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Lumbar Disc Bulge Management/Treatment

Alternative Terms

  • Lower back pain
  • Lumbar disc bulge management
  • Lumbar disc extrusion
  • Lumbar disc herniation
  • Lumbar disc protrusion
  • Lumbar nerve root impingement

Causes of Lumbar Disc Bulges

    • Accident:  Motor vehicle accident; fall; near fall with sudden violent motion of the spine
    • Bending forward (Occupational Risk Factors for Symptomatic Lumbar Disc Herniation.  Occup Environ Med 2003; 60:821-830)
    • Core stability, poor
    • Injury
    • Joint stiffness
    • Lifestyle involving large amounts of sitting, bending, or lifting
    • Lifting, heavy, associated with bending or twisting
    • Muscle tightness
    • Muscle weakness
    • Obesity, overweight condition
    • Posture, poor
    • Trauma

    Non-Surgical Treatment Options (All-Inclusive Listing)

    • Acupuncture
      • Stimulates energy points
    • Biomechanical correction
      • Alternative terms:  Back brace, brace, bracing, corset, lumbar support, postural taping
      • In the long term, may cause loss of muscle tone
    • Decompression treatment, traction
      • Pulls the vertebrae apart
    • Diet
      • May apply if patient is overweight
    • Education
    • Ergonomics
      • Lumbar roll or other form of support while sitting
    • Exercises
    • Heat/cold therapy
      • Especially effective in first 24-48 hours
        Use cold packs initially, heat after a few days
    • Injections
    • Manipulation
      • Chiropractic manipulation
        • James M. Cox, Chiro-manis treatment manual for lumbar disc protrusions and other low back conditions, Cox, 1975
      • Massage
        • Wang Qinjian, Chinese Medicine Massage Cures Diseases in Good Effects--Lumbar intervertebral disc protrusion, DVD, Beauty Media, 2007
        • Massage and Drawing Therapy for Lumbar Disc Protrusion, DVD, Beauty Media, 2008
      • Sacro Wedgy
    • Medication (temporary relief)
      • Anti-inflammatories, e.g. aspirin, ibuprofen, Naproxen, Celebrex, Vioxx
      • Oral steroids
      • Narcotic painkillers, e.g. codeine, hydrocodone-acetaminophen (Lortab, Vicodin)
      • Neuropathic ("nerve pain") medications, e.g. gabapentin
      • Muscle relaxants
      • Corticosteroid injections (Lumbar Interlaminar Epidural Injections in Managing Chronic Low Back and Lower Extremity Pain. Pain Phys 2009; 12:163-188)
    • Modified activity
      • R.I.C.E. Regime in the initial phase of injury. The R.I.C.E regime is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). The R.I.C.E. regime for a lumbar disc bulge primarily involves resting from aggravating activities (this may include the use of a protective brace) and regular icing. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
      • Avoiding activities that aggravate symptoms, e.g. reaching, bending, lifting, twisting, rowing (mayoclinic.com)
      • Reducing workload if necessary
    • Posture, body positioning
      • Reducing sitting to less than 10-15 minutes at a time, 1-2 hours per day
      • Sitting with lumbar support
      • Activities that help to push the disc back in, e.g. lying with back straight, standing, walking with back straight, back arches
      • Resting with hips and knees flexed
      • Bed rest for 2-4 days
    • Spontaneous regression
      • Spontaneous Regression of Lumbar Herniated Disc. J Chin Med Assoc 2009; 72:650-653
      • Spontaneously Disappearing Lumbar Disc Protrusion. Br J Gen Pract 2008; 58:646-647
    • Time
      • Four to six weeks
    • Weight loss
      Physical therapy
      • "Core" muscle strength and stability rehabilitation program
        • Abdominal muscles
        • External obliques
        • Lower back muscles
      • Prevents recurrence by teaching proper body mechanics, decreasing pain, increasing flexibility and strength
      • Heat, ice, traction, ultrasound, electrotherapy (e.g. ultrasound), hydrotherapy 

    Surgical Treatment Options

    Organizations & Resources

    Lumbar Disc Bulge Management - References

    • Surgical vs Non-Operative Treatment for Lumbar Disc Herniation:  Four Year Results for the Spine Patient Outcomes Research Trial (SPORT).  Spine 2008; 33:2789-2800.  Found surgery superior to nonoperative treatment in all outcomes except work status.
    • Acute Lumbar Disk Pain: Navigating Evaluation and Treatment Choices. Am Fam Phys 2008
    • S. Mills (Ed.), Guide To Back Pain: Techniques to make your Back Pain Disappear, Kindle, 2008
    • Lumbar Disc Protrusion. Am Fam Phys 1999
    • Lifting (heavy), associated with bending or twisting

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