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Bulging Disc

Bulging disc or Herniated disc is a lesion that occurs more frequently in the lower back. This disease is the one that causes the most pain in the back and changes in sensitivity to the thigh, leg and foot. Approximately 80% of people will experience low back pain at some point in their lives. The most common location of the lumbar disc herniation is on the disc between the fourth and fifth lumbar vertebra (L4 / L5) and the disc between the fifth vertebra and the sacrum (L5 / S1).

In most cases, the symptoms improve naturally at three months, but can be aided with clinical and physiotherapeutic treatments. Even if the patient feels well without treatment, it is important that he make a treatment program that focuses on the normal functionality of the spine and its strengthening. The researches are categorical: after the first symptoms of back pain, the muscles that protect the spine begin to become weak and atrophied.

The population needs to know that this disease has no cure. People get better from pain, they get back to normal life most of the time, but it's good to make it clear that rest and medications do not return functionality or strengthen muscles that have become weak with the disease. We believe that this is one of the main reasons for so many recurring pains in the spine. So if you had an episode of severe back pain and those symptoms remained for more than three months, most likely others will come. This rule is valid for 100% of cases.Therefore, the secret is to do a physical activity in appropriate places and with specialized professionals.


The term "hernia" means projection or exit through a fissure or orifice of a contained structure. The intervertebral disc is a fibrous and cartilaginous structure that contains a gelatinous liquid at its center called the nucleus pulposus . The disc lies between one vertebra and another of the spine. This fibrous ring, when cracked or worn, allows the gelatinous liquid that is maintained at its center to expand or bulge its structure and may also leak out. When this phenomenon occurs in small proportions, we call the disc protrusion . If the lesion in the fibrous ring that holds the nucleus is large, the liquid contained in the nucleus may exit into the external medium, and when this happens, the disk may become smaller and flatter. This is why we call it a Bulging disc. Depending on the location of the "gel", the patient may experience severe pain or not. With this concept, it is clear that the important thing is to know the location of the Bulging disc, not its size.


The disc is composed of two main parts: one of them is the central part, called nucleus pulposo or viscous liquid. The core acts as a shock absorber to protect from the pressures and twists exerted by us on a daily basis. The second part is composed of a cartilaginous tissue called the fibrous ring. This ring maintains the nucleus in the central part and has elastic characteristics that allow and facilitate the movements of flexion, extension and rotation of the trunk. There is a very important structure called the terminal plate that forms part of this complex, but this structure belongs to the vertebra and is located in the upper and lower region of each vertebra. Thus, the integrity of these structures is that it conserves and nourishes the nucleus pulposus. With the degeneration of these structures, the nucleus liquids may migrate to the vertebral bodies. The beginning of this process is called Modic type I. Some authors claim that this inflammatory and degenerative process on the end plate may cause pain in the spine.

Removal of the nucleus pulposus or bulging of the disc may cause pressure on the nerve roots corresponding to the disc herniation or protrusion. This pressure on the nerve root may cause the most diverse symptoms that will be described later.


95% of people who suffer from Bulging disc do not need surgery on the spine, and can treat with non-invasive method.

13% of medical visits involve spinal pain.

15% of the world's population suffers from Bulging disc.

70% of the population over 40 suffers from some type of problem in the spine.

This disease is the third cause of early retirement, back pain are also the 2nd main reason for people taking leave at work.

People with an age range of 25-45 years have the highest index of cases of disc herniation.


The word "spine" already tells us all about the importance of this structure in our body. It is the center of balance of the musculoskeletal system of the human being and provides the basis for the stabilization of our body, allowing a perfect distribution of the forces and gestures exercised in our day to day or in sports practices. It is no wonder that many spinal injuries are attributed to imbalance and misalignment of this structure. In other words, bad posture is undoubtedly the great villain of the problems in the spine.

There is a correct posture for any movement that we perform, even when we are in a static position. With day-to-day running, it is not always possible to obey all the rules, but we can still take the utmost care to not overload our muscles and joints.


- Protrusives: The disc widens, but contains the gelatinous liquid in its center. The disc base bulges and becomes wider than the original diameter. The walls of the disc can touch regions and areas of great nervous sensitivity, generating pains and incapacities.

