Back Pain Relief from Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the sacroiliac (SI) joints and the axial skeleton often having a strong genetic predisposition. Ankylosing spondylitis is a disease characterized by pain and progressive stiffness. It is part of a group of rheumatic diseases medically known as spondyloarthropathies which actually involves the vertebral joints and shares the human antigen HLA-B27.

Understanding Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the sacroiliac (SI) joints and the axial skeleton often having a strong genetic predisposition. Ankylosing spondylitis is a disease characterized by pain and progressive stiffness. It is part of a group of rheumatic diseases medically known as spondyloarthropathies which actually involves the vertebral joints and shares the human antigen HLA-B27.

Ankylosing spondylitis is considered to be hereditary, even though environmental factors have been suggested. Most people with the HLA-B27 antigen do not develop AS. It is known to affect white males about four times as often as females. Onset typically occurs between the ages of 15 and 45.

In the early stages of the disease, the sacroiliac joints, where the spine articulates with the back of the pelvis, become inflamed and painful. As the disease progresses, ossification is triggered by the Immune system’s defense mechanism. Ossification causes new bone to grow between vertebrae eventually merging them together increasing the risk for fracture. Eventually, ossification affects the spinal ligaments leading to the stenosis or narrowing of the spinal canal which can cause neurologic deficits.

Signs & Symptoms of Spondylolisthesis

  • Dull low back pain and localized stiffness involving the gluteal and lumbo-sacral areas.
  • Insidious or gradual onset of symptoms experienced by people younger than 40 years.
  • As the disease progresses, pain and limitation of movement becomes more persistent and experienced on both sides of the spine as the symptoms progress up the spine.
  • Stiffness and discomfort of the hips, shoulder and ankle joints arise.
  • Symptoms tend to worsen in the morning and following inactivity.
  • Alleviation of low back pain with exercise or activity.
  • Patients may complain of difficulty in breathing or chest tightness.
  • Cauda Equina Syndrome (specific nerve compression) may develop causing bilateral lower extremity numbness, weakness, and incontinence.

Professional Treatment for Ankylosing Spondylitis

  • Treatment for Ankylosing spondylitis (AS) is aimed at relieving the patient’s symptoms and preventing spinal deformity which mainly includes physician prescribed non-steroidal anti-inflammatory medicine.
  • Adhere to a physical therapy program that will strengthen back muscles, improve posture, increase flexibility and range of motion, and techniques to enhance breathing.
  • Consistently participate in activities that help alleviate stiffness. Warm baths, stretching activities performed in bed prior to rising and aquatics activities such as swimming and pool running are strongly advised.
  • Management may also include the use of drugs that block cell growth (cytotoxic drugs) in people who do not respond well to corticosteroids.
  • Non-surgical treatment such as traction and/or bracing are used to manage spinal fractures resulting from AS.
  • Corticosteroid therapy and TNF-alpha inhibitors have been FDA-approved for the treatment of Ankylosing Spondylitis and can lead to stunning improvement in the inflammatory and systemic nature of AS.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What is a Schober test?
  2. How early should Ankylosing Spondylitis be treated with a Tumor Necrosis Factor-blocker?
  3. What associated symptoms can I expect with this disorder?
  4. My blood workup tested positive for HLA-BA27 antigen, what are my chances of contracting AS?
  5. What does the Gaenslen’s maneuver measure?
  6. What is a “Bamboo Spine” and how do I prevent it?
  7. Can you elaborate more on the use of a halo brace or a TLSO device and how will they help me?

Elite Sports Medicine Tips from Mike Ryan

  • IMPROVE YOUR RANGE.  Regular daily exercise is an effective method to deal with symptoms of AS. Complete body flexibility exercises are needed to maintain joint motion from head to toe.
  • WATCH YOUR WEIGHT. Maintain your optimum weight and embracing a healthy diet will minimize the stress on your spine.
  • STAY HOT. Use a heat pack and warm baths help to increase the blood flow to the spine and surrounding tissue to help reduce pain and stiffness.
  • AIM TO BE ACTIVE. It is very important to understand that excessive rest is not the best solution to decreasing your stiffness. Maintain an active lifestyle.
  • ALWAYS WATCH YOUR STEP. Sports carrying a higher risk of falls such as skiing as horseback are best avoided to minimize the risk for spinal fractures.
  •  GAIN BY REDUCING THE PAIN.  Deep tissue massage, ultrasound, passive stretching, heat/ice and acupuncture may all have a positive role to play in reducing pain and maintaining mobility.
  • SUSTAIN THE FLOW BUT KEEP IT SLOW. Swimming, dancing and exercises to improve muscle tone, strength and flexibility are ideal while rapid twisting movements should be avoided.

