What is a disc bulge?
Did you know that almost 80% of the global population experience an episode of low back pain at some point in their life, with degenerative disc disease and lumbar disc herniation (disc bulge) being the most common.
A disc bulge is also known as a bulging disc, slipped disc, or disc protrusion and is a condition during which a nucleus pulposus is displaced from intervertebral space. This can happen in the lumbar (low back), thoracic (mid back) or cervical (neck) spine.
Here, the side and cross sectional views of a herniated disk are shown. In a herniated disc the soft, jelly-like centre of the disc can push all the way through the outer ring (source). This can cause pain, and may or may not press on the adjoining nerve, which can cause pain to travel down our thigh or leg, and even down to the inside or outside of our feet.
Should I be concerned, will my disc bulge get better?
Most occurrences of a bulging disc (disc herniation) resolve with conservative treatment and resolve within as little as two to eight weeks. 85 to 90% of cases will resolve within this time-frame and without substantial medical intervention.
It can be scary when you have back pain, or have been informed you have a bulging disc, but there is really good evidence to show that it will get better, without the need for surgery.
Disc Bulges - a normal part of ageing process??
Recent evidence has found that disc bulges and degenerative back conditions are a normal part of ageing, just like grey hair and wrinkles on your skin. We should not fear them as being a life sentence, rather just a normal part of life. Furthermore, they don't always result in pain.
The study below shows that when 20 year olds WITHOUT back pain were scanned, 37% of them had disc degeneration, and 30% of them had a disc bulge. However, with increasing age, this number continues to increase, and in our 60's 88% of people WITHOUT BACK PAIN were shown to have disc degeneration, and 69% WITHOUT BACK PAIN shown to have a disc bulge.
What should I do?
Listen to your body and stay as active as you can within your own pain limits. You may find paracetamol helpful in settling your pain in the initial stages.
You may find that sitting is better than standing, or vice versa, or standing and arching your back a little, or maybe even laying down and swaying your bent knees gently from side to side. Whatever movement you find that is comfortable for you, and your pain remains below a 2 out 10, continue to do.
As your back starts to feel better you may be able to go for some walks, or extend your walks. Backs love movement, and the latest research now tells us that rest is not the best remedy. Deep breathing has also shown to be beneficial in relaxing the musculature of the back, helping to decrease pain.
What are the long term solutions for disc bulge and back pain?
Following on from the initial recovery phase, an essential part of helping back pain is strengthening and this is what Exercise Physiologists are the experts at! If we can help to strengthen your back, it is less likely that physical load will irritate it, this means that you have a decreased chance of recurrence and less severity of symptoms of future episodes.
We now know that pain is multifactorial, this means there are multiple aspects that affect our pain, including psychological and social stressors, nutrition, sleep and physical aspects. We can help to assess your pain and help you to understand your pain, and the things you can do it decrease pain, and improve your strength to help you to live an active life.
Discs respond to load and like getting stronger, just like muscles. It has been found that in people who run or lift weights, that their discs are stronger, fatter and healthier!! What a great reason to exercise!!
We'd love to help you with your back pain!!
Please get in touch or book online to book with an Exercise Physiologist who has a modern and evidenced-based approach to disc bulge and back pain.
What is the thoracic spine?
The spine is made of 5 different sections being the cervical, thoracic, lumbar, sacrum and coccyx. The thoracic spine starts at the bottom of the neck and ends at the abdomen and is the longest section of the entire spine. The thoracic spine consists of 12 vertebrae stacked on top of each, called T1 down to T12. These vertebrae support the neck, rib cage, connecting joints and soft tissues along with blood vessels and nerves.
What is the Thoracic spine’s role in the body?
The thoracic spine is crucial in supporting and stabilising the rib cage which protects all of our vital organs underneath, including our lungs and heart.
It also protects the spinal cord which sends all messages and signals throughout the entire body. The spinal cord travels from the brain, down through the vertebrae before it branches off into smaller bundles in the lumbar portion of the spine.
What kind of movement does it produce?
The thoracic spine is not as mobile as the neck and lumbar spine and it is quite limited in forward and backward movements at the top vertebrae. Although the thoracic spine can produce more rotational movement within the top few vertebrae to help twist our chest and shoulders.
Common causes of thoracic spine pain?
There can be many possible causes for upper back/ thoracic pain but some of the most common include;
Initially an increased range of movement through the thoracic spine is important to ensure that the spine can move freely without restriction. This may be done by lengthening out the muscles through the front of your chest and shoulders to enable a more upright posture to return. Increasing strength through the thoracic, lumbar and cervical spine will also assist in developing endurance to maintain an upright posture, preventing pain from returning in the future. Each case is assessed and treated individually to determine the best approach for each client.
Accredited Exercise Physiologist.
85% of shoulder pain in primary care is sub acromial, so, if you have ever had unexplained shoulder pain it is likely to be subacromial shoulder pain. This term is not a specific diagnosis however is commonly used by health professionals. Other names that you may have heard are subacromial impingement syndrome, subacromial shoulder impingement, or just shoulder impingement. If you have ever suffered or been told your pain is subacromial shoulder pain and you're unsure what it is and how to help it, let me help you! We will nut this out together!
What is Subacromial Shoulder Pain?
