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Bulging Disc Exercises & Effective Long Term Treatment Strategies

Written by: Nick Jack
Category: 2014
on 18 April 2016
Hits: 57567

In my 16 years as a trainer specializing in rehabilitation and teaching people the principles of core strength and functional movement skills the most common injury I have seen is a Bulging Disc. An extremely painful injury that can significantly alter your daily life and take a long time to recover from. Some people come to me after years of severe pain, surgery, on all types of medication that not only did not help them but also ended up giving them side affects to new problems. This condition can really knock you down and give you a beating both physically and mentally if the right strategy from the outset is not adopted. While we have all heard about severe damage to backs which can occur because of lifting something too heavy, like a deadlift in the gym or moving a fridge in your house. Most back pain episodes, and in particular bulging disc injuries are the result of everyday activities, postures and sports movements, involving repetition and small to moderate forces. Over time, these add up to produce pain and stiffness. When in pain our instant reaction is to find something to get out of pain, and while this makes sense and obviously needed, is not the solution to the real problem. This process is only step one in a process of many if you want to get rid of pain for good and avoid it in the future. Unfortunately as we are so conditioned into treating symptoms this is where many people stop their rehabilitation program. Once the pain is removed they go back to their life this time making some adjustments to their lifestyle, (no longer doing gym, or changing jobs) to avoid being hurt again. This now sets you up for more injury as you begin to move in compensatory ways. In this article we are going to provide you with some tips on what to look for and how to change these compensations.

What Is A Lumbar Disc Bulge?

When a client first tells me they have been diagnosed with a bulging disc I can sense that they are not 100% certain what that means. I like to explain things as simply as possible as it then helps you to understand WHY it happened and then what you need to do. More or less buying into your own program from a better understanding of it. Many people used to think this was an injury that mainly happened to people in their 50's or older but I work more with people in their late 20's and early 30's than any other age group. A bulging disc injury is a common spine injury sustained to your spine's intervertebral disc. It can occur in your lumbar spine (lower back), thoracic spine (upper and mid-back) or even your cervical spine (neck).

A bulging disc can commonly be referred to as a slipped disc or a protruding disc. However, when the disc bulge is significant enough for the disc nucleus to come out of the annulus, it is known as a herniated disc.

Okay so let's look at how this works.

The lumbar spine comprises of many bones known as vertebrae, each of which is separated by a disc. The disc comprises of many layers of strong connective tissue wrapping around the disc. In the middle of the disc lies a soft jelly-like substance which is capable of changing shape. When this jelly-like substance protrudes from the disc due to a tear in several layers of the connective tissue, this is known as a lumbar disc bulge. One of the best explanations I have ever heard is from a website called Physioadvisor.com and they use an analogy of a vanilla slice.

"Imagine a vanilla slice wrapped in five layers of sandwich wrap. The top and bottom layers of pastry represent the vertebra (bones), the custard represents the jelly-like substance of the disc and the sandwich wrap represents the connective tissue around the disc. If you were now to pinch the front of that vanilla slice, you could imagine, the custard would squeeze towards the back of the vanilla slice and may tear two or three layers of sandwich wrap at the back of the vanilla slice. As a result the custard is no longer supported as effectively at the back of the vanilla slice and therefore bulges out at this location. In the disc, the situation is the same. Bending forward closes down the front of the disc, pushing the jelly-like substance within the disc towards the back. Overtime or suddenly, this may tear several layers of connective tissue at the back of the disc resulting in a disc bulge."

I really like to use analogy's a lot as I find it helps people to really understand what is going on and that is one of the best I have heard. The varying degrees of herniation can vary significantly as seen below.

Now we know what a bulging disc is, we now need to recognize here WHAT MOVEMENT CREATED THE PAIN!

This gives you clues on what you need to rectify and will make up a big part of your program moving forward.

Sciatica often occurs as a secondary problem to the bulging disc and symptoms can present as other injuries. Sciatica is refers to pain, tingling, and/or numbness felt along your sciatic nerve. The sciatic nerve runs down the back of the thigh, down the shin to the toes, and can be traced back to the nerve roots that exit the spine at L4/5 and L5/S1. The pain felt in your butt and legs is when the sciatic nerve is being pinched. This usually occurs in your lumbar spine (lower back). Again another reason why it is so important to get a complete diagnosis before attempting to apply a corrective program.

You can read more about our article on Sciatica here "How Do You Know If You Have Sciatica or Piriformis Syndrome"

 

Spinal Fusions Rarely Work!

In all my years working with hundreds (if not a thousand by now) I have not met one person who has been better off after undergoing surgery on their spine! Not one!

