In this video we discuss:
- What a disc bulge actually is
- Whether or not your low back pain is likely being contributed to by a disc bulge
- 3 easy exercises that you can start doing to alleviate back pain caused by a disc bulge
Transcription of the video:
Hey guys, for those of you who don’t know me, my name is Ryan VanNieuwenhuyze, and I’m a Doctor of Physical Therapy here in Connecticut. The topic we’re going to be covering in today’s video is low back pain and the concept of disc bulges.
So what usually happens in the clinic is somebody will develop some new onset low back pain, they will either talk to their friends or family members who say that they must have slipped a disc or something like that, or they’ll see a medical provider that orders some images like MRIs that show some disc changes on that image. So I want to go over a couple of facts about back pain before we actually get into what we’re going to do about the situation. So the first thing you need to know is that low back pain is very, very common. About 80% of the adult population in the world will experience it at some point in their lives. But very rarely is low back pain the sign of a very serious emergency situation. I think it’s estimated that about 3% of low back pain cases are emergent situations in which you need immediate medical attention otherwise you may experience some severe adverse effects.
So just so you know, if you do have low back pain, and this is a first time or if it’s a recurrent thing, it’s most likely not a very serious medical emergency. The second thing you need to know is that most cases of new onset low back pain resolve all by itself over the period of several weeks, usually in the four to eight week range. So if you do have some onset of back pain, try not to worry too much about it, as it’ll most likely get better over time. And it’s most likely not indicative of anything too serious going on.
Now, when people talk about disc injuries, everybody says that they must have slipped a disc. And this couldn’t be further from the truth. Those discs are anchored in between the adjacent vertebrae by tons of very strong ligaments and they do not move anywhere. So if somebody says you’ve slipped a disc, that is not true at all.
Next is the fact that most disc injuries also heal by themselves over time. There’s been several studies done that looked at how many of these disc injuries heal by themselves without any medical intervention, and it’s upwards of 66 to 70% of all disc injuries. Interestingly enough, the more severe the disc injury is, the bigger the disc bulge or disc herniation, the more likely is just to heal by itself over time without any intervention.
And the last thing is just because you have a diagnosed disc injury on MRI, it doesn’t mean it’s necessarily causing your pain. They found that changes in discs happen pretty much just as frequently in the pain free population as they do in people who do have low back pain. So because they’re just as prevalent in those populations, it’s very hard to say for certain that just because we have a disc injury on MRI that’s causing your pain, or will likely lead to you having pain in the future. So just because you’ve had those disc changes, it doesn’t mean you’re always going to have back pain, and it actually may not even be associated with the pain that you’re experiencing at this point.
Low back pain is a very complex topic. It’s very multifactorial, many things go into it besides just what you see on an image. Things like exercise, your activity level, physical and mental stressors, how much you like or dislike a job, all of those things kind of paint this big picture that can go into you experiencing back pain. So it’s not just you have a disc injury and therefore you will have back pain. There are many, many factors involved.
Now for most people who are diagnosed with this type of injury, they often have pain that’s significantly worse with sitting and bending forwards and often those people will have pain down the leg as well. Very frequently that pain is kind of diagnosed as sciatica. But true sciatica is laid out in a very specific distribution, and that’s the sciatic nerve distribution which is from the buttock down the posterior portion of the leg, potentially to the calf and down to the foot.
If you have pain in the front of your leg or on the side of your leg, that’s not true sciatica. Even though it is still the same type of pain, it is just affecting different nerve roots. So again, people have pain that’s usually worse was sitting and bending forwards. Often it will go down the leg and their pain is usually better with standing and bending backwards.
So the next thing that we’re going to do is just go over three quick exercises that you can do to start getting rid of this pain, and start kind of calming everything back down.
Okay? All right, guys. So this is just the first exercise I am going to demonstrate. This is called prone on elbows, and is an extension based exercise. Its whole goal is to basically get you back into a little bit of extension, which is the position or movement that most of these people find some relief with. So all you have to do is go on your stomach, prop yourself on your forearms, and you can do one of two things, you can either stay here for a prolonged period of time, like three to five minutes, or you can stay up for 30 seconds, and then go back down flat for 30 seconds, and repeat that for several sets.
What you should notice is that if you are having leg pain, the pain should ideally start to come up out of the leg and centralize towards the back. If that happens, that’s a process called centralization. And it means that you’re kind of doing what you need to do to get this back under control. So we want to see movement of the pain up out of the leg or a reduction of the pain in general. So that’s the first step.
The next step is just a press up, which is a little bit of a progression on the prone on elbows. All you do is put your hands underneath your shoulders, press up, try to keep your hips on the floor, and then back down. Initially, you may not be able to go all the way up, that might be a little bit too sensitive for you. So if that’s the case, all you have to do is go up until you feel mild to moderate discomfort, pause for a second and then back down. As you continue to do more reps, what you should find is that you can go a little bit higher each time and the pain starts to get a little bit less and less.
Now the third exercise is a little progression on the press up. This is called extension in standing, and is a little bit of progression because now you’re going to be in a position with gravity acting through the spine. All you have to do is put your hands on your hips, and you’re going to arch back from your lower back and then come back upright. Again, I don’t want you just to push your hips forward, I actually want you to try and bend backwards.
Again, we’re going to have you do a couple sets of 10, and that’s the third exercise for this type of back!
All you have to do is perform a couple sets of these exercises periodically throughout the day, and that should start alleviating some of the pain that you’re having. Now, if you find that these exercises cause pain to go further down your leg, or they significantly increase your pain in general, these exercises may not be appropriate for you to do and you should probably hold off on them until you get further evaluated by the proper healthcare professional.
If your pain does not improve over the period of several weeks, I would advise seeking out a qualified physical therapists, family care physician, or orthopedist to evaluate you and determine the best course of care for you.
In summary, low back pain is very common. It’s very rarely the sign of a very serious medical emergency going on. And even if you have a disc bulge as diagnosed on MRI, it may or may not be associated with the actual pain that you’re feeling. If you do have pain that’s worse with sitting and bending forwards, especially if it’s going down the legs, you can try some of these extension based exercises and they should help to start getting rid of some that pain for you.
If you need personal help resolving your low back pain, or coming up with a plan to get you back into the gym after an injury, schedule a call with our expert physical therapists by clicking the button below!
Barbell Physical Therapy and Performance is a physical therapy clinic located in North Haven, Connecticut that specializes in helping injured lifters, barbell athletes, and gym-goers resolve their injuries and get back to training without any pain medications, surgeries, or skipping the gym. We also help people in the New Haven, Branford, West Haven, Hamden, and Cheshire areas!