- Extrusions: Extrusive lumbar disc herniation is a very frequent and important orthopedic condition that affects the intervertebral discs of the spine that function as true shock absorbers. Pathology occurs when there is a rupture of this fibrous ring and the internal gelatinous content or nucleus pulposus leaves by means of a fissure in the membrane, with loss of contact of the extravasated fragments with its internal environment.

- Kidnapped: The Bulging disc is the one that ruptures the wall of the disc and the gelatinous liquid migrates into the spinal canal, up or down. In addition to the pressure in the nerve root, it causes inflammation and continuous compression. It is the type of hernia that causes the so-called chemical pain, because this nucleus pulposus, when outside its natural environment, has acidic chemical properties and causes unbearable pains. The patient presents with antalgic posture, tilting the trunk to the side that gives him comfort. In this case, the improvement will only be possible with medication, rest or even surgery.

Keeping the correct posture is not important, just for good appearance, postural changes since childhood, for example, already predispose problems in adult life. Hence the need to prevent incorrect posture habits. See, next.


The important thing is never to force too much, just a part of the body, the bones have to bear equal weights. When you sit down, for example, you should never support weight on one leg, letting the other one loose. It is fundamental to learn the non-waste of energy during the execution of movements or in a static position, distributing the weight of the body in a balanced way. Some tips to avoid postural problems:


When performing household activities, avoid working with the trunk fully inclined if standing; In the act of ironing, the table should be high enough for the person not to lean, another tip is to use a footrest by alternating them whenever there is some discomfort. To put on your shoes do not tilt your body to the floor, sit down and bring your foot to the knee. When lifting a weight above the height of the head, one should lean the weight on the body and climb on a ladder or stool to deposit it properly. When lifting a weight should be lowered by flexing the knees down without bending the spine, get up by transferring the load to the muscles of the legs that are stronger than those of the spine, if it is possible to place the object in a cart and Push.


At bedtime you also need care like choosing a good semi-hard mattress or foam to distribute well the body weight, a good pillow and adopt some correct postures in bed. If you usually sleep on your belly up use a pillow under your knees; When sleeping on the side, a pillow between the legs that should be folded. Sleeping on the stomach is not recommended, but if you can not otherwise use a pillow under the belly and not the head, decreasing the lumbar curvature.


Sitting properly is also very important for good posture. Try to keep your feet flat on the floor; Thighs gently touching the largest possible seating area; Avoid crossing your legs and leave them slightly apart; The spine should be kept upright in order to preserve its natural curves (lean your back completely on the sofa or chair, avoiding spreading). Keeping the spine upright is always better than leaving it tilted in any situation. Adopting a correct sitting posture avoids back pain and serious spinal injuries. When you sit properly, there is a uniform distribution of the pressures on the intervertebral discs and the ligaments and the muscles work in harmony, avoiding unnecessary wear and tear.


At work it is also important to adopt less harmful postures. If you work sitting down, your arms should be hanging over your body or your forearms resting on the work table. Avoid full-body twists, get up or use an appropriate chair that spins easily to grab something, talk to someone or throw paper in the trash. If you work with a computer, try to adjust the screen so that the top edge is at the time of looking at the horizon, keep the chin parallel to the ground. To read, avoid as much as possible to lower your head if you need to get a book holder.


1 - Hereditary factors;

2 - Direct or repetitive traumas;

3 - Smoke;

4 - Advanced age (also causes degenerative lesions);

5 - Sedentarism (it is a determining factor for back pain);

6 - Action to tilt and turn the trunk frequently;

7 - Position of standing or sitting for a long time, especially at work;

8 - Action of lifting, pushing and pulling objects;

9 - Repetitive movements at home or at work;

10 - Sports practice;

11 - Work that causes vibrations in the body;

12 - Work driving;

13 - Fleke the trunk frequently to catch objects;

14 - Psychological and psychosocial factors.


The most common symptoms are localized pains in regions where there is a disc injury .These pains can be radiated to other parts of the body. When the hernia is in the cervical spine, pain or sensitivity changes radiate to the upper shoulders, arms, hands, and fingers. If the Bulging disc is lumbar, the pain radiates to the legs and feet. The patient may also feel tingling, numbness, burning and pain in the inner thigh. People report that it is a "pain in the ass" and that there is no position to improve. Some report that they get worse at bedtime.This happens because at that moment the body becomes relaxed and the discs rehydrate, increasing its volume, and consequently compress the nerve roots. In more severe cases, compression may cause loss of leg strength and even urinary incontinence.