The word subacromial refers to the space between the top of the arm (humorous) and the pointy bit of your shoulder (acromion). Refer to the picture below to help you. Within this space, important shoulder muscles run, you may have heard of the rotator cuff, or more specifically supraspinatus (one of the rotator cuff muscles, there are 4). Another structure that is within this space is a bursa, a fluid filled sack for cushioning and comfort of the rotator cuff.
The pain you experience is due to some form of irritation of these structures within the subacromial space. This irritation can begin from a traumatic event such as grabbing something really fast and wrenching on your shoulder or from overusing the shoulder, when the shoulder is worked more than its capacity can handle. People who commonly get this shoulder pain are people who do some DIY gardening or home renovations and particularly when they are with overhead movements. Often the cause of your shoulder pain is a combination of overusing the shoulder and poor shoulder mechanics.
The common diagnosis you may hear are;
Whatever the mechanism, the structures of the subacromial space become inflamed and cause pain.
Management of Your Shoulder Pain
You may find yourself going down many different pathways to manage your shoulder pain with different health professionals however some have been found to be more effective to others. Specific exercise to improve shoulder strength and function have been found to be very effective for subacromial shoulder pain.
Treatments that are often seen for this type of pain include:
Activity modification and exercise have been the most effective in producing long term success in improving shoulder pain. Below we will go through management for improving shoulder pain
Unloading the shoulder or modifying activity
We have to take steps to modify whatever is irritating the shoulder. What movements are hurting your shoulder at the moment? What movements help your shoulder pain? What things do you do to relieve pain? When is your shoulder pain the worst? These are all the questions we need to answer so that we can modify the activity we are doing and unload that shoulder and settle down your pain and get you back to the activities you want.
Loading up the shoulder
I know what you're thinking, I've just told you to unload the shoulder! However we also need to find a load that the shoulder can handle so we can reduce the amount of strength lost meanwhile building up specific shoulder strength. Not to mention there are certain exercises that have shown to have a reducing effect on pain.
As I said above, often the cause of your pain is from overuse and poor mechanics, therefore it is important that we target improving the mechanics of the shoulder and build up the strength of the shoulder so it can handle a higher capacity.
Loading up the shoulder is a gradual process, the trick is to find the right starting point and progress as our body adapts so that we avoid the best we can flare ups of pain along the way. Flare ups, however are common and sometimes unavoidable, however doesn't mean we are doing damage to our body.
There are certain types of muscles that we aim to target in the initial phase of shoulder rehabilitation to improve shoulder mechanics and strength and these include;
Rotator cuff muscles: The rotator cuff muscles are important for shoulder stability and strength. The job of these muscles is to rotate the Humerus (upper arm) both internally and externally, however their arguably more important role is to hold the head of the upper arm in the socket of the shoulder. By improving the strength and durability of these muscles we can help improve the stability of the shoulder particularly when it is moving. Below is an exercise targeting rotator cuff muscles.
Muscles that move the scapula (shoulder blade): As the upper part of the arm (humerus) is joined onto the scapula at the glenoid fossa, the muscles that move the scapula have an important role in keeping the glenoid fossa in the correct place for shoulder movement. Not to mention the movements the scapula can do help to improve the subacromial space. Below is an exercise targeting the muscles that move the scapula (shoulder blade).
Muscles that adduct the Arm (bring the arm towards the body): These muscles are important as when you lift your arm above your head, naturally the muscles of your shoulder are pulling the upper part of your arm (humerus) upwards towards the acromion (pointy bit in your shoulder) reducing the subacromial space. Essentially the adductors of the arm help to pull the upper part of your arm (humerus) towards the ground. Below is an exercise targeting the muscles that adduct the arm.
You may be wondering, I've got all this great information and some exercises I can try! How long will it take before my shoulder pain will go away and I can start to do what I want? That questioned cant be answered on here as shoulder recovery is very individualised however research has shown that people with shoulder pain typically don't start to feel improvement until up to 6 weeks and it can take 12 weeks or longer before they can get to a satisfied outcome.
Key takeaways from this Blog are:
Don't be alarmed! It's better to take 12 weeks then to have ongoing pain for years. If you have read this blog and still don't know where to start, come in and see one of our exercise physiologists.
The videos shown are just some examples of baseline exercises and may not be the right exercise for everyone.
Accredited Exercise Physiologist
Everyone has experienced pain throughout their lifetime, it is an experience produced by the brain to protect you! But when it is persistent or chronic it is not fun, however it is more than likely not tissue damage being the major factor to your pain experience. So what is driving my pain?
Think of yourself as a cup
If you think of yourself as a cup, and in the cup you have all the stressors in your life that may be contributing to your chronic pain. Stressors can be anything from work stress, past history with pain, anxiety, physical stress, fear of movement, false beliefs and even lack of support. When we see a lot of these stressors in our lives, the cup gets too full, it overflows and we might get pain.
How Do We Stop the Cup From Overflowing?
We have two options to stop the cup from overflowing, we could decrease what's in the cup or we could increase the size of the cup.
Decrease What is in the Cup
To decrease what is in the cup we have to identify what stressors are in the cup first and then decrease the impact these stressors are having. Some strategies to do this are:
Increase the Size of the Cup
To increase the size of our cup we again have to identify what is in the cup and then develop our ability to combat these stressors. Strategies include:
So ask yourself what's in your cup? What can I decrease? or how can I build a bigger cup?
To help understand pain visit https://www.youtube.com/watch?v=C_3phB93rvI
Accredited Exercise Physiologist