What to Do When Suffering from “Damn Back” aka Spondylolysis

Spondylolysis is a condition created when a localized fracture of the bony arch, referred to as the pars interarticularis. This injury is most commonly located in the lumbar spine. This stress fracture is usually do to excessive force or repeated strain. Learn how to fix that “damn back” problem.

Understanding Spondylolysis

Spondylolysis is a condition created when a localized fracture of the bony arch, referred to as the pars interarticularis. This injury is most commonly located in the lumbar spine. This stress fracture is usually do to excessive force or repeated strain. This low back injury is typically found unilateral and if it becomes bilateral, it can easily progress into spondylolysthesis, characterized as having bilateral fractures and a forward “slippage” of the body of the vertebral spine.  An injury to the pars interarticularis is often referred to as a pars defect.

Young athletes participating in sports which involve contact, backward bending and aggressive rotation such as football, wrestling, martial arts and gymnasts are more succesptable to suffering this type of a back injury.  A comprehensive history is needed to determine if past activities contributed to the current low back pain. Obtaining lumbar spine x-ray, CT scans or even MRI may be required to confirm the diagnosis.

Signs & Symptoms of Spondylolysis

  • Pain and stiffness located at the center of the lower back.
  • An increase in symptoms with backwards bending or lumbar extension.
  • Patient notices an increase in symptoms with an increase in activities and an decrease in symptoms with rest.
  • With more severe cases of spondylolysis, the patients can experience pain radiating down one or both legs which is referred to as neurogenic pain.
  • A localized ache or stabbing pain involving the central low back region following prolonged standing or sitting.
  • If nerves are involved, there may be a decrease in lower extremity reflexes and/or the sensation of pins and needles in the low back, hips or legs.

Professional Treatment for Spondylolysis

Treatment of symptoms from these stress fractures are often accomplished in 3 general steps.  Initially, the low back is “quieted down” followed by efforts to improve both the core strength and core flexibility and lastly, returning to normal activities with a comprehensive education of the “Do’s and Don’t’s” to avoid any setbacks.

  • Implement an aggressive flexibility plan focusing on the low back, hamstrings, quads, groins and hip flexors.
  • Using a low back brace if needed to stabilize the lower back and pelvis during functional activities.
  • Initiate a progressive core stability program that addresses functional abdominal strength and endurance while training the trunk and pelvis to avoid excessive lumbar extension.
  • Continue to apply ice to the entire low back while resting on a firm surface with a pillow under your abdomen.  Only when the main symptom is “stiffness” should heat  be used.  The heating can be utilized via a hot tub, heating pad or hot packs.
  • Postural training to promote a painfree posture involving the pelvis, low back, upper back, shoulders, neck and head.  All of these areas have a direct impact to the lumbar spine and the pars defect.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Avoid all activities and positions that promote hyper-extension of the lower lumbar spine.  This “sway back” or lordotic curve is normal and necessary but when it becomes excessive and the pelvis rolls too far forward, that’s when spondylolysis becomes painful.
  • Slowly progress with low back strengthening exercises such as planks, bridges, Superman exercises, balance drills and proprioception exercises.
  • In extreme cases where non-surgical treatments becomes ineffective, a surgical laminectomy or posterior lumbar fusion is considered.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. How bad is my back injury and do I have spondylolysis or spondylolysthesis?
  2. Can you show me the “Scotty Dog” view on my x-ray?  This is a key view on an x-ray of the lumbar spine used to confirm the diagnosis for and the difference between spondylolysis and spondylolysthesis.
  3. How can I alleviate the pain I’m currently experiencing without causing further injury to my back?
  4. What activities and exercises do I need to avoid while I rehab my back to significantly improve my back function?

