Battle of the Bulge

Have you been diagnosed with a bulging or protruding disc? Commonly known as a "slipped disc", disc herniations are typically a natural consequence of aging, but may be caused by trauma.  It has been shown that both genetic and environmental factors contribute to disc herniations. Discs degenerate and the inner core leaks out, placing pressure on the spinal nerve, and typically sending pain into the hip, buttock, and leg (sciatica.)

The majority of disc herniations ( about 95%) occur in the low back at the junction of the lumbar(L) 4-5 vertebrae or L5-S(sacrum)1. Typical onset is between 40 and 50 years of age, and three times as many women as men suffer from disc herniations. Only about 5% of herniations are symptomatic.

The vast majority of these herniations are postero-lateral in nature, with foraminal (or far lateral) prolapse accounting for a mere 5-10% of cases. Recurrent torsional strain is  a significant cause of lumbar disc herniations.

This is a major reason most enlightened physical therapists and other fitness professionals tell clients to avoid sit-ups, the bicycle exercise, and the scorpion move, all of which put extremely high compressive forces on the low back. In addition, excessive running while overweight, improper foot and knee biomechanics, poor lifting technique can contribute to disc herniations.

Symptoms include:

• Low back pain
• Leg and foot pain
• Numbness and weakness in the leg and foot
• Buttocks pain
• Weakness and numbness in big toe and ankle (L4-L5)
• Loss of ankle reflex and numbness in sole and outside of foot (L5-S1)
• Pain worse with sitting and/or bending forward
• Pain worse with coughing,sneezing or Valsalva maneuver
• Sharp, burning, and/or stabbing pain

The good news ? About 90% of patients suffering from these herniations show dramatic improvement within 3 months without operative care.

Typical treatments include:

• Physical therapy ( massage, ultrasound, chiropractic adjustment, traction, stretching and strengthening)
• Heat/ice
• NSAIDs
• Oral steroids or epidural cortisone injection 

In 80% of cases, symptoms are alleviated with conservative treatment. Patients are advised to lose weight, concentrate on core strength, flexibility, and obtain corrective devices ( such as orthotics) for biomechanical issues such as leg-length discrepancy or over-pronation.

As always, keep moving as much as possible. Blood flow to the affected region enhances the healing process. In fact, it is quite common for disc herniations to improve without medical intervention. The "battle of the bulge" is one you can win with a cautious and informed approach.