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Bulging Disc Treatment - It All Starts With How You Move

Written by: Nick Jack
Category: 2014
on 06 October 2017
Hits: 22158

The pain felt from a bulging disc is immense, and anyone who has experienced this will tell you exactly how scary it can be, especially if it left them temporarily paralyzed! They will also tell you that they would do anything to never have this happen again. But what tends to happen is we seek treatment, the pain subsides, and we start to go back to what we did before. We tend to blame the injury on the movement we were doing at the time, or what we did just prior to the back going. Eg Lifting a box, gardening etc. But really the cause of these injuries is very rarely from one incident. The true cause of these injuries is from repeatedly moving poorly. Common daily activities we think nothing of are often where the injury is formed. Many of us may be able to go through life getting away with some bad movement if it is countered enough with good movement. However, the person who does not build reserves and just keeps stealing from their body will pay the price. The very first thing you should do with your treatment for a bulging disc is to identify your poor movement and change it. If you ignore this, you are likely to suffer repeated episodes that get worse each time. In this article I am going to share with you some valuable information on how to do this.

What Is A Bulging Disc?

 

When you understand what a bulging disc is, and more importantly how it is created, you can begin to put the pieces together of what you were doing leading up to this. This will help you to expose the real culprit and allow any treatment you receive to have a greater chance of working.

The lumbar spine comprises of many bones known as vertebrae, each of which is separated by a disc. The disc comprises 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.

There are two ways this is felt. The first is an immediate "stabbing" pain after picking something up like a box off the floor, and the second is a gradual "build up" of pain. For example after sitting in the car following a long drive. Now as much as they are felt differently, they were both caused poor repetitive movement. There are two key movement patterns that are behind this problem, BENDING and ROTATION. We will explain in detail how this works and provide several examples of activities that you will need to be aware of.

Identify Your Pain Trigger Which Is Poor Movement

Success with any rehabilitation program requires removing the cause. If you fail to do this, you will just end up where you started. As much as removing pain is important, there is no point to leaving the cause of the pain unchecked. Leading back pain researcher Stuart McGill refers to this as "picking the scab". Where do you look for your cause?

The first thing to look for is inactivity

This is often associated with sitting for long periods and sitting poorly.

Compression of our discs is normal to some extent and happens all day due to Earth’s gravity. Most of these forces and motions are handled pretty well by the spine, and usually causes us no trouble. The spine is a strong, durable and yet flexible structure designed not only to transmit force but also allow a whole heap of movements in all planes of motion.

However, when the amount of these forces exceed the spine’s capability to withstand being squashed by various postures we repetitively adopt, or the dysfunctional way that we move, you will find pain is not far away.

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. Take a look at the chart below to see exactly how much compression is placed on the spine when sitting poorly.

You can see how the slouched sitting position places 275kg of pressure into the discs! This is much more stress than bending over. Make sure you read the article - How much compression on the spine is caused by sitting to see the full breakdown of various positions.

Now it is not realistic for some of us to stop sitting as our jobs may require us to do this. What it does mean is you need to adjust HOW YOU SIT.

The very first thing you need to do is move your butt back into the corner of the chair and ANTERIORLY TILT your pelvis so you can maintain an optimal position of the spine and hip. Some people may find this very tiring as the muscles required to do this may be very weak. Using a lumbar roll to sit in the curve of your spine may be very useful here as well as taking breaks by standing up or even kneeling on the floor every 10 minutes to give your muscles a rest.

Watch the video below of how to do this. 

The next area to look at is movement.

This is where I look for POOR BENDING MOVEMENTS which is the most common cause of bulging discs. And also at rotational movement.

Repeatedly rotating your spine instead of using your hips and thoracic spine will "tear the disc". Rotational movement has been given a bad name over the years for the damage it can cause. The problem however is not with rotation itself for if that was true we would never see any professional golfers or tennis players as they all would have torn discs. The problem is more to do with HOW YOU ROTATE. You can read more about this specific subject by reading our article "Is Twisting & Rotational Exercise Bad For Your Back?" If you are a keen golfer or tennis player and have a had a torn disc it may be a good idea to seek some advice from a coach to evaluate your technique before going back to playing.

Let's take a look at the poor bending actions first as these are where this movement is used in many of our daily tasks.

Poor bending actions are where we see someone constantly flexing their spine instead of using their hips. Sometimes occupations requiring constant bending contribute to this problem, but it is not the occupation, it is how you bend that is the problem. If it was the occupation then 100% of the people in this job would have a bulging disc. There is no problem with bending if you use your hips and maintain a neutral lumbar curve. Problems arise when you use your spine to do the bending. 