Elite Sports Medicine Tips from Mike Ryan

  • Stick to the Plan – Your specific physical therapy program is individually planned for you. The program may take weeks or months but stick to the plan to ensure an optimum recovery.
  • Balance is the Best –  Your goal is to attain the perfect combination between strength and flexibility of your paraspinal and abdominal muscle groups.
  • The Nasty S Word – Sitting may be easy to do but it can destroy your low back.  Learn to sitting properly and do as little of it as possible.
  • Body Mechanics is Key – As with sitting, poor body mechanics with standing and lifting will hurt your back very quickly.  Become a believer in that and you will quickly get back to an active lifestyle.
  • Become The Ab King – Flexible low back muscles with strong Abs is the winning combo with spondylo.
  • Know the Good C Curve – With standing and walking, the “C” curve of your low back has it’s opening facing backwards.  Strive to maintain the “Good C Curve” and your back will thank you.

The Slipping Back Problem of Spondylolisthesis

Spondylolisthesis is a condition that causes an alteration of the normal alignment of the spine. The lumbar spine accepts a majority of the weight bearing stress. Because of this important role, it the most susceptible level of the spine for this type of an injury. Learn how to stand up straight against Spondylolisthesis.

Understanding Spondylolisthesis

Spondylolisthesis is a condition that causes an alteration of the normal alignment of the spine. The term was coined from its Greek root words, spondylo + listhesis which means “vertebra” and “to slip”, respectively. Hence, the particular description of this injury when one of the spine bones slips forward over the one below causing a mechanically motivated inflammation involving the surrounding bone, capsule, ligaments and nerves resulting in pain and limitations.

The lumbar spine accepts a majority of the weight bearing stress.  Because of this important role, it the most susceptible level of the spine for this type of an injury. There are two major causes of this disorder observed in a specific group of people.

For younger adults, slipping of the 5th lumbar vertebra occurs because the vertbraes of the spine tend to sit in a forward direction over the sacrum.  Meanwhile gravity applies a force which increases this forward slippage of the vertebral body.  Another factor is the type of sporting event.  Activities that increase the extension of the lower back can easily result in a stress fracture of the bony ring of the lumbar spine.  When this fracture present with no slippage, it is referred to as spondylolysis.

Signs & Symptoms of Spondylolisthesis

  • Low back pain and tenderness which increases with lumbar extension or twisting.
  • Pain and stiffness which can involve the buttocks area.
  • Tight feeling in the hamstrings region or weakness on the thigh and/or leg.
  • Walking accompanied by  a back and forth shifting shuffle pattern.
  • Slowed lower extremity reflexes.
  • With serious cases, difficulty controlling bowel and bladder functions.
  • Sudden weakness and poor voluntary control of abdomen muscles.

Professional Treatment for Spondylolisthesis

  • Rest on a firm surface in a non-weight bearing position, which completely eliminates the symptoms.  This is usually most effective in a supine (face-up) or side lying positions with pillows placed behind the knees.
  • Implement a progressive flexibility plan focusing on the hamstrings, quads, and hip flexors.
  • A core stability program targeting your functional abdominal strength and endurance along with enhancing trunk and pelvis control.
  • Always avoid all positions and activities that increase lumbar hyperextension, the #1 enemy of spondylolysis and spondylolisthesis of the low back.
  • Wearing a low back brace or corsets may be a smart option for players with a weak core and/or pain with prolonged sitting.
  • Rehabilitation therapy is recommended to minimize activities causing extension pressures at the lumbar vertebrae and to build up your muscles promoting an antilordotic posture.
  • An optional form of treatment for chronic suffers is an epidural steroid injection (ESI).  ESIs is a potent anti-inflammatory injection which helps to reduce pain and swelling. This type of treatment is only considered with advanced cases or when physical therapy is not completely effective.
  • In severe cases where the lumbar slip is causing abnormal walking patterns, loss of control in bowel or bladder function, or simply a worsening condition, surgery may be required. Surgical procedures may include laminectomy, posterior fusion with instrumentation or posterior lumbar interbody fusion.
  • Employing updated physical therapy modalities are also provided to decrease pain and reduce swelling. Treatments of heat, cold, ultrasound, and electrical stimulation may be used to reduce pain, enhance painfree motion and minimize muscle spasm.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What part of my spinal vertebrae is responsible for my pain and limitations?
  2. How important is my core strength to my recovery?
  3. What condition would require wearing a rigid back brace?
  4. Do you think I will eventually need surgery to fix my spondylolisthesis?
  5. When I’m painfree, what preventive steps I should take to avoid a recurrence of this injury?

