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Lumber Slipped Disc

Lumbar Slipped Disc

 (Bulging Disc, Disc Prolapse, Prolapsed Disc, Herniated Disc, Intervertebral Disc Injury)

What is a lumbar disc bulge?

The lumbar spine (i.e. lower back) comprises of many bones known as vertebrae, each of which is separated by a disc The disc comprises of many layers of strong connective tissue wrapping around the disc. In the middle of the disc lies a soft jelly-like substance which is capable of changing shape. When this jelly-like substance protrudes from the disc due to a tear in several layers of the connective tissue, this is known as a lumbar disc bulge (figure 1).

In the disc, the situation is the same. Bending forward closes down the front of the disc, pushing the jelly-like substance within the disc towards the back. Overtime or suddenly, this may tear several layers of connective tissue at the back of the disc resulting in a disc bulge.

Lumbar disc bulges most commonly occur in those who are 20 to 50 years of age. The lowest disc of the spine (L5/S1) is most commonly affected with the disc above (L4/L5) the second most common.

Causes

There are three main activities in everyday life which typically cause lumbar disc bulges provided they are forceful, repetitive or prolonged enough. These include: bending forward, sitting down and lifting (especially in combination with twisting). Occasionally, lumbar disc bulges may occur following a trivial movement involving bending forward such as picking up a small object or sneezing. In these instances, the disc has normally been subject to repetitive or prolonged bending, sitting or lifting forces leading up to the incident.

 

Several factors may contribute to the development of a lumbar disc bulge. These need to be assessed and corrected with direction from the treating physiotherapist and may include:

  1. a sedentary lifestyle
  2. being overweight
  3. poor core stability
  4. muscle tightness
  5. muscle weakness
  6. joint stiffness
  7. poor lifting technique
  8. poor posture
  9. a lifestyle involving large amounts of sitting, bending or lifting

Signs and symptoms

Patients with this condition may experience a sudden onset of back pain during the causative activity, however, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms are typically felt in the lower back and may be located centrally, on one side or on both sides of the spine. The patient may experience pain radiating down the leg into the buttocks, thigh, lower leg or foot (sciatica). Muscle spasm, pins and needles, numbness or weakness may also be present. In some cases, patients may appear to stand with their spine noticeably out of alignment as a result of the disc bulge. Symptoms are generally exacerbated with activities involving lifting, bending forwards, prolonged sitting, or when moving from sitting to standing (e.g. getting out of the car). Coughing, sneezing and twisting may also aggravate symptoms. Patients with a lumbar disc bulge often experience pain that is worse first thing in the morning.

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Prognosis of a lumbar disc bulge

In patients with the perfect balance of activities, the lumbar disc may be pushed into position in as little as three days. Typically, however, patients take approximately 2 to 3 weeks to push their disc back 'in'. Once the disc is 'in', the patient should be pain free and have full movement. However, the torn connective tissue at the back of the disc only begins to heal from this point. It takes approximately six weeks of consistently keeping the disc 'in' to allow the torn tissue to heal to approximately 80% of its original strength.

Physiotherapy for a lumbar disc bulge

Physiotherapy treatment for a lumbar disc bulge is vital to ensure an optimal outcome and may comprise:

  • STM
  • electrotherapy (e.g. ultrasound,TENS, Decompression unit etc)
  • lumbar taping
  • bracing
  • mobilization
  • traction
  • the use of a lumbar roll for sitting
  • dry needling
  • exercises to push the disc back 'in' and to improve strength, core stability and flexibility
  • education
  • activity modification advice
  • biomechanical correction
  • ergonomic advice
  • clinical Pilates
  • hydrotherapy
  • a functional restoration program
  • a gradual return to activity program