Physiotherapy for Disc Bulges
Disc bulges are much more common than you’d think. About 50% of people in their 40s have disc bulges on an CT or MRI scan and 84% of 80 year olds! However, 50% of people in their 40s don’t have low back pain or leg pain. Go figure…
What’s a disc bulge?
A disc refers to the intervertebral disc that sit between each of your vertebrae up your spine. Their job is to transmit loads, allow our spines to bend and rotate and provide a space for our nerve roots to exit. A disc bulge is a protrusion, extrusion or sequestration of intervertebral disc material outside of this normal resting position. This is into the spinal canal, lateral foramina or elsewhere.
This can happen slowly over a long period of time, which is why many people without pain have evidence of disc bulges on imaging. It can also happen suddenly which is usually accompanied by sudden onset leg pain, loss of leg strength and/or sensation changes. This is usually a result of a large loading event.
What are the symptoms of a disc bulge?
Patient’s with sudden disc bulges will usually have sudden onset leg pain, loss of sensation or pins and needles, and muscle weakness. The leg pain is usually worse at night, and it can be very uncomfortable to sleep. These patients often find it very difficult to sit and bend, and are often most comfortable lying on their side. The most common low back disc bulge is an L5-S1 bulge. Symptoms include “sciatica” leg pain and calf weakness.
How can Physio help my disc bulge?
If your disc bulge is chronic, we will assess you and determine other differential diagnoses for your pain and treat as appropriate. Treatment may involve education on your diagnosis, manual therapy and rehab exercises.
If you present with new, sudden onset leg pain, we will assess you to determine whether a disc bulge is the cause of your pain. If it is a disc, we will likely refer you to your GP to get some imaging done to confirm this. We will also provide you with some management strategies in the meantime to help your body heal this new injury.
Disc bulges are horrid, unremitting and painful. However, most resolve in about 8 weeks without the need for surgery. For the unfortunate few, we may refer you for a surgical opinion.
If it’s not a disc bulge, then why does my back (or legs) hurt…
There are many differential diagnoses for low back pain. Chronic low back pain can be a result of how you move out of habit (are you a “perfect posture” or “lift with your legs not your back” type of person?), it may be due to age related changes in your spine such as arthritis or lumbar spine stenosis, or just a stiff, hypomobile joint. Others spend too much time in asymmetrical positions.
I’ve got a disc bulge and my back’s buggered is a classic presentation in our rooms, let us show why this may not be the case and how you can help your back become pain free.