Elite Sports Medicine Tips from Mike Ryan

  • Go to the core of the problem: Exercises such as planks, pelvic tilt and crunches focus on strengthening core core muscles.
  • Prevention is always the better alternative: A pre-existing bilateral spondylolysis can easily develop into spondylolisthesis.
  • Aim for the right angle: Keeping the spine healthy requires consitent changes in posture.  Movement helps the spine promote circulation and reduce muscle fatigue. Sitting for a prolonged period eventually will make a even a healthy low back unhappy.
  • Get ahead of your game: As you make progress, progressively advance into functional strengthening exercises that get your core, trunk and lower extremity ready to get back in the game!

Why You Are Having Leg Numbness

“I’m having numbness down my leg and no one seems to know why!” she barked out frustratingly over the phone.  I hear similar complains from high level athletes and desk jockeys almost on a weekly basis.

80% of the population suffers from low back pain within their lifetime and numbness or pain down the leg is a common symptom.  Finding the reasons for the nerve involvement is almost as difficult as treating this injury.

Bulging lumbar disc, herniated disc, bone spurs, spinal stenosis, scar tissue, piriformis muscle syndrome and nerve entrapment are just a few of the possible sources of leg numbness.

Understanding Leg Numbness

If you have static on your home telephone, where could the problem be located?  Your puzzled look is justified.  The truth is that the “lesion”, as we say in sports medicine, can be in the headset of your phone, the wire going to the wall, the jack in the wall, the wire in the wall, the connection on the telephone pole, on and on.  The truth is that the source of the problem could be anywhere between your ear and the microphone in the phone of the person on the other end of the phone call.

Although the distance is significantly shorter, much of the same can be said about the numbness down your leg.  The pressure on your leg nerve can be located anywhere from within the spinal cord to within the leg itself.

It’s important for the readers to understand that when pressure is placed on a nerve, typically the initial symptom is numbness.  If greater pressure is applied to any part of a nerve and more of the inner nerve is impaired, leg pain and weakness in the pattern where that nerve travels can result.

This is the reason why a doctor will implement a variety of tests including reflex tests, manual muscle tests, pin-prick tests and range of motion assessments while comparing each of the results to the opposite leg.  Understanding the exact type and location of the symptoms is the first step to determine where the lesion is located and, ultimately, how to treat the leg numbness.

Signs & Symptoms of Leg Numbness

  • Numbness and/or pain can extend anywhere from the low back to the toes.
  • Low and mid-back spasms often accompany leg numbness.
  • A sharp “stabbing pain” in the low back region can initiate symptom.
  • can be initiated by a sharp “stabbing pain” in the low back region.
  • The intensity of the symptoms and even how far down the leg the numbness travels is often worsened with prolonged sitting and with the transition from sitting to standing.
  • A sense of hip and leg weakness is common with leg numbness related to nerve pain.

Professional Treatment for Pain Down the Leg

  • Contact your orthopedic physician for a thorough exam.
  • Get off your feet as much as possible to decrease the pressure on your lumbar spine and associated nerve structures.
  • Lying on your back on a firm surface with pillows under your knees is often the best position to rest and sleep.
  • Low back massages, PAINFREE hamstring stretches and lumbar icings will help to minimize localized spasms and pain.
  • While lying on your back with knees bent and feet on the floor, slowly use your arms to pull each knee to your chest while exhaling.  Alternate each leg for 5 reps then 5 reps with both legs together while keeping your head and shoulders relaxed and resting on the ground.
  • Progressive crunches with firm exhale with your feet on the ground along with no low back pain or any increase in leg numbness.
  • Strong emphasis on core stability, hamstring flexibility, sound body mechanics and maintaining a lordotic (sway-back) curve position of the lumbar spine with all activities.
  • Progressive return to activities while avoiding setbacks that would initiate the pain>spasms>more pain cycles.

Asking the Questions a Pro Athlete Would Ask

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What is the source of my leg numbness?
  2. Can you show me on a model or picture exactly what my low back looks like and what is contributing to my leg numbness?
  3. Do I need to have an MRI to determine the status of the discs in my lumbar spine?
  4. Am I at risk for permanent numbness and/or weakness in my hip and lower extremity?
  5. Do I need surgery or can I avoid surgery with a very aggressive low back therapy program?
  6. In your opinion, who are the best low back physical therapists in town?