Now I am not here to try and rubbish surgeons or the medical world, as the work they do is nothing short of amazing putting people back together after horrific accidents or even birth defects. Science really helps significantly with these cases which prior to this technology many would die or live a life severely disabled. Technology also significantly helps in diagnosing injuries and where things that previously may have been undetected to be identified and corrected. The type of cases I am referring to are where people have developed a chronic pain or problem that WAS NOT from a traumatic accident, but instead a postural problem developed over time.

Using surgery to correct the end result of something that has evolved from lack of exercise, poor exercise choice, poor movement and postural habits is plain ignorance.

And if you don't believe me then read what surgeons have to say. The book by Dr Ian Harris pictured below goes into great detail about how spinal fusions actually make people worse instead of improving their pain.

Dr. David Hanscom, an orthopedic surgeon with a practice in Seattle, is unusual in that he tells most of his patients they don't need surgery. He's written a book detailing his novel approach to chronic pain treatment, called "Back in Control: A spine surgeon's roadmap out of chronic pain."

"Spinal fusions are a lucrative business and great source of revenue for the hospital and surgeon. Unfortunately, they rarely work for the patients. Spinal fusions arose from the assumption that disc degeneration was a source of back pain. Therefore, it was thought that by fusing the disc together with the bone, which eliminates motion, you would get rid of the pain. However, that has since been proven false. Disc degeneration actually does not cause back pain. That's been well-documented," Dr. Hanscom says.

"The success rate of the spinal fusion for back pain was about 24 percent, but we still kept doing it. Then, in 1994, when this paper came out Washington showing that the return-to-work rate one year after a spinal fusion for back pain was 15 percent, I just stopped. Every paper since then has showed pretty much the same dismal results; there's maybe a 20 to 25 percent success rate of spinal fusion for back pain...

And the downside of a failed spine surgery is terrible. It's really bad. These people are condemned to live their entire lifetime, 30 to 40 more years, in chronic pain." Despite such findings, spinal fusions are still popular. Each year, some 600,000 spinal fusions are performed in the U.S. with a high percentage of them being performed for non-specific low-back pain, at a cost of more than $600 billion."

Source: www.mercola.com

What should you do? The first thing you need to do is relieve pain and remove the pain trigger.

Step 1: Relieve Pain & Symptoms Using Horsestance or McKenzie Stretch

One of the simplest forms of relief is to use walking

When you walk, the health of your back muscles is improved in the following ways.

  • Increases blood flow. Decreased physical activity can cause the small blood vessels of your spine to become constricted, reducing blood flow to the spinal muscles. Walking helps open up the blood vessels, increasing the supply of oxygen and nutrients to these muscles.
  • Flushes out toxins. Muscles produce physiologic toxins when they contract and expand. Over time, these toxins can accumulate within the lower back muscle tissues and cause stiffness. Walking helps flush out these toxins and improve flexibility.

These two factors can assist you in building strength in the muscles of your lower back and reduce the chance of pain. They will not be enough to strengthen your body on their own, as you still need to develop sound movement skills (bending in particular) and have many exercises to strengthen the muscles supporting the pelvis. But this is a great start and a simple way to preserve some basic stability and strength. You can read more about this in the article - Why walking is a great exercise for back pain

The other relief exercises I would use are the McKenzie stretch and the horsestance also known as "bird-dog".

As there are many different types of disc bulge it is important you discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed provided they do not cause or increase symptoms. In my experience with working with hundreds of cases of disc bulge this first exercise is like "gold" to people when in pain and in some cases the only position that gives them relief. In Yoga this is known as the cobra pose, but it is commonly known in the exercise world as the McKenzie stretch. The reason this works so well is that the prone position (lying face down) allows gravity to let the fluids that have been squeezed out, (remember the filling of the vanilla slice) to drain back into the annulus of the disc.

It is also important to note here that this movement is called extension and lying face down does not require any muscle strength as the position itself forces it. In 90% of bulging disc cases it is caused by too much flexion or bending forward poorly. So it is no surprise that an exercise like the McKenzie stretch that provides the exact opposite provides relief instead of pain.

 

If pain is quite severe I will prefer the Horsestance exercise as it is much less aggressive and a great way to encourage basic core stability at the same time as relieving the discs from pushing on the scitatic nerve. Watch the two videos below to see both of these exercises used.

 

Both of these exercises get the lumbar spine out of flexion which is why it provides relief. The worst thing you can do is lie down and rest.

Rest is a good thing for most injuries as it allows the body the opportunity to heal itself. However you can have too much of a good thing when it comes to back pain. Lying in bed for too long can make matters much worse and many people will often feel worse first thing in the morning.

