Last week, I had a patient in the office with a mild bulging disc in his lower back.
This patient could BARELY walk into the office, he was in so much pain. Climbing onto the chiropractic adjusting table was all that he could manage, although thankfully for him, after the chiropractic adjustment and treatment it was easier getting off.
Unfortunately, bulging discs and herniated discs are not something new for us…in fact, we see this all the time in our chiropractic clinic.
What causes a disc bulge?
First, let’s briefly discuss the anatomy of a vertebral disc, and what happens with a disc bulge or disc herniation.
Between almost every vertebra in your spine, you have something called a intervertebral disc. These discs are designed to act as shock absorbers, to bear the weight of the body compressing down on them.
There is an inner layer of the disc, termed the nucleus pulposus, and an outer layer or annular fibres.
From things like chronic slouched sitting, or doing too many forward stretches, or trying to do sit-ups for your abs (which by the way, aren’t only bad for your low back, but don’t really work your abs!), the disc material in the front portion of the disc is slowly forced backwards.
The inside of the disc, called the nucleus pulposus, is basically a gel-like material. If there’s enough forward pressure, pushing down on the front of the disc, the disc gel is slowly forced backwards.
If this goes on for long enough, for months and years, eventually something has to give! The disc material slowly forces its way through the outer layers of the disc, BULGING out, or even herniating through the outer annulus layers. This leads to a disc bulge, slipped disc, or herniated disc. This can compress the spinal nerves as they exit in the lumbar spine, leading to severe pain.
OUCH!!!
What causes a bulging disc to flare up?
Generally, the same mechanism of injury that causes the disc bulge or herniated disc is the same mechanism or activity that causes the bulging disc to flare up.
In the vast majority of cases, these are forward bending or flexion type activities.
Potential aggravating forward bending activities:
- Slouched sitting where you are flexed forward
- Tying up shoes
- Putting on socks
- Conventional hamstring stretches by forward bending to “touch your toes”
- Sit-ups
- Bending down to pick up something that is too heavy
All of these activities potentially compresses the front part of the disc, potentially forcing the disc material further back. This can worsen the disc bulge or herniated disc, causing the pain to worsen, and if severe enough can lead to a ruptured disc.
Do disc bulges get worse over time?
Unfortunately if disc bulges are left untreated, and if the abnormal spinal stresses that caused them continue, they will often worsen over time.
For the disc bulge or herniated disc to have any possibility of recovery, the instigating stress must be minimized.
If the repeated forward bending stress continues, or the improper body mechanics continue, very often the inner disc material will continue to push backwards, causing the disc bulge to worsen, to herniate, progressing into the spinal canal and towards the spinal cord.
This may cause severe back pain as an exiting spinal nerve root is compressed, or sciatica/sciatic nerve pain in the lower back and down into the leg.
How to treat a disc bulge or herniated disc?
For the vast majority of patients, the first step is to identify what they are doing in their life to cause the disc bulge or herniated disk in the first place.
For most people, as discussed above, this will be an activity which is causing repeated forward bending in their spine. This may be postural in nature, occupational with their work, exercise related, or just typical poor movement patterns.
Once identified, try to eliminate any forward bending activities, or minimize them as much as possible.
This is especially important in the morning, for the first hour after waking up, when there is more disc pressure in the spine, and you are more vulnerable to a disc bulge, slipped disc or disc herniation.
Be especially cautious about any intense exercise first thing in the morning for a lumbar disc herniation, so as not to aggravate it, making the pain worse and potentially causing severe pain.
Tips to treat a disc bulge:
- Gentle, slow walking can help. Movement helps to inhibit some of the pain signals, and can help with proper lumbar disc function.
- Avoid forward bending in the lower back, especially in the morning. Be careful getting out of bed, and try going on your side to get up, versus flexing forward at the waist.
- With an acute herniated lumbar disc, ice is best for the first 24-36 hours. Beyond that most people respond best to heat.
- Avoid any intense stretches or exercises, particularly in the acute pain stage for pain relief.
- Consult with a spinal specialist, like a Doctor of Chiropractic well versed in disc injuries and treatment. Gentle chiropractic adjustments can help with pain relief initially, and to prevent further lumbar disc issues in the future.
Does stretching help a lumbar disc bulge?
When I spoke to this particular lumbar disc patient at our Toronto chiropractor office Transform Chiropractic, he told me that it had started several days ago, was getting progressively worse, and that he’d been trying to “stretch it out” to relieve the pain. He’d been trying to touch his toes, and other similar types of flexion stretches, which he thought had helped it feel a little better temporarily afterwards, but he was still getting worse.
We hear this all the time. People who think that stretches like trying to touch your toes, are good for your lower back and discs.
The reality is that forward bending stretches are bad for your lower back and for lumbar disc bulges. In fact, with a disc bulge or herniated disc this is one of the worst things you can do.
So why would doing that typical forward, touch your toes stretch, be bad? Because this forward movement, compressing the front of the disc, is the exact movement and stress that bulged or herniated the disc in the first place. Doing stretches like this, in the long term, only makes it worse.
If it’s bad for your discs, and may actually worsen the disc injury, why can the stretch make it feel a little better right afterwards?
Because there are things called stretched receptors in muscles, including in your hamstrings and calf muscles, that are stimulated when you do this type of stretch. Stimulation of these stretch receptors results in a temporary feeling of relaxation, as some of the pain signals are temporarily blocked.
Feels good in the short term, but results in long term problems, and the disc issue getting worse!
Easy to see how this is confusing to people, as it feels good as you’re doing the stretch, and even for 20-30 minutes afterwards, but the problem continues to get progressively worse.
So, if you have disc issues in your low back, stop doing this type of stretch! Even if it feels better in the moment, in the long term, you are making your condition, and you, worse.
For more information about lumbar disc bulges and herniated discs, and other lower back conditions, please refer to our back pain condition page on our Transform Chiropractic website:
https://staging.transformchiropractic.com/back-pain-toronto/
If you have any questions, or we can help in any other way, please feel free to contact us at our Toronto chiropractic clinic.
Dr. Byron Mackay