Elite Sports Medicine Tips from Mike Ryan for Leg Numbness

  • No Low Back Pain? – With leg numbness, the actual low back pain may be minimal.
  • Centralization – Simply stated, the less numbness/pain in the leg the better.  The farther the symptoms extend down the leg, the greater the pressure on the lumbar nerve.  That’s not good.  Centralization is when the pain moves out of the lower extremity and into the lumbar spine.  That’s better.
  • Disc 101 – Only the outer rim of the disc has nerve fibers so if you’re damaging them, you will never know.  Avoid a slouched posture and keep the curve in your low back and your discs may be nice to you.
  • Un-Clear Mechanism – Sometimes it obvious but often pain down the leg “just happens” and it will take a specialist to determine why.
  • Take The Blinders Off – Look at the big picture.  Hip injuries, poor sleeping surfaces, childhood injuries and bad shoes can all be reasons for back injuries so step back and evaluate all the factors.

Tips For Getting Relief From Sacroiliac Joint Pain

If you experience pain when twisting at the waist or bending over, you may be suffering from Sacroiliac joint pain. The two sacroiliac joints are often not recognized or appreciated by most people because of their “bigger brother” located next door:  the lumbar spine.  Meanwhile, the true importance of the SI joints cannot be understated.  When these joints become symptomatic you will quickly realize their contributions to your normal motion.
These joints are the only two bony connections between the entire lower spine and the pelvis and lower extremities.  Think about that for a minute: that means all the weight of your spine, shoulders, head, arms and anything you are holding in your arms has only two small joint surfaces to technically bare the forces of all that weight in the SI joints!  That is just one reason why any disturbance of the sacroiliac will be painful and considerably impair your ability to perform normal movements without pain.

Found on the backside of the pelvis just above the large and strong buttocks or gluteus maximus muscles, the two SI joints can be located when examining just below the beltline on the back of the pelvis.  There you will feel one bony pump on each side approximately 4 to 6 inches apart.  Those bony landmarks are called the posterior superior iliac spines (PSIS) and the sacroiliac joints are located just inside of the PSIS.  Often these landmarks are tender to touch and swollen.

The sacrum is a larger triangle shaped bone that is positioned below the lumbar spine and between the two SI joints.

Why is SI Joint Difficult to Treat?

SI joints are vital connections that allow three-dimensional motion of the pelvis, hips and low back.  Motions such as twisting, bending and squatting are great examples of how the SI joints naturally assists the function of the entire lower extremity, pelvis and low back.  In conjunction with the one pubic symphysis, located at the front of the pelvis, painfree function becomes effortless.

Understanding the sacroiliac joint motion and pathologies is not easy.  Because of the complexity of the anatomy and movement patterns of the SI joint and low back, the evaluation and treatment of sacroiliac dysfunctions is still controversial.

SI joint dysfunction is a sports medicine term that is often used when describing various injuries involving the SI joint. A biomechanical problem that creates physical symptoms in the SI joint and surrounding tissue,  typically the problems of this dysfunction can be related to the sacroliliac joint being too still (hypo-mobile) or loose (hyper-mobile).  Because of the complexity of the SI joint and the joints above and below the pelvis, too little or too much movement of the SI joint will create pain and physical limitations.

Signs & Symptoms of an SI Joint Injury

  • Various levels of pain in the low back below the beltline and off to either side of the midline.
  • Discomfort and slight swelling noted with palpation of the area just medial or inside to the PSIS above the buttocks muscles.
  • Commonly associated with excessively tight hip flexors and hamstring muscles.
  • A sense of the pelvis “being off” or “rotated on one side” with activity.
  • With severe or chronic conditions, radiating pain can be experienced into the lateral low back, buttocks region, groin and lower extremity.
  • Restricted movement with extreme flexion, extension and/or rotation.
  • An increase in symptoms after prolonged period of time in a soft chair or bed.
  • Movements related to a combination of low back and hip rotation such as putting on socks, twisting in bed and getting out of a car tend to create a catching sensation in the low and lateral back below the beltline.
  • A leg length discrepancy is common as either a cause or a result of a sacroliliac joint dysfunction.
  • There may be tenderness on palpating of the ligaments that surround the joint.

