Lower back pain is one of the most common musculoskeletal injuries or complaints with approximately 85% of people experiencing back pain at some point in their lives.
Disc bulges are also just as common, but not everyone experiences pain from a disc bulge. In fact up to 50% of people with disc bulges are asymptomatic (i.e. don't get any symptoms). READ MORE ABOUT THIS IN OUR EARLIER ARTICLE HERE.
Lumbar Spine Anatomy
The lumbar spine consists of 5 lumbar vertebra and 5 corresponding nerve roots. The lumbar nerve roots
exit the vertebra through spaces called foramen.
What happens when you do get symptoms from a disc bulge?
This is what is known in the medical world as "radiculopathy".
Radiculopathy is a pathological process where the nerve exiting the vertebra or the spine is being compressed. It can manifest in various signs including pins and needles, numbness, tingling, burning, nerve pain and weakness.
This can be due to changes in bony anatomy, degenerative changes or the dreaded bulging disc, which causes narrowing of the little gap where the nerve exits.
This little gap is called the nerve foramen and narrowing of the foramen is referred to as foraminal stenosis or nerve root impingement on MRI reports.
What exercises can i do if I have a bulging disc?
The short answer is lots!
There have been 2 fantastic studies done over the last 7 years which have proved that 2 activities that were thought to be bad for disc bulges are actually good!
1) Bending (lumbar flexion)
1) Lumbar Flexion: Can I bend or should I keep my back straight?
In 2013, Singh and colleagues conducted Kinetic (dynamic) MRI's on patients with disc bulges to assess for disc displacement as well as foraminal size which showed that lumbar flexion does not cause displacement of the discs, but actually increases the size of the foramen, which means more room for the nerve!
The take home messages from this study were:
A) Flexion (bending) showed a significant increase in foramen size on dynamic MRIs indicating an increase in size available for the exiting nerve root.
B) The amount of posterior disc bulge was significantly correlated with posterior movement into the foramen with extension not flexion. This indicates that there is greater compression of the nerve and increased posterior disc bulge when you move into extension (arch backwards) not flexion.
Yes! You can do that too! A study published in 2017 by Belavy et al found those that ran 30-50kms/week actually had healthier, stronger, juicier lumbar discs compared to their less active counterparts.
What do I do if I have a disc bulge?
That's Easy....Walk, run and DO NOT AVOID bending! The great news is that disc bulges do heal with time, with even the serious ones healing within 12 months.
There are lots of other options for exercise so if you're not up to running or if you are have having trouble then please do not hesitate to get in touch with us at www.clinicalphysio.com.au.
1. Singh V et al, Factors affecting dynamic foraminal stenosis in the lumbar spine, Spine J. (2013)
2. Belavý, D. L. et al. Running exercise strengthens the intervertebral disc. Sci. Rep. 7, 45975; doi: 10.1038/srep45975 (2017)