I have a 30 year old client who is a rugby player. She was recently diagnosed with an L1 L2 disc bulge. I was wondering if you could suggest how I can reintroduce her into exercise.
I will share some thoughts and describe a strategy to assist you in your question/client progression. First, it is very important to realize a disc bulge is a structural analysis, not a functional analysis. In addition, pain is an elusive term and means a lot of different things to each individual. What you didn’t mention is whether your client is in pain or what her current functional threshold (what she can or can’t do) is. However, the good news is the disc has been identified by many experts as a Living Adaptable Force Transducer, which in simple terms means it has great remodeling capabilities… IF placed in the right environment. So, my first suggestion is to search for WHY this structural anomaly occurred in the first place. This analysis can only take place if your client is not in acute pain as you will be observing a compensation to the current situation and not what most likely led her to having the problem. In addition, in my clinical experience, people often have back pain, go the traditional route of care, find they have a “bulge” (which most of us do to some level) and then conclude this is WHY they’re in pain. Later they find out it’s not why. Although the structural test didn’t lie, it’s just not WHY as there are many reasons the body can experience pain as well as different types of pain. My suggestion is, once your client is out of the acute stages, it is critical to assess her current functional threshold. This is also a way to find where she is successful, leading you to what exercises are best at this point (re-introducing her back to exercise). In addition, search for the probable causes of back pain. Because the back is the crossroad to the body, many forces can get “trapped” within the low back and cause spasm, strain, etc. Again, it’s not the back’s fault. The fault lies elsewhere, and this is your key to helping her improve! If you’re interested in learning more, I would purchase the DVD from educator Gary Gray on the Lumbar Spine (click here for more info). This DVD will supply you with tests, functional exercises and research, which will allow you a complete assessment to exercise thought process.