Watch the video below as I show you several examples of this.

Things that contribute to your pain and can very quickly worsen your condition are the daily movements we think nothing of. Look at the pictures below and see how many times the lumbar spine moves into flexion with simple daily tasks where bending over is required. Every one of these movements is in the process of ruining your discs. If you do not change this movement you are guaranteed to compromise your strength and stability in areas being weakened by these movements and it is now a matter of time until you end up with a bulging disc.

Tying Your Shoelaces

The picture on the left demonstrates spinal flexion and poor bending action. The picture to the right shows how to do the same activity but save the discs from damage by adopting a neutral spinal position.

Picking Up A Bag Off The Floor

Again the picture on the left is the poor bending action that will ruin your back. There is no use of the hips with the legs locked out straight and all the bending done at the spine. The picture on the right demonstrates the good technique of firstly better leverage and use the hips. We will provide more exercises of how to learn this later.

Vacuuming

This time the good technique is on the left and poor technique is on the right. Again with poor technique you see the knees locked out and all the bending performed by the spine. In addition to this is the lengthened lever by having the handle too far away from his body. Longer levers create massive stress to the spine. No wonder vacuuming is so hard for people with back pain. With the good technique we can see that he keeps the handle close to his body to reduce the lever on his spine and also uses his hips more effectively to bend over.

Now there are a many more everyday movements we could include but I think you get the point. Use your hips and not your spine.

What About Exercise?

I have seen many clients where we help them through all of the phases of rehabilitation, the learn how to bend correctly, even with loads. Everything appears to be going okay and then a setback, bang, they are in pain again. The first thing they blame is the exercises, but after questioning them about what things they have been doing the real answer is found. Poor stretching habits, yoga, stupid abdominal exercises, and cycling have crept back into their routine that undo all their hard work.

When a muscle contracts it creates both force and stiffness. While stiffness is a good thing, too much can be a problem. If a muscle becomes more active it usually can add to spinal stability, but if it keeps working it will reduces motion and inevitably spinal stability by creating a buckling effect. This is very commonly seen with the rectus abdominis muscle producing a flexed trunk leading to disc bulges in the lumbar spine.

The rectus abdominis muscle can become a real problem if it is exposed to excessive and repetitive work as seen with abdominal crunches or sit-ups. As the abdominal musculature become progressively shorter and tight, the following postural aberrations may be seen:

  • Short and tight upper abdominal musculature
  • Depressed sternum
  • Forward head posture increasing chance of neck and shoulder injury not to mention poor breathing
  • Increased thoracic kyphosis and eventually the formation of a dowagers hump

You DO NOT need isolated abdominal exercises to strengthen your core. In fact many of the integrated exercises have been proven to be far more effective as seen in this video below.

With stretching, I find there are two types of people.

Those who hate it and never find the time. And those who love it and tend to overdo it. The people who hate it often need it the most whereas the people already using it will find more benefit using stability and strength movements instead. It is all about finding the right balance. Firstly when it comes to stretching, you MUST NEVER USE STRETCHES THAT ENCOURAGE SPINAL FLEXION IF YOU HAVE A BULGING DISC!

 

Often people like to stretch the area they feel the pain in. While this appears to make sense to try and release what feels tight, what this is actually doing is making the back even more vulnerable to pain.

Constantly loosening the lumbar spine especially with stretches that pull the knees to the chest or round out the lower back aggravate your discs. And if you continue to do this repeatedly you are now a big step closer to developing chronic pain and a herniated disc injury! The stiffness in their back could be due to poor stability in the first place so continuing to weaken your stabilisers will only make you worse.

People tell me they feel good after they stretch. And while the stretch may give you some temporary relief via reducing the pain sensitivity in the nerves, it is setting you up for long term problems.

I remember a client who was suffering with a disc bulge for years and he would love to use Yoga poses and various stretches where he pulled his knees to his chest to try and stretch out his back in the belief this was doing him good. What was actually happening was this stretching routine was the catalyst for his back pain. It took me several months to convince him to stop doing this routine and let his back stiffen up.

Tight hamstrings are also blamed a lot for back pain people tell me they cannot touch their toes because of this. Poor toe touches will have more to do with hip mobility and the hamstrings are actually tightening up to protect you. The difference between hamstring muscles and the sciatic nerve is very important to differentiate. When the knees are locked out this is a nerve stretch and nothing to do with the muscles at all.