Treating Sacroiliac Pain

  • You’ll want to rest the low back, pelvis, hips and upper legs in a prone (face down) position with ice on the low back and posterior pelvis.  You should also avoid prolonged sitting, soft beds and chairs, activities that create symptoms and any one-legged positional movements.  In addition, three ways you can reduce or eliminate your pain are to seek:
  • Massage and soft tissue work to relax the hip flexors, groin muscles, lateral hip rotators, back extensors and hamstrings.  Massage techniques vary greatly and the benefits for sacroliliac pain cannot be understated.
  • Progress with a core-stabilizing program that improve both the strength and the function of the entire abdominal region.  The objective here is to perform stabilizing exercises that address the needs of the athlete without creating any symptoms in the SIJ, low back or hips.  Progress as tolerablable.
  • A biomechanical evaluation to determine if a muscle imbalance, leg length discrepancy, poor flexibility or other factors are contributing to the SI joint dysfunction.

Questions to Ask to Eliminate SI Joint Pain

Especially because the treatment of SI joints are so difficult to treat, it’s vital you receive clear direction on how to safely treat your pain.  Here are the questions a saavy professional athlete with sacroliliac pain will ask his sports medicine specialist to ensure he can safely return to his sport as quickly as possible:

  1. Are you certain of the diagnosis?
  2. Do I need an MRI to rule out any disc, nerve or bony pathology that is contributing to this injury?
  3. What are the warning signs with this injury that will tell me that my back injury is getting worse?
  4. What can I expect with this injury for the next 2, 4 and 6 weeks?
  5. Who do you consider to be the expert lumbar spine and pelvis rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Sports Medicine Tips For Your SI Joint Pain

  • The Patient is Usually Right – You’re the patient and it’s your back so listen to yourself!  Sure the doctors and sports medicine specialists have some pretty cool diplomas on the wall and a lot of initials after their name but no one knows your low back like you do.  Trust your insight.
  • SI Joint Phobia – I’ll let you in on a secret that many in the sports medicine world do not like to admit:  The sacroiliac joint is not understood by a majority of doctors and for good reason.  It’s confusing and very complex and unless you work with it first hand every day, most will “shotgun it” with a little of this and a little of that. Therefore, it’s helpful to seek out a specialist with experience in this area before you schedule an appointment.
  • Body Mechanics WILL Make the Difference – Look at the way you move doing the little things like tying your shoes or picking up the newspaper.  If you’re losing your lordotic curve or sway-back curve, you’re loading both your SI joints and your low back.  Excess stress at either location is a bad thing.  Maintain that curve doing everything and chances are your SI joint will allow you to do what you want to do.
  • Ice is Your Friend – I know, I know…here we go again…Ice hurts but it’s exactly what you need for this injury.  Sure, Ice will make your back stiffer and that will require some additional time to warm-up.  But ice will decrease inflammation and pain which are two key steps to recovering from any back injury.  The Pro’s will tell you that ice is their best teammate.  Stop avoiding this extremely beneficial remedy and do what you know you need to do…ICE and lots of it.
  • Find the Source – A hyper mobile sacroiliac joint is often related to a traumatic episode to the low back or an alignment problem elsewhere when compared bilateral.  Get with a specialist who can find the source of the problem to determine if the sacroiliac pain is merely a symptom.  Orthotics, chiropractor care or more aggressive core stability are just a few of the options to be considered.

Bulging Disc of the Low Back

Understanding a Lumbar Spine Bulging Disc

It seems that most non-medical people understand more about their computers and smart phones than they know about their good old friendly back.  With that being said, it demonstrates the irony of this information gap when statistics show that 80% of us will suffer from low back pain sometime in our lifetime!

The lower part of our lumbar spine has 5 strong and stabile bones called vertebra.  These vertebra stack on top of each other with intervertebral discs smartly located between each vertebra.  These lumbar disks have two functions:  Spacers and shock absorbers.

Each disc is thick and quite dense to protect the bones of the lower back while allowing for a very functional lumbar spine.  Inside each disk is a jelly-like nucleus called the nucleus pulposus with the very outer ring of the disc reinforced with the stabilizing structured called the annulus fibrosus.

When the lumbar spine is injured or put into a poor posture for a prolonged period of time, many things can happen to become the source of pain and limitation.  For the purpose of this article, let’s look at when the disc becomes the reason for someone having a bad back.  Unfortunately, a bulging disc is too commonly the reason for low back pain and managing a damaged disk may be one of the most important physical challenges that you face in your lifetime.

Bulging discs in the lumbar spine cause significant pain in the low back, buttocks area, groin and lower extremity.  Because of the complexity of the interactions with all the bones of the lumbar spine, disks of the spine, nerves of the spine and bones of the pelvis, the wide arrange of symptoms and treatments can greatly vary.

