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Disc Bulge Management Plan

By Tommy

A disc bulge is a condition in which the nucleus (inner portion) of a spinal disc remains contained within the annulus fibrosus (outer portion), unlike a herniated disc in which the nucleus leaks out of the disc. This protrusion or bulge can put pressure on the surrounding nerve roots which can lead to pain that radiates down the back of the leg and/or other areas of the body depending on the location of the bulging disc.      



Typical treatment plan
"Please keep in mind this is the most ideal plan for treatment and your outcome will vary depending on personal circumstances such as if are able to attend follow-up appointments, compliance to treatment recommendations and advice/exercises prescribed"


Stage 1 (0-2 weeks)
- massage and/or dry needling to reduce and prevent spasms in the area.
- correct any misalignment of the hips, pelvis, leg or lumbar spine.
- prescription of correct application of ice or heat principles.
- activity modifications to prevent aggravations.
- incorporate correct movement patterns to minimise any chance of re-injury.
- strapping for early adherence to corrected positioning of the lumbar spine.
- modify any aggravating activities in the workplace or at home.


Stage 2 (2-4 weeks)

- introduction of evidenced based strength training.   

- prescription of the correct exercises based on your individual assessment with routine progressions over the weeks.

Advice in the first 4 weeks or longer
- limit prolonged sitting to maximum of 10 minutes especially on hard surfaces
- avoid excessive bending
- avoid  excessive reaching
- avoid heavy lifting
- do regular short walks to keep active as pain allows
- squat (bend at the hips and knees) to reduce stress on lumbar discs when picking things up
- avoid bed rest and keep as active as pain permits (i.e work and move within pain limits)


Stage 3 (4-8 weeks)

- progression of program to improve the function of the structures that support the discs and lower back in general.
- work into a functional stabilisation program (aim to maintain correct movement patterns to reduce strain on the spine)
- work on stretching tight structures.

Stage 4 (8-12 weeks)

- work on high end dynamic strengthening exercises for full return to sports and work.


When should I see improvements?
Most patients will start to see some reduced pain the first 2 weeks but this time can vary depending on the severity of the disc injury, compliance to recommendations and if you are able to follow through the whole treatment plan.

How long will it take to get back to normal?
Once the pain has reduced you may consider that you are back to normal and finish treatment. 
However, the pain has reduced only as the inflammation has subsided.  
The healing in the disc is slow due to a lack of blood supply in the area and  this will take around the 12 weeks for a more structural repair.
Retraining the support structures around the back will give you long term protection. 
This gives the you the best chance of managing the injury in the long run as the disc can be re-injured if you have not completely rehabilitated the the supporting structures when you return to full activities.