Lower back disc bulge - do you know the signs?
Firstly, to understand what a disc is: it is a fibrocartilage structure which sits in between each of your spinal bones (vertebrae), the thickness of the disc is about one third of the vertebrae and they serve as shock absorbers and allow greater flexibility of the spine. A disc has two main components, a tougher outer layer (annulus fibrosus) and a softer inner portion (nucleus pulposus), in a damaged disc the outer layer may begin to bulge outwards and weaken, in some cases the outer layer can split leading to the inner portion leaking out, which is called a disc herniation. As well as having discs and vertebrae, your spine also contains a spinal cord and spinal nerves which branch off from the spinal cord. When a disc bulges, it has the potential to bulge into and compress the spinal cord or nerves, this is typically the cause of the majority of pain and symptoms from a bulging disc.
The pain and symptoms from a disc bulging into a nerve are commonly referred to as sciatica, however, you may also hear them referred to as a radiculopathy. Whilst the majority of us will experience some lower back pain at some point in our life, figures indicate that approximately only 5% of men and 2.5% of women will experience radiculopathy. A radiculopathy caused by a bulging disc will differ from mechanical back pain in that you may experience symptoms of pain in your buttock, groin, thigh, calf and foot which could be described as burning, stabbing or like an electric shock, you may also experience a pattern of numbness, tingling as well as weakness. These symptoms are typically aggravated by bending forward at your lower back.
Disc herniation’s are most common between the ages of 30-50 and are twice as likely to affect men. Risk factors are believed to be increased manual strain and torsion through the back (such as repeated lifting and twisting through the back), increased BMI and genetic predisposition, whilst smoking has also been indicated in increased disc degeneration. Trauma can also cause injuries to discs and they will also lose some integrity as you become older.
It is important to remember that disc injuries do typically improve and not everyone experiences painful or lasting symptoms from bulging discs, however, if you have the symptoms of a disc injury it is important to have these professionally assessed and treated. The symptoms of a radiculopathy are not always caused by a bulging disc; therefore, your Physiotherapist will be able to assess you to provide a probable diagnosis on what is causing your pain, developing a treatment plan on the most appropriate way to attempt to reduce and resolve your symptoms. You do not need to have an existing diagnosis or scan to attend to a Physiotherapy assessment and your therapist will inform you if they feel it would be important for you to have any further investigations or referrals.
Physiotherapist’s have many tools at their disposal to help in the treatment of a herniated disc, and these are typically geared towards pain reduction, improving healing, building strength, fitness and return to normal function. Depending on your symptoms your treatment may involve manual therapy of your spine, massage, electrotherapy, acupuncture, a specific progressive exercise program and practical advice on your condition.
In rare cases a disc bulge can be a medical emergency, so if you experience a numbness in your genital region, urinary retention, bowel incontinence, sexual dysfunction or loss of power in the leg then you would require immediate urgent medical attention and investigation. However, the vast majority of lower back radiculopathy cases can be assessed and treated safely and appropriately by your Physiotherapist.
If you have any questions at all regarding your back, please get in touch and would be more than happy to help. Use our FREE online ‘Ask A Physio’ service to get in touch with the experts.