Dispelling the myths surrounding disc bulges and back pain.

The story.

You’re at home, you reach down to pick up your shoes and “bang” you get this sudden, crippling back pain. You call your physio/chiro/osteo/doctor. They assess you and say that you probably have a slipped disc or a disc bulge and that you need an MRI. You go home, jump on the world wide web and are confronted with all sorts of pictures showing discs pushing on nerves. Every website you read says that you may need surgery and you should be avoiding heavy lifting, bending and twisting. Sound familiar?

There are 3 main problems with the above scenario.

1. Scans rarely add value.

Patients symptoms rarely correlate with what we see on their scans . A systematic review by Brinjiki and colleagues in 2014 looked at all the studies published on asymptomatic people i.e. they had no symptoms or history of symptoms. They found that all the studies regularly reported disc problems in pain free subjects.

30% of all 20yr olds had a disc bulge and no pain. This percentage increased with age, with over 60% of 50yr olds having a disc bulge, and these are people who had no symptoms whatsoever. We also regularly find that patients with acute, crippling low back pain have no evidence of acute tissue damage on MRI.

A study in 2015 (Fritz and colleagues) also found that back pain patients who had an MRI or CT scan spent up to $5,000 more on rehabilitation compared to those who didn’t . The reason for this is multifactorial and mostly is the result of “Pathologisation” (which we will talk about in a later post).

So having an x-ray, MRI or CT scan for your back pain will in most cases be a waste of your time and money. (The only exception to this rule is if you have signs or symptoms suggesting serious pathology like a fracture OR if you have constant pins and needles, numbness and weakness in a dermatomal distribution).

2. Disc bulges are more likely to cause leg symptoms rather than back pain. If you have back pain, and no leg symptoms, it is unlikely that a disc is the cause of your symptoms. The reason is that the disc itself is actually very poorly innervated (Garcia-Cosamalon and colleagues 2010) meaning that the disc itself does not contain a lot of sensory nerve fibres. It will really only start to cause you grief if it starts to contact and compress the nerve root. If it gets to this point, you may have pins and needles, numbness, weakness of the area supplied by the nerve that is affected. Even at this stage we can reliably diagnose it without the use of scans.

Patients with true disc bulge symptoms will most likely present to the clinic complaining of leg symptoms but no back pain.

3. Avoidance of movement can result in poorer outcomes . By all means avoid heavy lifting until your pain settles but there is no reason, nor any evidence, to suggest that avoiding bending or avoiding twisting will help healing or speed recovery. We actually know that stiff spines are painful spines so avoidance of specific movements can result in reduced mobility and reduced strength in the long term . Getting moving early, and recovering your mobility and flexibility early, with the help of a competent clinician, is the most effective treatment.

So if the above story sounds like you, don’t panic! Approximately 95% of patients with acute low back pain who present to a competent physiotherapist recover completely within 4 weeks, most even sooner.

If you’re reading this and have already had an MR or CT scan, remember these findings are normal and most likely are not the cause of your pain. Low back pain is multifactorial, so having it assessed by a competent practitioner is the fastest way to get you moving again.


What exercises can I do if I have a disc bulge?

Lower back pain is one of the most common musculoskeletal injuries or complaints with approximately 85% of people experiencing back pain at some point in their lives.

Disc bulges are also just as common, but not everyone experiences pain from a disc bulge. In fact up to 50% of people with disc bulges are asymptomatic (i.e. don’t get any symptoms). READ MORE ABOUT THIS IN OUR EARLIER ARTICLE HERE.

Lumbar Spine Anatomy

The lumbar spine consists of 5 lumbar vertebra and 5 corresponding nerve roots. The lumbar nerve roots exit the vertebra through spaces called foramen.

What happens when you do get symptoms from a disc bulge?

This is what is known in the medical world as "radiculopathy".

Radiculopathy is a pathological process where the nerve exiting the vertebra or the spine is being compressed. It can manifest in various signs including pins and needles, numbness, tingling, burning, nerve pain and weakness.


This can be due to changes in bony anatomy, degenerative changes or the dreaded bulging disc, which causes narrowing of the little gap where the nerve exits.

This little gap is called the nerve foramen and narrowing of the foramen is referred to as foraminal stenosis or nerve root impingement on MRI reports.

What exercises can i do if I have a Disc Bulge?

The short answer is lots!

There have been 2 fantastic studies done over the last 7 years which have proved that 2 activities that were thought to be bad for disc bulges are actually good!

  1. Bending (lumbar flexion)
  2. Running

1) Lumbar Flexion: Can I bend or should I keep my back straight?

In 2013, Singh and colleagues conducted Kinetic (dynamic) MRI’s on patients with disc bulges to assess for disc displacement as well as foraminal size which showed that lumbar flexion does not cause displacement of the discs, but actually increases the size of the foramen, which means more room for the nerve!

The take home messages from this study were:

A) Flexion (bending) showed a significant increase in foramen size on dynamic MRIs indicating an increase in size available for the exiting nerve root.

B) The amount of posterior disc bulge was significantly correlated with posterior movement into the foramen with extension not flexion. This indicates that there is greater compression of the nerve and increased posterior disc bulge when you move into extension (arch backwards) not flexion.

2) Running

Yes! You can do that too! A study published in 2017 by Belavy et al found those that ran 30-50kms/week actually had healthier, stronger, juicier lumbar discs compared to their less active counterparts.

What do I do if I have a bulging disc?

That’s Easy….Walk, run and DO NOT AVOID bending! The great news is that disc bulges do heal with time, with even the serious ones healing within 12 months.

There are lots of other options for disc bulge exercises, so if you’re not up to running or if you are have having trouble then please do not hesitate to get in touch with us at clinicalphysiostives.com.au


  1. Singh V et al, Factors affecting dynamic foraminal stenosis in the lumbar spine, Spine J. (2013)
  2. Belavý, D. L. et al. Running exercise strengthens the intervertebral disc. Sci. Rep. 7, 45975; doi: 10.1038/srep45975 (2017)