Bulging Disc

What is a Bulging Disc?

A bulging disc is an unhealthy condition where the spinal discs shift away from their normal position. A spinal disc consists of a hard casing with a liquid-like center. When these spinal discs change their position, swelling occurs in the fluid-like material at the weakest section of the disc's shell. This swelling is also known as herniation or a protruding disc.

What is the Use of a Spinal Disc?

These discs are present between the vertebrae and serve two primary purposes:

• Act as a shock absorber
• Protect the spinal tissue and bone from damage
• Facilitate easy movement

Symptoms: How Do You Know if You Have a Bulging Disc?

Depending on the severity, the symptoms of a bulging disc include:

• Mild tingling
• Numbness
• Moderate to severe pain

There are two stages of bulging discs, and the symptoms of these stages vary:

Pre-Herniation:

Before the disc extends to the stage of herniation, a case of a bulging disc may go unnoticed because there may or may not be any pain. Symptoms typically appear when the issues become too severe, making it difficult to manage.

Post-Herniation:

The symptoms of a bulging disc post herniation include:

• Tingling or numbness: in the fingers, hands, arms, neck, or shoulders, indicating a bulging disc in the cervical area.
• Aching: in the feet, thighs, buttocks, and lower spine, indicating problems in the lower back.
• Loss of strength: while holding or lifting things.
• Difficulty walking.

Alert: Post-herniation symptoms could be life-threatening; hence, if you notice these, you should consult your doctor immediately.

Complications if a Bulging Disc is Left Untreated:

Complication	Symptom and Characteristics
The sciatic nerve is affected	Sensations are present in only one leg.
Bulging disc compresses the nerves that control the bladder	Bladder incontinence or loss of bladder control.
Mid-spine bulging disc	Pain in the upper back that goes up to the stomach or chest.

Symptoms associated with a bulging disc may go unnoticed for years, and the risk of complications increases over time. Hence, if you notice the slightest discomfort that may indicate a bulging disc, you should talk to your healthcare provider.

What Causes a Bulging Disc?

Common causes of a bulging disc include:

• Inactive lifestyle and unhealthy habits like smoking
• Injury or frequent heavy lifting
• Weak back muscles increasing the risk of sudden herniation
• Trauma or accident
• Bad posture while sleeping, standing, or exercising
• Obesity
• High-contact sports
• Not using proper running shoes
• Everyday activities that strain the back, such as vacuuming or feeding your pet

How to Diagnose a Bulging Disc?

While investigating the cause of your bulging disc, your physician will ask you about:

• Your lifestyle
• The physical activities you regularly perform

Based on the preliminary investigation, your doctor may recommend the following medical imaging procedures for detailed and accurate analysis:

• X-ray
• CT scan
• MRI scan

The results of these procedures will help diagnose the disorder causing the bulging disc and its complications, such as:

• Lumbar Stenosis: Narrowing of the lower spine's open spaces, leading to pain, tingling, and weakness in the buttock, leg, and foot.
• Spinal Stenosis: Compression on the nerve caused by a herniated disc, bone spur, or narrowing of the spine, also known as sciatica, causing inflammation, pain, and numbness in the affected leg.
• Disc Herniation: An age-related disorder where the outer ring degenerates over time, leading to inflammation and intense pain.

Treatments for a Bulging Disc

Once diagnosed, immediate self-help remedies include:

• Adjusting posture while sleeping, sitting, and standing to minimize strain on the back
• Exercising to reduce obesity, a major trigger factor for bulging discs
• Physical therapy to strengthen back muscles and regain full range of motion

Ways to manage and reduce pain before complications become life-threatening include:

• Over-the-counter anti-inflammatory medications
• Heating pads
• Ice packs
• Exercise
• Massage therapy

If the condition becomes extreme, your doctor may recommend surgery, although surgical interventions are rare.

Physical Treatments for a Bulging Disc

Your physiotherapist may recommend the following exercises:

Piriformis Stretch:

• Lie on your back with both feet flat on the surface and both knees bent.
• Hold the right bent knee with your left hand and pull it across your body towards the left shoulder.
• Hold the stretch for at least 20 seconds and then return the right knee to the original bent position with feet flat on the surface.
• Repeat for the left leg.

