Active Health Hub

Symptoms, Causes and Treatment Options

In nearly two decades of treating low back patients as a chiropractor at our clinic in Portsmouth UK (Active Health), a very large proportion of them have been related to disc bulges and herniations. When I tell my patients that I suspect they have a disc bulge, they can understandably be very alarmed. 

However, I’m pleased to say that most people are able to recover from them once they understand the injury and how to manage it.

1. What this page will help you understand

My aim for you after reading this page is that you will understand:

• What is a bulging vs a herniated disc?
• Common symptoms (and simple tests)
• Why disc bulges happen
• What to do (practical advice)
• Helpful Products (link) and habits that may support recovery day to day
• How long does a disc bulge take to heal?
• When to seek urgent medical advice

NB: If your pain runs down your leg, I would suggest also reading my sciatica page as these conditions can be linked. 

1. What is a Bulging Disc Vs a Herniated Disc?

TRUE STORY: I remember back in one of my early years in university at the Anglo-European College of Chiropractic in Bournemouth (now known as Health Sciences university)… the tutor was doing his lecture and he kept mentioning this word DISC as if everybody knew what he was talking about. I was imagining an old school CD being somehow in the spine!

I kept quiet for a while, but in the end, risked humiliation and put my hand up to ask what it really was.

To my surprise, he looked astonished…and then asked the rest of the class if THEY had heard of it? At least half the class shook their heads in slight embarrassment making me feel slightly better!

You see, us chiropractors often just ASSUME that people know these things! Luckily, I know a thing or two about them (it would be worrying if I didn’t!) so I can explain.

Your spine is made up of bones called vertebrae stacked up on one another. Between them sit Spinal Discs, which act like shock absorbers in the spine and help your back move smoothly. 

Each disc has 2 layers:

• A tough outer ring
• A soft centre inside

A bulging disc happens when that outer ring becomes strained or weaker and the inner softer centre starts to push out slightly. The disc still stays mostly contained but it can bulge out. 

A simple way to think about is to imagine a jam doughnut being gently squeezed. The jam pushes outwards but the doughnut hasn’t burst.

This is different to a herniated disc where the outer layer has torn and some of the inner material pushes through
Common Bulging/Herniated Disc Symptoms

Here are some of the most common symptoms of a disc bulge that I see in clinic:

• Pain in the low back…can be central or one sided
• Pain travelling into the buttock or leg (maybe with pins and needles/weakness in the leg and/or numbness) (see sciatic page)
• Restricted movement especially bending forward
• Pain worse with and after sitting
• Pain often eased slightly by walking 
• Worse in the mornings

Here are some simple tests (which you can safely do) and things I look for in an examination which can also give more clues that a disc bulge is causing the problem

Is there pain when the patient coughs or sneezes?

• Is there pain when I gently raise the patients leg up when they are lying on their back? 
• Is the patient leaning more to one side or the other and unable to bend to the opposite side?

NB: This last point is the brain in ‘protection mode’. Our brains are incredibly clever and will contract the appropriate muscles to take pressure off of the injured area. This however causes a great deal of muscle tension and restriction in movement. If this is you right now, don’t worry…it straightens up in time

1. Why it happens?

Disc bulges normally happen due to repetitive stress or load to the disc. It’s often something that builds up over weeks, months or years. Research has shown that discs are put under more pressure when the spine is in FLEXION (bent forward) and twisting positions.

The common patterns that I see in clinic are patients who:

• Sit long periods especially in slumped positions (eg. office workers)
• Bend a lot especially mixed with twisting (eg. ground workers/builders)
• Have low core strength/hip mobility
• Have a poor diet/poor sleep

AND MOST COMMONLY A MIXTURE OF ALL THE ABOVE

What’s My Advice To You If You Have A Suspected Disc Bulge (general guidelines)?

When it comes to disc problems, there’s no magic fix…most people do best with a combination of strategies. 

1. Pain relief options

I always advise my patients to listen to your body. Initially it can be so painful that you can barely move!

