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!
- Bending (lumbar flexion)
- 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
References
- Singh V et al, Factors affecting dynamic foraminal stenosis in the lumbar spine, Spine J. (2013)
- Belavý, D. L. et al. Running exercise strengthens the intervertebral disc. Sci. Rep. 7, 45975; doi: 10.1038/srep45975 (2017)
How to Treat and Manage Stiff Ankles
If your ankle mobility isn’t up to par, the next steps depend on the source of the restriction. Generally, if the limitation is felt at the front of the ankle, it may be due to joint-related issues.
- Banded Ankle Mobilizations: This technique involves using a resistance band tied to a stable surface while performing ankle flexing exercises on a step. Check out this quick helpful video for guidance.
Conversely, if the tightness is located in the back of your ankle around the Achilles tendon region, consider:
- Contract/Relax Stretches: A simple exercise like the bent-knee calf raise can effectively relieve restrictions in this region.
Lastly, for an immediate solution, consider using a wedge or support under your heels during a squat. Two papers from The Journal of Strength and Conditioning Research have shown that wedges can enhance squat depth without negatively impacting biomechanics. While some may see this as a “cheat,” the science supports it. If you struggle to achieve that 12 cm in the knee-to-wall test and find it challenging to squat low, use that wedge!
Hip Range of Motion
How Much Flexibility Do I Need and How Do I Test It?
For effective squatting, studies have determined that achieving 125 degrees of hip flexion is necessary—this is 35 degrees beyond a right angle. To test your hip mobility, you can use an inclinometer available on your iPhone. Simply follow these steps:
- Lie down on your back with your legs extended.
- Place the inclinometer length-ways on your thigh,
- Gently lift your knee towards your chest to measure the maximum angle, without moving the opposite leg.
How to Treat and Manage Stiff Hips
The hip joint is mostly passive during a squat, so if you’re experiencing limitations, it’s most likely due to an issue with the hip joint itself. There is up to 20% of the population that may be limited by the shape of their hip joint and the way it developed during childhood and adolescence. If that is the case, it makes if very difficult to improve the range of motion. Things like acetabular retroversion or a lower femoral head/neck offset ratio cannot be changed.
For the rest of the population, here are some effective strategies for improving hip mobility:
- Banded Hip Mobilisations: These exercises can help increase the range of motion in your hips by stretching and mobilizing the joint. Look for a demonstration in this video.
- Inner Range Hip Flexor Strengthening: Strengthening your hip flexors can counteract tightness and enhance your ability to squat lower.
- Like with ankle mobility, adding a heel wedge can help. By elevating your heels, you may experience a reduction in trunk forward bend, minimizing the hip flexion required and facilitating a more comfortable squat position.
Conclusion
Mastering a deep squat requires more than just strength; it hinges on sufficient ankle and hip range of motion. The studies from 2015 and 2022 have made it clear: flexibility in these joints is paramount for optimal performance.
By regularly assessing your mobility and implementing these targeted exercises and techniques, you can improve your squat depth, enhance your overall strength training, and reduce the risk of injury. Remember, every body is unique, so listen to yours and adjust your approach accordingly. Happy squatting!