The reason this happens is the discs in the back re-hydrate overnight by filling up with a concentrated protein that is a water-like substance. This is how our discs receive their nutrition to remain in good health. When this happens they swell to a larger size which is fine for someone with good spinal mechanics and position. But it is bad news for someone whose spine is not in optimal alignment as these larger discs now pose problems and makes movement very stiff and awkward until the discs reduce back to their normal size.

Now that we have found some relief positions and also know extension provides relief this now tells us where to go in terms of creating a program to get rid of your problem for good.

  1. We need more exercises to strengthen the body to enable good lifting mechanics and maintain spine in ideal posture
  2. We need stretches to weaken the muscles that provide flexion
  3. We need to teach you how to move correctly with the bending movement pattern
  4. We need to eliminate any repetitive movements that contribute to faulty bending or flexion related muscles tightening up

What comes first? That's easy, point number 4 is what should be first for if this remains the program has no chance as all your good work is poured down the drain every time you do what caused the problem in the first place.

Step 2: Eliminate The Pain Trigger

Recognizing and avoiding the pain mechanism as McGill likes to call it is essential to pain free life. By understanding your pain trigger you can begin to understand how to get rid of it for good or even avoiding more damage to begin with. But how do you find your trigger? Watch the videos below to see examples of how pain triggers develop from poor movement.

 

Many times we go through intense assessments, provide home exercises, stretches, stability drills for the client to do and after a few weeks the person has not changed much with their pain. Why?
In 99% of these cases the trigger that is causing their pain is still at play and has not been changed and it is a DAILY ACTIVITY  they think nothing of. Any of the corrective work we have done in the gym is instantly wiped out when the person continues to move with poor postures, motions and methods they had before.

The most obvious thing to look for here is how long you sit, and what your posture looks like when you sit down. Poor posture when sitting, standing and working stresses your spine. Sitting is by far the most significant factor and with so many of us these days in sedentary type jobs it is the most common cause. Sustaining a slouching or forward bending of your spine leads to overstretching and weakness of the posterior fibrocartilage (or annulus) of the spinal discs. Over time, this leads to poor disc integrity and displacement of the disc nucleus fluid posteriorly. This places your spinal joints and nerves under pain-causing pressure.

To decrease the effect of poor posture on your spine it is important to continually attempt to a maintain a good posture or even better, regularly change your posture. Setting up your workstation correctly will be a good start and regularly taking breaks to give your hips and spine a break will be another.

Read our article - How much pressure is placed on the spine when you sit to see exactly how to set up your workstation and prevent this from creating more damage.

If you are in a job that is not requiring you to sit for long periods it may be a movement pattern problem such as how you rake leaves or how you bend over on a work site. Refer to the pictures below.

Don't disregard training techniques. Poor deadlift form or even people who do too many sit ups (see picture above) and exercises to develop "ripped abs" often develop this problem from the amount of repetitions forcing them into flexion. These exercises are a great way to create a bulging disc! Other things to look for might be your sleeping positions, standing on one leg too often or any repetitive task you do. Once you have identified this your job is to eliminate it or change it as much as you can.

Read this article to see more - Treating bulging disc injuries is all about how you move

Step 3: Improve Hip & Thoracic Mobility

The muscles typically involved in creating the poor position are the thoracic region, hips, hamstrings and the abdominal muscles. Using stretches daily to gently loosen these tight overworking muscles will then enable us to strengthen the weak muscles that provide extension. It is important to always release tight muscles first.

The main reasons for this is to ensure optimal range of motion of joints is present and also to weaken the neural message being sent to the tight overworking muscles. When pain is present it sets off faulty messages to nerves and muscles in order to prevent future pain. This faulty message disrupts timing of movements and will continue to stay in place unless something is done to restore it back to normal. A bit like virus on your computer. And the only way to weaken a message is by stretching or massage. Now there is many different things to stretch and it would be impossible to say that everyone should do the same stretch. You must find what is tight for you and stretch that.

Read this article to see more about how to do this - How to identify mobility restrictions that effect how you move

Out of the tight muscles I would definitely rank the THORACIC REGION & the HIPS as suspects number one and tow on my list of areas to investigate.

Having worked with hundreds of cases of herniated discs I would say in over 80% of all cases, loss of hip and thoracic mobility accompanied with dysfunction was the biggest contributing factor relating to the pain. Without adequate hip mobility your lumbar spine has no choice but to bend and flex during movements that it should remain stable and in neutral. Spending time doing "core" exercises is a complete waste of time if the hips remain stiff, rigid and unable to move as they are designed.