IMPORTANT: A common mistake I see is that people think they should be working through the pain. This however is not the case. Yes, it’s good to do some gentle movements regularly but in the case of a disc bulge/herniation, it also needs a break! Here’s some general guidelines:

• Relative rest (reduce aggravating activity)…lie down, find a comfortable position. Sometimes a cushion under the legs can help. 
• Gently mobilise every 30-60 mins if tolerated (link to leg swings exercise) 
• Ice for 10-15 mins (link to ice pack) every 3-4 hours 

NB: I have always found ice particularly effective when faced with a patient with muscle spasms related to a disc bulge. Some people prefer heat. Both can be useful depending on the stage and how your back responds

• McKenzie Extension exercise: You will need to watch this video to check to see if your injury is appropriate for this exercise (Link McKenzie exercise)
• Gentle short walks (5-10 mins) every 2-3 hours if tolerated

2. Keep moving without overdoing it

Yes, it’s true that you should keep trying to move but only as your pain lets you. Build it up slowly as you feel able, don’t try to rush. A good basic plan is to: 

• Walk daily (start small build up)
• Change positions frequently
• Avoid sitting for long periods 

IMPORTANT: It may feel comfortable sitting down for a while which might make you feel that it is ok to do so. The thing to notice however is not how you feel when you’re sitting but how you feel when you get up.  If you’re super stiff/sore and struggle to straighten up, then that position is not helping your recovery.

This is why I mentioned the lying position above eg. lying in bed. This way you can move and stretch easily regularly (exercise link) as well as being in a position which normally does not place as much pressure on the disc.

1. Improve your desk and sitting set up

Nobody can have ‘perfect posture’ all the time. But we can all make improvements resulting in less strain and more variety.

Here are some simple ergonomic upgrades that I have seen make massive differences with my patients:

• A quality ergonomic chair (see my recommended chair LINK)
• A lumbar support cushion for your office chair and car (LINK)
• Set a timer to stand up every 30-45 minutes
• Raising your chair so you’re not slumping forward
• Using a standing desk (LINK)

NB: In my experience, a standing desk works best when used for ‘position switching’ rather than standing ALL day. Therefore the desk I have recommended has a very simple mechanism allowing switching from sitting-standing in seconds. 

VARIETY IS THE KEY

1. Support better sleep

Sleep is when our healing takes place. If your mattress is uncomfortable or not supportive enough, it will not help. Trust your gut instincts, my patients often KNOW when their mattress is not suiting them. 

You should have the feeling of “I can’t wait to get into my bed”. If you wake up stiffer it’s a clue something might need changing.

If you don’t, then helpful options include:

• A more supportive mattress (See my guide LINK)
• A mattress topper (Product Link)
• Try sleeping with a small pillow in between your knees if you are a side sleeper

2. Rehab exercises (The long-term fix!)

Once the pain starts to decrease, I suggest gently progressing with exercise. Start with number 1, and do them for one week and make sure they are comfortable to do…then add in no. 2 for a week, and so on.

1. Gentle mobilisation exercises (LINK) (Week 1)
2. Glute and core activation (beginner exercises) LINK (Week 2)
3. Practice bending/lifting techniques LINK (Week 3)

1. Advance to core and glute strength work (LINK) (Week 4)

Remember consistency is key with exercise rehabilitation. Also, as I always say, listen to your body. Sometimes the pain will tell you that the disc is just not ready for a certain exercise and that’s ok. You can come back to it down the line

2. How Long Does it take to Improve?

Even after I’ve seen several hundred of these cases over the years, it’s still impossible to give an exact timeline: It all depends on: 

• The severity of the injury
• The patients’ lifestyle (eg you are a builder and still having to work every day it will likely take longer)
• The patient’s general health (eg. drinking alcohol eating a poor diet and not getting enough sleep are not going to promote healing)
• How much nerve damage there has been (more likely with herniated discs)

Typical Recovery Times

• A mild flare-up: 1-3 weeks
• Moderate symptoms: 4-8 weeks
• Persistent /recurring: Several months

The main thing is to keep sticking to the guidelines as much as possible. Our bodies have a natural ability to heal themselves but only if they are given the right environment to do so. 

Red Flags (seek urgent help)

• Loss of Bladder/bowel control
• Numbness around the groin/buttocks/genitals
• Muscle weakness in the legs that is progressively getting worse