I Have a Bulging Disc. What Do I Do Now?

A bulging disc is when an intervertebral disc extends beyond its usual boundary. There are varying degrees to how severe a bulging disc may be. More severe cases result in disc herniation. This can lead to symptoms like back pain, neck pain, numbness, and weakness. Disc issues can happen in both the neck and low back, though it is most common in the lumbar spine. The question is that when you suspect or find out that you have a bulging disc, then what is next? This article reviews the various stages of a disc bulge, discusses how physical therapy can help, and what to expect with PT to help rid you of disc-like symptoms so you can get back to normal life without discomfort.

**This is not medical advice. Please consult your medical provider for more information.

Common Causes and Symptoms of a Bulging Disc

Bulging discs are a common condition affecting the spine. While most common in the lumbar spine, it is possible to experience these symptoms in the cervical spine too. The thoracic spine has a very low rate of disc bulges or herniations.

Symptoms can come on very suddenly or slowly over time. Disc bulges and herniations most commonly occur from the normal aging processes we all go through. Over time, the intervertebral discs lose hydration and the nucleus pulposus weakens, increasing the risk for disc herniation. Repetitive movements can also lead to an increased risk of disc herniation or bulging.

Symptoms to look out for are pain in the low back, sharp or shooting pains and numbness down one of your legs, or weakness in the leg. For more severe cases, you may notice this in both legs. Also, considering how severe a disc bulge may be, it could be pressing on the spinal cord, known as myelopathy.

An MRI will be able to tell if you have an issue with an intervertebral disc and will also help determine the stage (see below). However, it is very important to note that an MRI is known for finding bulging discs in patients who are asymptomatic, meaning that the person experiences no pain or other symptoms. Just because a bulging disc is present does not mean that it causes any pain. In fact, most cases that are symptomatic will resolve on their own in a couple of weeks.

The Different Stages of a Bulging Disc

There are various stages to look for when dealing with intervertebral discs and the possibility of a bulge or herniation. Here are the stages:

Bulging/Herniation: slight displacement of the nucleus pulposus; most are asymptomatic
Protrusion: the nucleus pulposus passes through the inner rings of the annulus fibrosus; it may encroach on the foramen or the nerve root
Extrusion: the nucleus pulposus displaces into the spinal canal through disrupted fibers of the annulus fibrosus
Sequestration: nuclear material from the nucleus pulposus emerges through the annular fibers and escapes into the spinal canal

Typically, the latter stages tend to be more severe. However, it is still important to note that even in the beginning stages, there may be some displacement of the nucleus pulposus. Not every person is going to experience symptoms. This is why it is important to match your symptoms to your imaging findings. You may receive an MRI for low back pain. This MRI may pick up a bulging disc. But that does not always mean that your back pain is coming from the bulging disc.

Physical Therapy: What to Expect

Physical therapy is often a first line of defense for bulging discs. It will help restore spinal mobility, get rid of any muscle imbalances, normalize your walking, and help you get back to doing the activities you miss.

In PT treatment, expect to engage in a variety of exercises designed specifically for disc problems, whether lumbar or cervical. These exercises will be tailored specifically to what your deficits are. If you are having issues with walking, your exercises will be broken down to help you walk better. If you are dealing with shooting pain going down your leg, the exercises will work on reducing the amount of pain and eventually not letting it travel as far. Your physical therapist can also assist with pain management techniques that may be necessary when flare ups occur.

The large amount of your treatment will likely involve identifying your directional preference—finding the movement patterns that alleviate your pain and those that exacerbate it. Identifying your directional preference can be an empowering process as it allows you to take control of your pain.

How to Find Your Directional Preference

Finding directional preference is key to treating disc bulges. Finding your directional preference is about finding which direction you can repeat a movement into which either causes your pain to centralize or alleviates the pain. Centralization refers to the pain not travelling as far. In other words, the pain centralizes towards your spine.

Let’s look at an example. Let’s say you have pain going down the back of your right leg and it goes down to the back of your knee. You notice every time you bend forward to reach for something across the table or whenever you bend to tie your shoes, your pain travels all the way down to your ankle. This is what we call peripheralization. Peripheralization is when the pain travels further from the center of your body. When dealing with disc issues, peripheralization is what you want to avoid. What we want to find is centralization.

As stated earlier, centralization is when the pain does not travel s far and it centralizes, or stays closer to the center of the body. Let’s take the same example from above. You notice every time you lean backwards your pain is no longer traveling to your knee. Instead, it travels from your back to your right glute, just before your thigh. This is an example of centralization because the pain is not traveling as far from the center of the body. It is not going as far to the ankle like when you bend forward and it isn’t traveling to the knee like it normally is at baseline.

This means that your directional preference is lumbar extension. Every time you move into lumbar extension, the pain centralizes. This is the direction that we want to see. You then take your directional preference and incorporate it into your treatment plan. The exercises you perform should incorporate the direction that centralizes your pain.

Repeated Movements: Treatment for Bulging Discs

For most disc-related cases, extension starts off as the go-to directional preference. Some cases will involve flexion, but 90% of the time, lumbar extension will be what centralizes your pain. Regardless, you just need to find which direction centralizes your pain. This is your starting point.

