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Bulging Disc Exercises & Effective Long Term Treatment Strategies

Written by: Nick Jack
Category: 2014
on 18 April 2016
Hits: 24010

In my 11 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. Now we know what it 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"

IMPORTANT - Read This Before Moving On

Before moving on 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 I highly suggest to download our detailed Back Pain Secrets program that includes a 85 page Ebook and 90 minute video with exercises, stretches, mobilizations and a step by step program. 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 to download our FREE cheat sheet titled '7 Simple Steps To Overcome Debilitating Back Pain, or to get a copy straight away by clicking the image below.

Spinal Fusions Rarely Work!

In all my years (11 years now) working with hundreds (if not thousands now, we are online as well) 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

Step 1: Relieve Pain & Symptoms Using The McKenzie Stretch

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 hamburger) 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.

How To Do The McKenzie Stretch

Begin lying on your front with your hands in a push-up position as demonstrated. Slowly straighten your arms, keeping your lower back relaxed and allowing your back to drop into an arch. Go as far as you comfortably can without increasing your symptoms and then return back down. Repeat 10 times provided there is no increase in symptoms. Repeat 5 times daily. If it hurts to come up just lay on the floor in a prone position for a few minutes 5 times per day. As already mentioned for some people this is such great relief and allows the disc to settle itself down.

Now that we know extension provides relief this now tells us where to go in terms of creating a program and what we need.

  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 Repetitive Movements That Contribute To Faulty Bending Or Flexion Muscles Tightening Up

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 called Move More And Sit Less 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.

Step 3: Weaken Muscles That Provide Flexion

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.

Read our article on that here Lower Back Pain & Why It Is Important To Stretch 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. But to help you out here is some stretches I would suspect as potential problem areas. Again you can get the full video of each stretch plus many more in our Back Secrets Program

Below is 3 examples of an abdominal stretch, hamstring stretch and basic hip stretch.

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

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

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, 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 Rotation?

This would be part 2 of the movement skills that are essential for lower back pain. Many people have been told that rotation and twisting is bad for your back and never to do it. Well if that was true we would see all professional golfers, tennis players and Olympic discus throwers all in hospitals for these athletes spend 8 hours per day for years on end doing exactly that. So this comment is absolute rubbish.

Twisting of the lumbar spine is very dangerous and is linked to many painful back injuries with the most common being a disc tear, but rotation of the thoracic spine and the hips is not, and is actually what the body needs. What tends to happen is that people lose their mobility at the hips and thoracic region from sitting and poor training habits and when these two areas become stiff, rigid and tight, we are unable to rotate effectively. This forces the body to find another way, and it has no choice but to twist the lumbar spine, which is like trying to twist a door hinge. A hinge only bends and flexes, it cannot twist.

By telling someone to stop twisting is madness for what happens when they go to use the vacuum cleaner, throw a ball to their dog in the park or play with the kids? How are you they going to rotate if they have not addressed this poor movement pattern? They are going to compensate and end up in pain again. You MUST learn how to execute this movement correctly or you will suffer with pain the rest of your life!

You can read more about this in detail in this specific article "Is Twisting & Rotation Exercise Bad For Your Back"

Below is two videos to help you with rotation for the hips and the thoracic region.

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. Again all covered in great detail in our Back Pain secrets program, but you can also access many of our You Tube videos for more ideas. To keep this simple here is some easy exercises you can use.

Watch the videos below of a video that explains all of the key movement patterns and the second video is of the deadlift compared to a real life movement. At the bottom of the page you can download some free reports with instructions and pictures of many exercises you can use for the strengthening phase.

Do You Want Proof That This Works?

Here is a great story of a client who suffered a bulging disc that left her paralyzed and how she used all of the methods described in this article to overcome her pain. The picture below is of her doing a 70kg deadlift from the floor!