1 - Back pain for more than three months;

2 - A crooked column when it enters into crisis;

3 - Night pain that worsens during sleep and stays awake;

4 - Pain that worsens when standing with the leg extended;

5 - Quite difficult to sit for more than 10 minutes;

6 - Reduction of strength in one or both legs;

7 - Impossibility to stand on one leg with one leg;

8 - Pain, tingling or numbness in the limbs;

9 - Extreme difficulties to hold the urine;

10 - Reduction of income and discouragement to perform routine activities;

11 - Headaches associated with pains in the nape of the neck and extending to the shoulders;

12 - Difficulties to move or lift an object.

Any of these symptoms represents a serious problem for your spine. Do not take medicine on your own or expect your pain to improve on its own. No type of pain in the spine should be ignored, especially when the patient detects the presence of one or more of the symptoms listed above. When identifying similar discomfort, seek medical help immediately. Masking pain through the use of medicines (for oneself) or "homemade recipes" is putting your health at risk. The ideal is to investigate the cause of pain and other symptoms with the help of a specialist so that the root of the problem (and not just the effects it manifests) is treated properly and effectively.


The diagnosis can be made clinically, taking into account the patient's history, the characteristics of the symptoms and the result of the physical examination performed during the evaluation. The most common regions to be affected with disc herniation are the lumbar spine and the cervical spine.

When people look for a professional with complaints of neck pain, we initially explore the possibility of some facial asymmetry, observe the type of bite, and analyze whether the patient's behavior has characteristics of anxiety or stress.These factors contribute to pain in the cervical spine and even the Bulging disc.Tests such as X-rays, CT scans and magnetic resonance imaging help determine the size of the lesion and to locate where the exact spine area is, but they are not decisive for the conduct.

The most important and decisive examination is what we do with the patient: listening to what he has to tell us about his pain, trying to know what he does in his daily life at home and at work, and understanding the reactions of the body. All these details can make a great contribution to the improvement of the patient, and it is up to the professional to be attentive. The lack of attention with the patient is one of the neglect factors of the health professionals' conduct. Care and attention with our patients is imperative.

Lumbar pains also have their peculiarities, but as with cervical pains, we first try to listen to the patient and then to do the clinical examination. Having a good physical evaluation of the hip is of fundamental importance, as it is very common for people who have limitations or injuries in this region to also have pain in the spine. This relationship between the hip and the spine has already been the subject of much scientific research. Today we can state categorically that there is a strong connection between the two structures and that it is very common to find in our patients pain or restrictions in both structures.

Most importantly, today we have excellent treatment alternatives without surgery. The population should be aware of these new concepts of treatment and not accept the first proposal of invasive procedures. Federal, state and municipal governments and health plans are no longer able to afford so much spinal surgery account and - most importantly - many of these procedures are not bringing the desired results to patients. There are doctors who are requiring the patient to sign a long contract before the procedures. All this for the doctor to be aware of future claims or lawsuits. It even seems to confirm the unsuccessfulness that will exist with the procedure. It is important that everyone researches and has more caution and patience when choosing the doctor.


People with suspected disc herniation are diagnosed in only 1% to 5% of cases with the pathology. Most do not have a Bulging disc, but other problems, such as the famous parrot's beak , that is, the structural or functional failure of the intervertebral discs.

Often, the symptom that the patient believes to be of a particular disease is actually the result of another problem that can be simpler - and also more serious. Hence the need for an accurate and early diagnosis. No patient should undergo any treatment before the first step (irreplaceable): the evaluation. A specialist should perform all procedures to identify the problem to be treated, the specific needs for that patient's condition, and the limitations presented by the patient. Once this initial step is done, care can be directed to the patient with a greater guarantee of safe results through treatment.


Changes in lifestyle are indispensable to prevent the onset of Bulging disc. Among the guidelines, we can highlight:

- Avoid smoking;

- Practice physical activities under professional guidance to, above all, strengthen the support muscles of the spine, making it more resistant to possible impacts;

- Adopt a healthy diet to control body weight and prevent the spine from suffering from overloads;

- Do not carry excess weight on a daily basis or at work;

- Practice stretching exercises;

- Maintain an adequate posture in all situations.