Now that you have found your directional preference, repeated movements is what will be incorporated into your treatment. This means repeating the movement that is your directional preference. If extension is your directional preference, the majority, if not all, of your exercises should incorporate lumbar extension. Examples of this would include prone on elbows, prone press ups, or standing lumbar extension.

The important thing to consider when doing these exercises is that volume is your friend. Repeating the movement over and over again, especially when it helps alleviate the pain, is the ultimate goal. You can repeat these movements throughout the day, as often as you need to to help with pain management.

Incorporating Other Planes of Motion

Once you’ve found relief in one direction of movement, begin to slowly incorporate other planes of motion. If flexion once caused peripheralization, start to test small ranges into flexion. This can be as simple as starting to pull your knees into your chest or sitting and leaning forward with your arms supported on a table or on your thighs. Just as before, the movements should be repeated, not held. If you notice peripheralization, then you might not be ready to incorporate this direction yet. Pain levels intensifying is acceptable; we are looking strictly for if the pain travels further. That is when we stop. As long as you can tolerate the pain, continue with completing exercises into this new direction.

Other planes of motion will include the frontal and transverse planes. These movements include rotation and side bending of the spine. You will incorporate these movements the exact same way you introduced flexion, as reviewed earlier. Side bending is as simple as it sounds—side bend repeatedly to one side or the other. Try both if you are able to. Just remember the sign you are looking for (peripheralization, which means stops). Rotation is a direction you can perform a few different ways. You can simply stand and rotate your trunk. You can can lie down with your legs supported by a swiss ball and rotate them side to side. Or you can do this same thing without the swiss ball with your legs on the ground.

Eventually, you want to be able to tolerate all planes of motion without peripheralization, and eventually, without any pain!

Returning to Regular Activity

Once you are on the path to recovery after a bulging disc and you are able to move freely with minimal to no pain, recovery starts to look at functional strengthening. This is what will get you back to being able to perform all your daily tasks, including taking out the trash, doing dishes, getting up and down the stairs, returning to walks or hikes, and lifting the kids. We might be thinking that once all the pain is gone, this should be no problem. But think again. If you suffered from leg weakness initially when experiencing symptoms or if you haven’t done certain things for some time, we can recognize that it will be some time before we are able to return to our regular activities and normal lives. This is the whole point of functional strengthening

It can be as simple as starting with exercises that mimic your daily activities or your job duties. Think about what you have to do on a daily basis. This can be sitting, standing, walking, reaching, squatting, or any other movement that you perform to get tasks done. You might be someone who finds it hard to sit for long periods of time, but you work a desk job that requires you to sit for eight hours of the day. Try incorporating exercises or breaks that break up your time sitting. Set a timer to stand up every 30-60 minutes. Perform a few seated exercises at your desk, such as seated marches, long arc quads, seated clams, or seated heel raises. Think about getting your legs moving and think about changing your position often. Over time, you will start to notice that you can sit for longer durations of time.

If getting back to daily walking is your goal, find where you current limit is. Lets say you can only tolerate walking 10-15 minutes at a time before you start to feel your pain come back on. Work at the current time you can tolerate and when your symptoms start, perform the directional preference exercises that alleviates the pain. Stand and perform a few back extensions. If the pain successfully resolves or doesn’t hurt as bad, try to extend your walking distance by another minute or two, as long as you can tolerate the pain if it returns. Over the days, see if you can go a little further and always know you have an exercise or two in your back pocket to help extend your walking time and distance.

You can take all of these principles and apply it to anything you are doing, including getting back to working out. Start off light with easier movements. Pay attention to the exercises that make you feel worse and make you feel better. Repeat what feels better, and limit the exercises that make things feel worse. Your body is telling you it just isn’t ready for that yet. Over time, as you get stronger and tolerate more activity, you will start to see that all exercises no longer bother you and the pain is a thought in the past.

When to Consider Surgery for a Bulging Disc

Navigating the journey of a bulging disc can be uncertain and discomforting. It’s a condition that can dramatically affect your quality of life, prompting you to consider all avenues of treatment. Among these, surgery can emerge as a daunting prospect. Under certain circumstances, it becomes not only viable, but necessary. The question is when is surgery necessary?

In cases where the seriousness of symptoms arise is when surgery is the only option. Red flags include symptoms related to cauda equina syndrome. This includes saddle anesthesia, loss of bowel/bladder function, and bilateral leg numbness/weakness. If you notice any of these symptoms, seek immediate medical attention. Imaging will be able to confirm the findings. Always speak with your healthcare provide if you are concerned with your symptoms or have questions. They will offer guidance in helping you navigate any medical considerations.

Now, in less serious cases, surgery may be an option if you have failed conservative treatment. That is, if you have tried physical therapy and/or other forms of therapy, treatment, and modalities, with little to no improvement in your symptoms. Having a consult with a surgeon can help determine if you are a candidate for surgery. If you end up having surgery, physical therapy will be expected for post-surgical rehabilitation and recovery.

TL;DR

A bulging disc can cause pain, stiffness, and nerve irritation. Physical therapy can help with treatment focusing on identifying your directional preference, using repeated movements to reduce symptoms, and gradually restore motion in all planes of movement. With the right exercises and guidance, many people return to regular activity without surgery. This post reviews how to find your directional preference and use repeated movements to manage your symptoms and rid you of pain to get back to living your normal life pain-free.

I Have a Bulging Disc. What Do I Do Now?