"Firstly I’d like to say a big thank-you to the entire team at No Regrets, for making me feel welcomed from day one. I am absolutely flattered to be named, client of the moth.. but it is all thanks to you guys!! So how did I become client of the month? On November 29th 2014 my entire world came crashing down, I tried to get out of bed, after going to sleep with a slight pain in my back and woke up, unable to walk. I was convinced I was paralysed, no matter how much I tried, I could not put one foot, in front of the other. My fiancé tried to pick me up, to take me down the stairs but it hurt to be touched. The tears rolled down my face, not so much for the pain, but more because I had no idea if I would ever walk again. Using the hand-rails on the stairs, I lowered myself onto each step, it took me about 10 minutes to go down 15 steps. It then took another  20minutes for me to shuffle myself 5 meters to the car, grasping my fiancé for support because I felt that my legs would give way any second. We went to the emergency department  and I was told there may be some kind of nerve damage. An MRI confirmed that I had a bulged disk in my lower spine, that was pushing on the nerves and as a result I was in a lot of pain and had reduced feeling in my foot.- the pins and needles drove me insane!
The doctor said I couldn’t exercise and that I may need surgery to ‘cut out’ the bulge! I was told it would never go away, and I may always be in pain. At 23 that’s the last thing I wanted to hear. The next two months were agonising, I couldn’t do any of the things I had always taken for granted, I needed help to get dressed, to get in and out of bed, I couldn’t sleep properly because every time I moved it felt like a knife was being stabbed in my back. I couldn’t sit and have a meal with my family, and standing was limited to just a few minutes. It was like a game of Simon-Says with my back being Simon, an evil dictator that ruled my life! I consider myself to be a very independent person, the fact that I now had to rely on everyone around to do everything for me was devastating.

In February 2015 I decided that I would not let Simon (my back) win. My Mum had to drive me to my first session at No Regrets, as I still couldn’t drive properly. I was excited that I was back in a ‘gym’ environment, but scared at the same time, especially when I saw the stairs! I managed to hobble up the stairs using the trusty rail for support, I sat, rather awkwardly, for a bit, and then had to stand. Although my pain was taking up most of my thoughts, I managed to take in what Nick was saying. His extensive knowledge was amazing, and very reassuring. That day I also met Nathan,  I don’t think I would be where I am today is it wasn’t for him! That day I also learned I didn’t know how to breathe, who would have thought! The fist few sessions were slow, Nathan taught me how to breath properly using my diaphragm, and slowly began some easy exercises- I didn’t like the baby weights, but that’s all I could use! Two months in, I felt  less pain, I could now bend over without any problems, and I wasn’t scared of stairs anymore. Nathan was very cautious, and still today, asks if I feel any pain; but at the same time he knew how much I longed to get back to my big girl weights! Six months later, my sessions at No Regrets are the highlight of my day. I went from not being able to pick up a pen on the floor, to being able to dead- lift 75Kgs, without a problem. Six months ago It took me 15minutes to get down my stairs, today I climbed the No Regrets stairs- two at a time with a 10kg vest on, holding two 8kg kettle bells- that’s 26kgs of extra weight I had to haul up the stairs- but I did it!
Six months ago I couldn’t walk, now Nathan makes me run over 800 meters- I don’t like running so I pray for rain, but at least now I CAN DO IT!

Sometimes I find it hard to believe, how I was six months ago and how I am now. If someone back then, said that in six months I would be even stronger then what I was before the injury, I would have laughed in their face, said it was impossible!
But instead here I am! Lifting heavier weights every sessions, and becoming fitter than I have ever been before. So stuff you Simon- I WIN! I could not have done any of this without the help of the entire team at No Regrets. I know I can never repay them for giving me back my life, but I will endeavor to continue to be stronger, and work harder, as a reflection of everything they do.
THANK-YOU, YOU REALLY DID CHANGE MY LIFE!" - Laura Cannistra.

You can read more stories just like Laura at our Testimonials page on our website.

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

What type of back pain do you have?

Lower Back Pain causes & Nutrition

How to loosen tight hips that create Back Pain

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