Spinal Extension:

• Lie on your stomach on a mat with legs straightened out.
• Keep your elbows on the ground and slide your pelvis, hips, and shoulders down in a relaxed position.
• Lift your upper back while pressing your hips into the mat, keeping your head and neck in a neutral position.
• Hold for 30 seconds, then lower to the beginning position.
• Repeat for 3 sets of 30 seconds each.

Isometric Gluteus Medius Strengthening Exercise:

• Lie on one side with the Gluteus medius muscle you are trying to exercise on the upside.
• Place a belt around both ankles.
• While keeping both legs straight at the knee, lift the top leg straight until there is tension on the belt.
• Hold this contracted position for 5 seconds and then slowly bring your leg back down.
• Repeat 10 times.

Figure Four Stretch:

• Lie on your back with legs bent at the knee and feet flat on the ground.
• Place your right ankle on the left knee.
• Hold the back of your left leg and gradually pull it towards your chest until you reach a comfortable stretch, feeling it in the glutes and hip.
• Repeat for the other leg.

Strengthening Exercise:

• Lie on your back on a flat surface with a pillow under your hips.
• Slowly lift your leg straight up with a 90° angle at the knee.
• Hold for 5-6 seconds and try to do 5 repetitions.

Hip Flexion:

• Lie on your back and gently pull one knee towards your chest while keeping your back flat.
• The opposite thigh can slide to the edge, but the pulled thigh should not move away from the midline.
• Hold for 30 seconds and try to do 2 repetitions with each leg.

Single Knee to Chest:

• Bend your leg at the knee and pull it into your chest until you feel a comfortable stretch in your lower back and hip joint.
• Avoid pulling with a jerk or beyond a comfortable position to prevent overstretching muscles.
• Hold for 15 seconds and repeat 5-10 times for both legs.

Iliotibial Band Stretch:

• Stand upright and cross your hurting leg behind your opposite leg.
• Bend your upper body away from the hurting leg until you feel a stretch across the affected Iliotibial band.
• Hold for 30 seconds and repeat for 5 sets.

Bridge Exercise:

• Lie flat on your back with legs bent at the knee and hands by your side.
• Place your feet flat on the surface under the knee.
• Contract your abdominal and buttock muscles and gently push your lower back into the ground.
• Lift your pelvis in the air by pushing the heels into the floor, forming a straight line with your upper body and thighs.
• Hold for 5 seconds, then gradually lower your body.
• Repeat 8-10 times.

'Cat-Camel' Exercise:

• Kneel on your fours - hands and knees, with hands directly under your shoulders and knees spread shoulder-width apart.
• Round your upper back in a curve, pressing your shoulders forward, holding this 'cat' position for 15 seconds.
• Slowly make a downward curve by arching your back, looking at the ceiling in this 'camel' position for 15 seconds.
• Repeat for 5 sets of cat and camel positions.

Forearm Plank:

• Lie on your stomach with forearms parallel to the surface.
• Tighten your core and lift your body like a pushup, balancing on your forearms and toes.
• Hold for at least 20 seconds, aiming for 30 seconds eventually.
• Try to do 2-5 sets, keeping your back straight to engage your core effectively.

Fastest Way to Cure Cervical Pain:

Your physiotherapist may recommend electrical therapy:

Ultrasonic Therapy:

• Uses ultrasound for deep healing of affected tissues, increasing blood circulation, and rapidly contracting and expanding microscopic gas bubbles around injured tissues.
• Benefits include faster healing, better pain management, and regaining lost range of motion.

Hot Pack Application:

1. Useful for managing injury-related pain and stiffness.
2. Consult your physiotherapist to know when to start using hot packs, typically recommended after the first week of treatment.
3. Heat treatment helps by increasing blood flow in the affected area and relaxing muscles, making it easier to stretch them and reducing pain.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812831/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573846/

Dr. Garima Singh
Physiotherapist
BPT and DPTR.