To fully grasp this concept read the article "Are Your Hips The Cause Of Your Back Pain"

Below are two great videos that explains this concept, which leads us to the next very important step - how to bend correctly!

  

Step 4: Teach You How To Move Correctly With Bending Pattern (Deadlift)

By far the riskiest exercise, and apart from rotation this would be the most difficult for most back pain sufferers to get right.

A real fear or re-injury is present with this injury as closely mimics the action they possibly completed when hurting themselves, and also may bring on the pain symptoms quickly. But as we have mentioned several times already, it is for this reason you MUST learn how to do this exercise. It is important to see the relevance of how this movement relates to so many real life movements. Which is why learning how to do this with your rehab program will supersede any other rehab method such as Pilates, massage, acupuncture etc. Learning how to set up correctly, how to use your breathing, and activate your inner unit prior to the lift are all things you will need a lot of practice to do.

Read our articles on Core Strength and How To Breathe Correctly When You Exercise for detailed instructions on how to do this.

Understand that you are not trying to strengthen anything yet, you are just learning how to move correctly. As already mentioned using the stretches to loosen tight areas preventing you from obtaining the ideal posture or position is critical before doing this phase. But the real secret is teaching the legs to the bulk of the heavy work at the right time.

The gluteus maximus and hamstrings work in concert to produce posterior pelvic tilt. At approximately 45% of trunk extension, when lifting an object off the ground the back extensor muscles become progressively more active, taking the load out of the posterior ligamentous system. It is the gluteus maximus and hamstrings that are prime movers of the load during the initiation of any lift requiring more than 45 degrees of trunk flexion. Where most people encounter problems is when the knees are straight.

If the knees are not partially bent, approximately 20°, the gluteus maximus will not become active. In such cases the load must initially be lifted by the hamstrings. This will often lead to faulty motor patterning, predisposing the lifter to injury of the hamstring complex and, ultimately, the back as it must flex to complete the movement. This is when the disc is forced out of the annulus and all the trouble begins.

Read our article "Deadlift Technique Tips To Protect Your Lower Back" for detailed explanation of the deadlift and bending movement pattern.

Watch the two videos below as we show you how to do demonstrate a simple method to learn this and the second video showing you how to use tape on your back to assist you in maintaining a neutral curve in your lumbar spine.

 

What About The Core?

For many years now we have been convinced to believe that strong abs means a strong core, and will prevent back pain. Even therapists and Doctors have been known to prescribe planks and abdominal exercises to treat back pain with this same type of thinking. We must realise that strength of the abdominal muscles WILL NOT change the faulty movement that leads to injury and pain. Your body will instantly sacrifice any strength if it only knows how to move with the same dysfunctional movement it has always used.

The main thing to understand is that the core is not just the muscles around the abdominal area.

The Core is a complex integration of small stabiliser muscles (the INNER UNIT) working together with large prime moving muscles (the OUTER UNIT) to produce movement.

These inner unit muscles attach to the body at the spine only, meaning that when they activate they generate little or no movement. They can only stabilise not move you. These muscles, TVA, Pelvic Floor, Diaphragm, and Multifidus are often the focus of clinical Pilates training with many researchers showing there is a delayed response with back pain sufferers. The TVA is classified as an "anticipatory muscle" meaning it is programmed to fire when it senses you are about to move, in order to stabilise the body. A bit like a construction crane being bolted to the ground before it goes to pick something up.

Often with back pain this automatic sensory program is either delayed or does not occur at all leaving the person's spine vulnerable to problems. So you can see how people would come to the conclusion - "all I need to do is work these muscles to become stronger and everything is fixed!"

However, there are several problems with this type of thinking! Usually the body is hurt in a standing position, not a lying on your back position. Meaning that it is also using the outer unit muscles within complex motor programs all within a split second. But even more important than all of this is one huge player - The Brain!

The picture shown below is a classic example of a person who is great at holding planks and doing sit-ups but the minute they bend they lose all control of the abdominal muscles as they know no other way to bend over. Their abs are not weak, they are simply sacrificed when they need to bend over. A bulging disc in inevitable in this situation and more ab work will be pointless. If anything working on hip mobility will do more good.

Look how similar the poor deadlift form is to the action of picking up something that is common to the bulging disc sufferer.

The outer unit are the larger and more powerful muscles more concerned with providing movement of the body. However these muscles help to control the range of motion and provides stability on a much bigger scale. These muscles do a very poor job of stabilising the pelvis and spine. The key here is one cannot work without the other. Both units need each other and they must learn how to sequence together perfectly in order to function efficiently.