- Prefer to go up and down stairs instead of using the elevator or escalator;

- Leave the car in the garage to cover small distances, such as going to the bakery;

- At work, try to get up every half hour and walk a little around the environment - this helps avoid the pain;

- Those who take the bus to return home can go down one stop before doing the rest of the route on foot;

- Small household chores, such as cleaning, taking the dog for a walk and bedding help to get the body moving and avoid future problems;

- It is important to practice a physical activity, because the sedentarism can cause back pain, due to muscle weakness.


During gestation, the woman's belly can grow up to about 40cm. This growth leads to changes in the morphology of the spine, occurring, mainly, increase of the curvature of the lumbar region. It is estimated that about 80% of pregnant women will have some type of back pain.

The cause of back pain is the change in the posture of women, who, due to the weight of the belly, move the center of gravity forward. This projection of the belly generates a lumbar hyperlordosis, that is, an increase in the curvature of the lumbar spine. Besides the discomfort, the pregnant woman has difficulty performing various activities , such as getting up and sitting, staying for many hours in the same position and even sleeping.

As the weeks pass, the center of gravity of the body shifts further and further. From the twentieth to the twenty-eighth week of gestation is the most affected period, but it can begin as early as the eighth week.

During pregnancy, an intense transformation takes place in the woman's body, so that she is prepared for the moment of childbirth.Hormones such as relaxin and estrogen, cause a greater laxity in the ligaments of the spine and the basin. Changes in posture during gestation, through compensations, help in maintaining the upright position and horizontal gaze, while fetal growth and uterus enlargement cause an increase in the woman's weight and affect the body's balance. The weight gain is initially concentrated in the belly and the abdominal muscles will decrease their tone by the growth of the uterus. Lumbar lordosis increases to compensate for this weight and overloads the lower portion of the spine. The result of all this is intense pain in the region of the spine.

It is noteworthy that women who already had a history of back pain before becoming pregnant have an increased chance of suffering from spine.


Women should pay attention to their health. Pregnant women can practice physical exercises in pregnancy as they are a great way to prevent back pain, given that these are key to keeping weight under control and, in addition, strengthen the abdominal muscles. But seek regular physical exercise, preferably with professional guidance. Remember to talk to your obstetrician to make sure that physical activity is released in your case.

Another important care is to maintain a regulated diet, only fattening the recommended one (9 to 12 kg, varying according to the woman's BMI when getting pregnant), after all, the heavier the pregnant woman is, the greater the overload in the spine.

Controlling postural habits daily, especially at work, and sleeping well are also essential practices for the well-being of the future mother.

- Care of the posture

The pregnant woman should have some extra care when it comes to posture. Attention to keep the posture erect! When sitting, leave the entire spine resting on the backrest, leaving a 90-degree angle between the body and the legs; The shoulders should always remain aligned and relaxed, otherwise the pregnant woman may experience pain in her neck as well.

Avoid staying for long periods in the same position, even with correct posture. This is another factor that can trigger the problem. Those who work long hours in front of the computer should take some quick breaks throughout the day, even if it is just the time it takes to get a glass of water or go to the bathroom.

Remembering that even after delivery, the pains can continue because of the dedicated effort in caring for the baby. So be careful about maintaining the upright posture and avoid straining, always lowering your knees and contracting the abdomen. Support your arms while breastfeeding and remain seated with upright spine.

- To relax

Since you can not control the increase of the belly, follow these guidelines and, as much as possible, perform stretches like this: lying on your back, flex both legs together, towards the trunk. Hold for 30 seconds and rest for one minute. Then repeat the movement two more times. This stretching can be done in the morning, before leaving home, after practicing physical activities or when you feel uncomfortable in the lower back. But to get up, you have to turn sideways and support the weight in your arms.

Doing a self-massage with tennis balls or the like also helps to reduce the tension of the muscles of the region.


According to studies, before 15 years, about 60% of boys and 70% of girls have already suffered from back pain. The problem is no longer exclusive to adults, children of different ages already have increasingly intense complaints of back pain.To prevent these pains from disturbing the children's group, the best is to prevent them as soon as possible. If proper care is taken early, educating children to have proper habits, the risks of back pain can be considerably reduced.

