Bulging Discs

Poor posture, unbalanced tight and weak muscles, stress, over training and joint dysfunction are all possible causes of low back pain. Frequently we see patients who may present with acute low back pain and sciatica.

Sciatica refers to back pain caused by a problem with the sciatic nerve. This is a large nerve that runs from the lower back down the back of each leg. When something injures or puts pressure on the sciatic nerve, it can cause pain in the lower back that spreads to the hip, buttocks and leg.

The most common symptom of sciatica is lower back pain that extends through the hip and buttock and down one leg. The pain usually affects only one leg and may get worse when you sit, cough or sneeze. The leg may also feel numb, weak or tingly at times.

The symptoms of sciatica tend to appear suddenly and can last for days or weeks.

Most people who get sciatica are between the ages of 30 and 50. Women may be more likely to develop the problem during pregnancy because of pressure on the sciatic nerve from the growing uterus and foetus. Other   causes include a herniated or bulging disc and degenerative arthritis of the spine.

What is a bulging disc?

To understand what a bulging disc is, we must first understand the anatomy of the spine.

Put simply, the spine is made up of individual vertebrae stacked on top of each other. Between each vertebrae is an intervertebral disc that provides a cushion so the vertebrae don’t rub together.

The discs between the vertebrae have a gel like material inside (called a nucleus pulposus).

A great way to think of the discs is like that of a balloon filled with water – these discs help resist compressive forces on the spine.

When a disc bulges, the gel like material inside gets pushed back towards the nerves and structures of the spine. This bulge can sometimes        compress nerves in your spine and cause pain, tingling / or burning sensation and / or other symptoms.

It is important to note that a bulging disc doesn’t always touch the nerves and, for many, a bulged disc doesn’t even produce any pain at all. However, it could progress to become a herniated disc eventually, which can be problematic.

What causes a bulging disc?

· Seated with poor posture for long periods of time.

· Repetitive bending, lifting and twisting, especially with poor form.

· Heavy lifting with poor form due to stress on front of spinal column causing disc to bulge out back.

· Can also result from osteoarthritis.

· Trauma such as a car accident.

How is a bulging disc different from a herniated disc and which is worse?

In most simple terms, a herniated disc is when the fluid material from the disc ruptures through the outer layer of the disc and now spills out. This material can directly compress on spinal nerves and spinal structures. If you use the water balloon example but now imagine the balloon has burst under pressure, that’s a herniated disc.

A bulging disc can be resolved over time if managed well, whereas the herniated disc will just scar down since the annulus (outer layer of disc) has ruptured.

A nice visual spine model is provided below differentiating between normal, bulging and  herniated discs:

What are the symptoms of a bulging disc in the lumbar spine?

· Low back pain.

· Leg pain (not absolute).

· Decreased lumbar lordosis (lower back curvature becomes flattened – flatter lower back over time).

· Lumbar and hip muscle tightness.

Wrists: delicate but complex

The wrist is one of the most delicate, complicated and vulnerable joints in the body. It’s classed as a complex joint, meaning multiple bones slide against each other to create a more complex movement – necessary in such a tight space and to be able to withstand the compressive forces wrists can handle! It’s capable of every movement possible from a joint in the body. 

The 7 small bones of the wrist sit between the two forearm bones and the long bones of the hand. Their location is from our tree dwelling ancestors and allows the hand to close and open, as well as working with the elbow to rotate up to (and sometimes over!) 360 degrees. Those same tree dwelling ancestors are responsible for some of the muscles acting on the wrist. There are very few muscles that exist in the wrist, the only main one called pronator quadratus. The rest live in the forearm and pass tendons across the wrist into the fingers or hands.

These tendons are the most vulnerable part of the wrist to injury and pass in a series of sheaths around the outside of the wrist, linking the wrist to conditions like tennis and golfers’ elbow. 

The most well known wrist injuries, along with the most common, are traumatic injuries from falls and impact – the typical ‘fall on out stretched hand’ or FOOSH. The small bones and corresponding joints make the area particularly susceptible to injury in this way.