The stabilizer muscles are not designed or know how to produce movement. And the large global muscles are not designed to create stability. To focus solely on only one area is a waste of time and potentially could ruin you. This is where the trick is, identifying which one is the main contributor to your problem, and secondly working out how to correct it WITHIN A MOVEMENT! And usually the movement that creates your pain is the one you need to work with the most!

"True core strength can only be developed using both inner unit and outer unit together in a standing position" This is where you will now be training the inner unit, the outer unit but more importantly the Brain and the Nervous System.

We can work on the core with basic exercises to begin with but wee must have the intention of improving how we move and integrating this learning into functional movement patterns. Watch the two videos below to see examples of how to do this.

 

You can read more about this core training and how it relates to back pain in this article - Why having a strong core does not prevent back pain

Step 5: Strengthen The Body With Good Lifting Mechanics and Maintain Spine In Ideal Posture

Lastly we use a combination of stability and strength training exercises methods to provide the body with the ability to hold itself in the posture that prevents pain and also be able to use the correct muscles for movement.

We can only get to this stage if we have completed all of the previous stages first. If you skip the previous steps you are risking further injury. And also if you do not complete this step you are also risking injury as you still have not prepared the body to withstand the demands of life. Far too many people do not get to this stage or the previous stage, relying on just the physio treatments and taking away of the pain. This is why they will suffer repeated episodes as the weak muscles are not able to hold their body up against gravity or any of the movements like picking up shopping bags or pulling a weed out of the garden. Always remember this if there is a tight muscle there is also a weak muscle. You must loosen the tight muscle but you must also strengthen the weak muscle to complete the job.

And on top of all that is the brain and nervous system that coordinate motor programs. You may be able to restore muscle imbalance but still have poor movement mechanics and dysfunctional motor programs that inevitably put you back in pain.

Studies have shown that people with poor isometric muscle endurance of the back extensors are 3 times more likely to suffer from low back pain! There are countless exercises you can use to strengthen your body and provide you with a good chance of full recovery. To keep this simple here is some easy exercises you can use.

Watch the video below of a video that explains all of the key movement patterns and how to gradually progress to integrated movement. 

 

Do You Need More Help?

Before you attempt to complete any exercises shown in this article make sure you have seen a qualified Health professional for an accurate diagnosis and assessment of your condition. I cannot stress this enough as self diagnosing can potentially lead to more problems. We often refer out to Doctors, Chiropractors and Physiotherapists before implementing our program. Being certain on where to start is crucial to the success of the program.

If you have seen a health professional and are now looking at implementing a series of exercises and stretches this article will provide you with many great ideas on how to do this. As many people struggle to implement this into a gradual progression I created a detailed step by step program called Back Pain Secrets that includes a 85 page Ebook and 90 minute video with exercises, stretches, mobilizations and in an easy to follow format. This can be done at home or in the gym and we cover everything about your condition in great detail from eliminating the cause to best strength exercises, even nutrition to speed up the healing process! For more information you can watch a quick trailer video of what is included. 

Click here or on the image below to get a copy.

 

We also have a FREE cheat sheet titled '7 Simple Steps To Overcome Debilitating Back Pain that gives you the following steps outlined for you.

 

 

Conclusion

I hope this article now gives you a better understanding of a Bulging Disc and exactly what exercises you will need to do to not just get rid of the pain, but also get rid of the reason you ended up in pain! The most important points to remember are assess don’t guess, get rid of repetitive movements causing you to bend poorly, stretch tight muscles first before trying to strengthen and aim to improve MOVEMENT PATTERNS in a standing position. If you take your time and do these steps right you will have a great outcome and never suffer with this painful condition every again!

You can also find other articles on back pain below.

 

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 200 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily.

If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program. International readers can request a Zoom call.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 16 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

  • Movement - By Gray Cook
  • Corrective Exercise Solutions - by Evan Osar
  • Back Pain Mechanic - by Dr Stuart McGill
  • Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
  • Low Back Disorders - by Dr Stuart McGill
  • Ultimate Back Fitness & Performance - by Dr Stuart McGill
  • Core Stability - by Peak Performance
  • Athletic Body in Balance - by Gray Cook
  • Anatomy Trains - by Thomas Meyers
  • Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
  • Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
  • How To Eat, Move & Be Healthy by Paul Chek
  • Scientific Core Conditioning Correspondence Course - By Paul Chek
  • Advanced Program Design - By Paul Chek
  • Twist Conditioning Sports Strength - By Peter Twist
  • Twist Conditioning Sports Movement - By Peter Twist