In childhood, back pain can be caused by a poor position in the high school chair or even at home, at the time of eating and studying. Other factors besides bad posture, which also contribute to the onset of pain: excessive amount of books in the backpack, lack of physical exercises that strengthen the back and body as a whole and sedentary habits, such as watching a lot of television and being very Time lying down. Injuries from falling or knocking can also upset your back, as can childhood obesity. It is known that most of the pain is of muscular origin.

The practice of physical exercises in childhood is the most important measure to prevent pain in the spine and that can become chronic in the future, including with the involvement of diseases such as Bulging disc. All, however, in moderation, for if the child practices many physical activities he may also suffer from the symptoms of pain.

One tip is to practice family sports and thus train teenagers and adults already accustomed to the exercises. These physical activities help to develop powerful and resistant muscles and contribute to proper formation of the spine. But, remember: the exercises should be supervised by physiotherapy or physical education professionals. It is also important to observe the posture of the child so that the postural defects do not end up generating deviations, severely harming the spine.


Obesity occurs when food intake is greater than the body's energy expenditure for its maintenance and day-to-day activities. Studies have shown the relationship of this disease with the prevalence of back pain. Alerting the fact that being overweight is harmful to the health of the spine.

When the individual is overweight, it ends up offering a greater load on the spine and, consequently, the discs are affected, increasing the risks of diseases such as Bulging disc. This is what many studies prove, that the greater risk of spine pain and diseases in the region is pointed out in groups of overweight, obese and morbidly obese people.

In addition, other habits can also influence pain. Smoking has been shown to be a major predictor of low back pain, as well as sedentary lifestyle, especially in individuals with higher BMI. This means that unhealthy habits such as smoking and not practicing physical activities have a greater weight in the health of the spine of overweight or obese individuals.

However, despite the discouraging factors, large gains can be gained through the practice of physical activities, or small changes in routine activities. When an individual stops being sedentary, practicing physical exercises, even simple household activities, can reduce the risk of back pain by 17%.

For those who are already overweight, increasing the amount of time for moderate physical activity (such as walking, water aerobics, cycling, and dancing) for more than 20 minutes a day can reduce the risk of low back pain in 32%.

Give a little more of yourself can make a difference! Going a little further in the exercises, especially aerobics, brings numerous benefits.For the morbidly obese, extending the average length of time spent doing a moderately intensive activity for at least an additional minute every time the exercise is performed reduces the chances of having back pain by 38%.


The use of the jump should be moderate. In the name of vanity, many women do not give up high heels and end up paying a heavy price for it. The posture required to "keep on the heel" can lead to spinal problems such as Bulging disc. This is because using jump requires postural changes when treading. The feet are in a position of plantar flexion (tip of the foot). With the change of the anterior axis of gravity, the base of support diminishes in the region of the heel, centralizing all sustentation of the weight in the region of the fingers of both feet.

The jump causes changes in the angle of the femur's cervix, which tends to press the cartilage of the acetabulum and, over time, wear it causing deformities, postural uncontrol and changes in gait. Many women afflicted by the disease have doubts about the best type of treatment. There are data indicating that only 5% of hernias need surgery. The topic has generated great controversy, since many health professionals have indicated surgery in most cases. Although, several studies point to conventional treatment with Physiotherapy, medications and exercise as one of the best for the treatment of Bulging disc.


Bulging disc presents different stages of evolution. When the level of spinal impairment is not so chronic, conservative treatment options such as physiotherapy techniques can be successfully adopted. The very administration of anti-inflammatory drugs and muscle relaxants, prescribed by the doctor, can also help a lot. Despite constituting the minority, there are the most serious cases, where no non-invasive procedure takes effect. In such cases, surgery may be necessary to correct the problem.

Usually, most cases of Bulging disc can be treated with a guarantee of success, however, it is necessary to maintain important habits throughout life to avoid relapses. The total recovery period is individual, that is, each patient evolves according to their conditions, there is no standard period. This process will also depend on the picture of the Bulging disc submitted to the treatment and the behavior of the patient in obedience to the medical guidelines.

