reaching the vertebral column creating the disc injury.
Physiotherapy treatment of lumbar disc bulges.
Seeking pain relief is the usual reason for a person to present to a physiotherapist. It is the skill of the Physiotherapist in firstly listening to the individual’s history and symptoms. The Physiotherapist will then use musculoskeletal and neurological tests to assess the type of lumbar disc bulge. Direction of the bulge is commonly posterior or at the back of the disc wall in the general population.
The first part of treatment is to decrease the inflammatory response in tissues using a selection of pain relieving modalities. This may include ice, ultrasound, taping, heat and dry needling. The next step will be joint mobilisation and exercises with core activation and gradual loading as healing of the disc occurs. Core strengthening exercises that tighten the deep abdominal muscle wall are usually recommended to promote good posture and restore normal function. Specific stretching and strengthening exercises to increase mobility and muscle strength are added to the program when the time is appropriate.
Once healing begins to take place, the Physiotherapist will tailor an exercise program that suits the individual’s needs and lifestyle. Education in proper body mechanics such as lifting, bending, work habits, home duties and sporting activity is vital to prevent a recurrence of the injury.