Understanding a Lumbar Spine Bulging Disc

Lumbar Spine Pain

It seems that most non-medical people understand more about their computers and smart phones than they know about their good old friendly back.  With that being said, it demonstrates the irony of this information gap when statistics show that 80% of us will suffer from low back pain sometime in our lifetime!

The lower part of our lumbar spine has 5 strong and stabile bones called vertebra.  These vertebra stack on top of each other with intervertebral discs smartly located between each vertebra.  These lumbar disks have two functions:  Spacers and shock absorbers.

Each disc is thick and quite dense to protect the bones of the lower back while allowing for a very functional lumbar spine.  Inside each disk is a jelly-like nucleus called the nucleus pulposus with the very outer ring of the disc reinforced with the stabilizing structured called the annulus fibrosus.

When the lumbar spine is injured or put into a poor posture for a prolonged period of time, many things can happen to become the source of pain and limitation.  For the purpose of this article, let’s look at when the disc becomes the reason for someone having a bad back.  Unfortunately, a bulging disc is too commonly the reason for low back pain and managing a damaged disk may be one of the most important physical challenges that you face in your lifetime.

Bulging discs in the lumbar spine cause significant pain in the low back, buttocks area, groin and lower extremity.  Because of the complexity of the interactions with all the bones of the lumbar spine, disks of the spine, nerves of the spine and bones of the pelvis, the wide arrange of symptoms and treatments can greatly vary.

“Bad backs” can obviously be related to any part of the lower or middle back.  When the lumbar disk’s annulus fibrosus is damaged, the contents of the disk including the nucleus pulposus can be forced outward between the vertebra.  The spinal cord and its peripheral nerves that supply the trunk and lower extremity.  This bulging of the disc is the main reason for pressure on the nerves as they exit the lumbar spine and create nerve symptoms into the regions of the body that the nerve innervates.

Spinal stenosis (narrowing of the spinal canal), bone spurs, spondylolysis, spondylolisthesis and herniations of lumbar discs can be other medical factors that can contribute to Lumbago or low back pain.  A thorough exam by a medical physician is the best starting point for anyone with pain, numbness and/or weakness extending down an extremity from the spinal canal.

Signs & Symptoms of a “Bad Back”

  • Low back, buttock and/or lower extremity pain, numbness and/or weakness, which may be intermittent or constant.
  • May experience pain with standing after prolonged sitting or laying down.
  • May be associated with lateral shifting of the torso away from the painful side.  This is a postural compensation that known as listing.
  • In severe cases, abnormal knee and ankle reflexes can occur.

Professional Treatment for a Bulging Disc of the Lumbar Spine

  • Rest on a firm surface in a non-weight bearing position that completely eliminates the symptoms.  This is best done by lying in a supine (face-up) position with pillows placed behind the knees.
  • Ice bags placed on your back while lying supine or prone (face down) with a pillow placed under the stomach.
  • Implement a progressive flexibility plan focusing on the hamstrings, quads, and hip flexors.
  • Core stability program that addresses functional abdominal strength and endurance while training the trunk and pelvis to avoid positions that create low back pain commonly associated with spinal stenosis.
  • The application of heat in the form of a hot tub, heating pad or hot packs should be SLOWLY implemented only when the main symptom is “stiffness” or when there is a need to increase blood flow in the low back/hip area to “get things looser” for activities.  The introduction of heat too early or too aggressively will quickly worsen the symptoms and prolong the recovery time for a bulging disk.
  • Back strengthening exercises such as planks, bridges, Superman exercises, balance drills and proprioception exercises while avoiding a kyphotic (slouched back position) curve of the low back which would assist in the posterior migration of the lumbar disc……not something that you want!
  • Some severe or chronic bulging discs may require an epidural injection from a physician

Questions a Pro Athlete Would Ask

A smart professional athlete with bad back who wants to safely return to his/her sport will ask his sports medicine specialist the following questions:

  1. Are you certain of the diagnosis and do I need an MRI to rule out any other problems?
  2. Do you think I can manage this bulging disc with rehab without having surgery?
  3. With my bad back and knowing that I want to remain very active and healthy for a long time, what activities do I need to avoid/modify to accomplish this outcome?
  4. In your opinion, what three (3) factors (for example: flexibility, posture, body weight, severity of my injury, fitness level, activities, occupation, Ab strength, and attitude) are most important for me to focus on with my rehab?
  5. Who do you consider to be the expert low back and bulging disc rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Elite Sports Medicine Tips

  • It’s all in the Curve – Posture, posture, posture!  If you you’re your lumbar disk to stay in it’s happy place, focus on your posture.  If you maintain the “hollow curve” (lordotic curve) or sway back posture during all activities, the lumbar disc is naturally pressed forward and away from the nerves.
  • Flexibility Makes Your Back Sing – The looser the muscles are of the low back, hips and legs the less work the back has to do to do anything.  It’s that simple.
  • “I Threw My Back Out (fill in the blank)!” – Few people throw their back out lifting a car off their crazy cousin.  Most people damage a lumbar disk with innocent motions like picking up the newspaper or putting on a shoe.

SIMPLE MOVEMENT + SLOUCHED POSTURE = LOW BACK INJURY

  • Make a List – Anyone with a chronic bad back can tell you what helps and what hurts their back.  Do your homework and know the reasons before your back becomes chronic.  Make a list of:
    • What Makes my Back Better
    • What Makes my Back Worse?
  • When Will I be Painfree? – 80% of the population have low back pain sometime in their lives.  Bulging discs, low back strains, herniated discs, spondylo and ligament sprains are just a few examples of injuries that can cause low back pain.  Treating a lumbar bulging disc early and properly is just what the doctor ordered to keep you active and pain-free.