PT on the Net Research

Lumbar Disc Bulge


Question:

Please can you help? I have a female client in her late 30s who has been told by a specialist that she has a bulging disc at L4/L5. She is a very active participant in cardio classes, and she loves running but has found it too jarring. She uses the Cross Trainer and does circuit classes. Her doctor has suggested swimming, but she loves the intensity... the sweating! She doesn't want to give up these activities. What should I suggest she do?

Answer:

Using your client’s subjective feedback on pain is a good rule of thumb, especially when dealing with the possibility of neurological symptoms from the L4/L5 nerve root. Activity that produces any radicular pain (nerve pain radiating from the spinal nerve root to the buttocks, legs or feet) is an immediate indication to cease the activity. This could mean your client has irritated the nerve root from the activity.

Although her doctor recommended swimming, you may also want to clarify that he/she did not contraindicate any other forms of exercise.

Before I would suggest anything, I would first ask, “What have you assessed?” The best way you can help your client is to provide her with specific functional exercises that correspond with your assessment. This will allow you to better apply exercises that would possibly address some of the underlying causes that contributed to her disc bulge in the first place and/or address any compensations her body has developed as a result of trying to avoid the pain she has had in the past.

For example, glute exercises may not be appropriate if she has a posteriorly tilted pelvis and is lacking adequate lumbar lordosis. Your program should always follow a logical progression that is based on your assessment. All “functional” exercises are not appropriate for all individuals (see my article series on "Before the Core" Part 1 and Part 2). But the right exercises that address her musculoskeletal deficiencies and movement problems will challenge her physically... and she will sweat!

In addition, you must take into consideration what your client’s activities of daily living (ADLs) and/or demands of employment (DOE) are and how they effect her body. She may need to incorporate a home program of corrective exercises that she can do to offset the negative effects her ADLs and DOE are having on her body. These would be done even on days she is not working with you.

Addressing her muscle imbalances can assist with providing her body an optimal environment in which to heal. Remember, as fitness professionals, we are never “treating” anyone. Treatment is performed by a licensed health professional.