“Bad backs” can obviously be related to any part of the lower or middle back.  When the lumbar disk’s annulus fibrosus is damaged, the contents of the disk including the nucleus pulposus can be forced outward between the vertebra.  The spinal cord and its peripheral nerves that supply the trunk and lower extremity.  This bulging of the disc is the main reason for pressure on the nerves as they exit the lumbar spine and create nerve symptoms into the regions of the body that the nerve innervates.

Spinal stenosis (narrowing of the spinal canal), bone spurs, spondylolysis, spondylolisthesis and herniations of lumbar discs can be other medical factors that can contribute to Lumbago or low back pain.  A thorough exam by a medical physician is the best starting point for anyone with pain, numbness and/or weakness extending down an extremity from the spinal canal.

Signs & Symptoms of a “Bad Back”

  • Low back, buttock and/or lower extremity pain, numbness and/or weakness, which may be intermittent or constant.
  • May experience pain with standing after prolonged sitting or laying down.
  • May be associated with lateral shifting of the torso away from the painful side.  This is a postural compensation that known as listing.
  • In severe cases, abnormal knee and ankle reflexes can occur.

Professional Treatment for a Bulging Disc of the Lumbar Spine

  • Rest on a firm surface in a non-weight bearing position that completely eliminates the symptoms.  This is best done by lying in a supine (face-up) position with pillows placed behind the knees.
  • Ice bags placed on your back while lying supine or prone (face down) with a pillow placed under the stomach.
  • Implement a progressive flexibility plan focusing on the hamstrings, quads, and hip flexors.
  • Core stability program that addresses functional abdominal strength and endurance while training the trunk and pelvis to avoid positions that create low back pain commonly associated with spinal stenosis.
  • The application of heat in the form of a hot tub, heating pad or hot packs should be SLOWLY implemented only when the main symptom is “stiffness” or when there is a need to increase blood flow in the low back/hip area to “get things looser” for activities.  The introduction of heat too early or too aggressively will quickly worsen the symptoms and prolong the recovery time for a bulging disk.
  • Back strengthening exercises such as planks, bridges, Superman exercises, balance drills and proprioception exercises while avoiding a kyphotic (slouched back position) curve of the low back which would assist in the posterior migration of the lumbar disc……not something that you want!
  • Some severe or chronic bulging discs may require an epidural injection from a physician

Questions a Pro Athlete Would Ask

A smart professional athlete with bad back who wants to safely return to his/her sport will ask his sports medicine specialist the following questions:

  1. Are you certain of the diagnosis and do I need an MRI to rule out any other problems?
  2. Do you think I can manage this bulging disc with rehab without having surgery?
  3. With my bad back and knowing that I want to remain very active and healthy for a long time, what activities do I need to avoid/modify to accomplish this outcome?
  4. In your opinion, what three (3) factors (for example: flexibility, posture, body weight, severity of my injury, fitness level, activities, occupation, Ab strength, and attitude) are most important for me to focus on with my rehab?
  5. Who do you consider to be the expert low back and bulging disc rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Elite Sports Medicine Tips

  • It’s all in the Curve – Posture, posture, posture!  If you you’re your lumbar disk to stay in it’s happy place, focus on your posture.  If you maintain the “hollow curve” (lordotic curve) or sway back posture during all activities, the lumbar disc is naturally pressed forward and away from the nerves.
  • Flexibility Makes Your Back Sing – The looser the muscles are of the low back, hips and legs the less work the back has to do to do anything.  It’s that simple.
  • “I Threw My Back Out (fill in the blank)!” – Few people throw their back out lifting a car off their crazy cousin.  Most people damage a lumbar disk with innocent motions like picking up the newspaper or putting on a shoe.


  • Make a List – Anyone with a chronic bad back can tell you what helps and what hurts their back.  Do your homework and know the reasons before your back becomes chronic.  Make a list of:
    • What Makes my Back Better
    • What Makes my Back Worse?
  • When Will I be Painfree? – 80% of the population have low back pain sometime in their lives.  Bulging discs, low back strains, herniated discs, spondylo and ligament sprains are just a few examples of injuries that can cause low back pain.  Treating a lumbar bulging disc early and properly is just what the doctor ordered to keep you active and pain-free.