Treatment for Bulging disc with Physiotherapy

Physiotherapy is excellent for the treatment of Bulging disc and can be done with stretching and strengthening exercises, electronic equipment, use of warm compress.Other techniques that may be useful are Pilates, hydrotherapy, RPG (Global posture Reeducation), Mckenzie and traction in the spine, for example.

The sessions can be performed daily on a weekend, when the person is feeling a lot of pain, but can be performed only once or twice a week when the pain arises only in certain situations such as lowering or lifting some weight off the floor, for example.

Benefits of Physiotherapy in Bulging disc

The physiotherapeutic treatment for herniated disks has the following benefits:

  • Relief of back pain and radiated pain for arms or legs, for example;

  • Increased range of motion;

  • Greater physical resistance;

  • Avoid surgery on the spine;

  • Decrease medication intake for pain control.

The disc herniation happens when the disc that lies between the vertebrae of the spine is damaged and can cause compression of the root of a nerve, for example. Usually before discovering hernia, about 10 years before there was some pain in the spine. The spinal regions most affected are cervical and lumbar.

6 ways to treat Bulging disc

Within the physiotherapy can be used several resources to combat pain and bring back the balance and well-being of the person who has Bulging disc. Some possibilities of treatment for people with intense pain are:

1. Use of electronic equipment

Devices such as ultrasound, valganic current, TENS and laser can be used as anti-inflammatories that help relieve symptoms by reducing pain and discomfort in the spine.They should be applied according to the need that the person presents, and their time of operation varies between 8 to 25 minutes, for each treatment area.

2. Heat

Another way to relieve back pain and prepare the body for a massage, because it increases blood circulation and the arrival of more nutrients at xxx. The heat can be used with heated pockets or towels or infrared light, for example for some 20 minutes.

3. Stretching

Stretching exercises are indicated from the beginning of Physiotherapy sessions and are important for increasing flexibility, normalizing muscle tone and reorganizing muscle fibers, and are also excellent for improving body posture on a day to day basis.

Stretching for lumbar disc herniation

4. Exercises

They are indicated for when the person does not present acute pain and help to strengthen muscular groups that are weak or unbalanced. There are several types of exercises that can be used, such as Global Posture Reeducation, Clinical Pilates and Hydrotherapy, for example, these last 2 can also be used as physical activity.

RPG exercises are monotonous, but they are a great help, being one of the best options to avoid having to undergo surgery for Bulging disc. Pilates exercises are particularly indicated because they strengthen the small but important muscles that keep the back straight and the strength of the abdomen, which also protects the spine. Hydrotherapy is performed inside the pool, being guided by a physiotherapist and consists of exercises that involve running inside the water and even swimming.

In this video I outline some exercises for sciatica, which are indicated in case of Bulging disc:

5. Cervical or lumbar traction

This is a type of treatment that can be performed manually, where the physiotherapist firmly holds the person's neck lying on a stretcher, keeping the entire spine aligned and pulls the head vertically, to promote a release of tension between the Vertebrae, allowing greater hydration of the vertebral disc and sometimes its return to the original location. The traction of the spine can also be performed on specific equipments that act in the same way, tractioning the neck in one direction and lumbar in the opposite direction, maintaining the traction for 20 to 30 seconds, for about 5 to 10 repetitions, for example.

6. Handling techniques

Handling techniques can be performed on the spine and serve to reduce pressure on the spine, realign all body structures and often cause a sensation of lightness and ease of movement. This technique is particularly suitable for when the person has difficulty performing certain movements because he feels 'trapped'.

Day Care

The person who has a cervical or lumbar hernia needs some care that can aid in pain relief, such as:

  • Avoid staying more than 2 hours sitting or lying down, provided it is not to during sleep;

  • Sleep in the correct position of the spine;

  • When lowering to get something off the ground, always bend your legs instead of bending your body forward;

  • Prefer to keep moving to decrease the stiffness of the spine, it may be walking or cycling, for example;

  • Prefer a firm mattress that supports improved spine, also avoid sitting on sofas and very soft and low chairs;

  • Anti-inflammatory foods , such as ginger and salmon, are best indicated whenever you are in a spinal crisis.

Exercising such as jumping rope or jumping classes in the gym is not the most advised because it can favour disc compression, triggering a new pain picture. Already exercises in water, such as water aerobics are more indicated because inside the water the body becomes lighter, not having as much impact on the joints and spine.

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