When people have trouble touching their toes, they usually blame it on having tight hamstrings, because that’s what they feel when doing the movement. But as we discussed earlier this is usually just a reaction to something else.

Watch the videos below to see a detailed explanation of stretches to avoid and why you cannot blame tight hamstrings for back pain.

  

You will find a ton of information about correctly stretching for back pain in the articles shown below.

Another activity to be careful of is cycling. 

Cycling Position

This looks very similar to all of the damaging movements we have just seen.

Even though this is an elite cyclist on a time trial bike and he has pretty good mechanics, you can still see some spinal flexion that can easily aggravate a back if done for long periods of time. Many recreational cyclists are nowhere near this excellent position and move further into flexion. Again many people can do cycling their whole life and have no trouble with their back as they have enough reserve from not beating their back up in other areas. I myself cycle all the time and have never had a bulging disc. But the more you beat up your back with poor movement doing things we have looked at already, the closer you are getting to a disc problem. It is easy to modify your riding position with a good cycling coach, or even changing bikes that can make a big difference.

The most important factor in riding position is that the forward lean should come from the pelvis rotating at the hip, rather than bending the back, which should remain as straight as possible. This is the same problem we see with basic sitting positions in the office that also lead to back problems.

Handlebar height plays a role in rider comfort as well. Handlebar height should be even with, or just slightly lower than, that of the seat. Setting the handlebars lower than four centimetres below the seat places increased pressure on the low back unless you are extremely flexible and able to rotate your pelvis forward.

You will find a ton of detail about this in the article - How to correctly set up your bike to avoid back pain

As far as corrective exercises are concerned it is impossible for me to give you a set of exercises to help you as you will need an assessment. We are all different and the circumstances that led to your problem will vary from one person to the next. Having said that I will share with you some of the most common things I use with bulging disc clients.

I also suggest reading our article Bulging Disc Exercises & Effective Long Term Treatment Strategies for more detail on specific exercises.

But let's give you 3 big things that are easy to implement right now and you don't need to go to a gym to do it.

Learn To Bend Correctly

We have spoken at great length on the importance of learning to use your hips to hinge, and not bend your spine. For some people, this is very confusing and takes a bit of coaching to make it automatic. In the gym world, this is known as the deadlift and it is a critical exercise for developing strength for lifting objects safely and being able to bend correctly.

The video below takes you through all the things you need to do to get this right.

Mobilize Tight Hips & Thoracic Spine

Sometimes you just cannot get in the right position.

You know what you need to do but you are just too stiff to do it. The two known areas of stiffness to affect the lower back are the hips and the thoracic spine. Both of these joints become stiff very easily and they can be difficult to stretch. Over the last 15 years I have found stretching with back pain sufferers to be not nearly as effective as hip mobilizing drills that mimic movements. The video below gives you a good example of how to do this.

I also suggest reading these articles for more ideas.

Activate & Strengthen Your Inner Unit Stability Muscles

These muscles are known to many as the core.

Unfortunately, many people have no idea how to correctly activate yet alone strengthen these muscles. These muscles are very important to providing stability to the lumbar spine and preventing it from flexing and losing it's stability when we move. With back pain sufferers these muscles are usually weak and lazy leaving the spine exposed to trauma. Using simple exercises to teach your body how to use these muscles again is a very important step in your development. Do not underestimate the power of these simple drills as it is the weakness from simple things like this that easily led to breaking you in the first place.

 

Do You Need More Help?

There are many things you will need to begin doing, and there are many factors you will need to consider. A thorough assessment of your posture and movement is critical and will reveal many of the underlying causes of your pain. Based on the results of this assessment you can implement a corrective exercise program that focuses on rebuilding movements, stability and strength.

We have a great program called Back Pain Secrets you can download with 90 minutes of video and a PDF report that takes you through all of this assessment process and provides a step by step program to help guide you on implementing the corrective exercises. Click the image below to see more and get your copy.

 

 

 

Conclusion

I hope this article helps to shed some light on how your injury is formed. And more importantly what you can, and MUST do to ensure it goes away and never comes back. If you are doubting the fact that simple strategies can work for you then make sure you check out our testimonials page with stacks of case studies of clients who have been able to get out of pain for good. Always remember to use your hips and not your spine. The more you can keep your back in neutral the better.

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 300 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. There is also a free newsletter you can subscribe to where I provide a fortnightly email with all of our latest tips and secrets.

 

About The Author 

Nick Jack is owner of No Regrets Personal Training and has over 15 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