However, other injuries can come in the form of repetitive strains to any of the joints or tendons and can also show in some of the nerves that pass through the wrist into the hand. The most common of these being carpal tunnel syndrome. Other tunnel syndromes are more rare but do exist, the next most common being a tunnel of gunyon syndrome, also known as a handlebar palsy.

That name is a giveaway as to the most common population to get this type of injury! However, it isn’t just cyclists – anyone with pressure on the ulnar side of the wrist (little finger side) with a gripped fist can be in the firing line, particularly with vibration, so power tools are a common cause.

Something to bear in mind with tunnel syndromes or any injury to the nerves in the hand or extremity is that it’s very important to rule out any other pathology or cause, as conditions such as type 2 diabetes are significant risk factors – they are also very commonly present in pregnancy! 

The high usage of the wrist in nearly any movement using the hand leads to overuse or repetitive strain injuries being very common in the wrist – linked with overuse in sports, actions like using scissors in hairdressing or using keyboards excessively. 

Some of the more interesting aspects of the wrist include a muscle left over from our tree dwelling evolutionary forebears, that isn’t present in everyone, called palmaris longus. This tenses the connective tissue of the hand and assists wrist flexion. One theory as to its development is that it assists climbing primates (and possibly climbing humans?!).  Did you know, the wrist bones in horses have fused to create their longer lower foreleg bones, meaning the joint that looks like their knee / elbow on the front leg is equivalent to our wrist! 

Treatment of the wrist is often complex – reduction in load through rest and active treatments in the form of exercise or stretching are common. Many different methods of management can be performed by chiropractors including taping, acupuncture, manipulation and massage. These are effective in many types of wrist injury but, due to the complex nature of the joint and the structures passing through it, make sure to seek advice from a qualified professional (chiropractor, GP, physiotherapist or similar) before any sort of  intervention! 





Let’s talk this over !

TMJ stands for temporomandibular joint and refers to your jaw. It consists of a lower and upper part, on each side, that articulate together and are separated by a disc.

The anatomy of the jaw is such that the lower part or mandible has a condyle that rests in the socket of the upper part of the jaw, which is the temporal bone and is part of the skull.

There are two main movements of the TMJ – a hinging action that is then immediately followed by a forward gliding motion which is facilitated by the intra-articular disc. The correct movement of the jaw is important for normal function and helps to keep people pain free.

This is quite a vulnerable joint and can create problems for people. It’s one of the most frequently used joints and can be overlooked when being examined for certain issues, such as headaches. It’s estimated that the temporomandibular joint is used between 1,500 – 2,000 times a day during  activities such as chewing, talking, swallowing, yawning and snoring.

When a clinician is assessing someone’s jaw, first they will start by taking a history and asking  questions. By doing this they are hoping to narrow down the possible pain generating tissue.

The TMJ can cause multiple issues. The most obvious might be direct jaw pain or restricted  movement but issues such as headaches can be less obviously associated with the jaw.

Other jaw issues are:

  • ear ache
  • lock jaw
  • tinnitus
  • clicking or grinding sounds
  • bruxism (grinding of the teeth or clenching the jaw)
  • nerve irritation and resultant nerve pain.

The clinician will inspect the jaw by looking at the movement as you open and close your mouth. Primarily they are looking for asymmetry such as that depicted below (jaw span), a bony and soft tissue palpation, where they feel the joint and, as it moves, try to determine any bio-mechanical problem. There is some simple muscle testing and a few neurological tests that may be performed too.

If a problem is found then some treatments can be offered by your chiropractor, but others may  require a dentist or doctor.

There are a wide range of management options, from manual treatments to home treatments,  including ice or heat, jaw exercises / stretches, muscle relaxation techniques, medication and mouth guards.

Possible issues

Some issues we see are muscle tightness which can cause asymmetrical movement of the jaw, pain and referred pain.

There are 4 muscles of mastication (chewing) that move the jaw; the temporal muscle, medial and lateral pterygoids (found inside the mouth) and the largest, the masseter. If these get tight and tense they build up with toxins and become painful. If very painful, they can refer pain.

Bruxism is a common issue and is characterised by jaw clenching and teeth grinding. This is often done unconsciously and can be caused by emotional stress. Physically it can result in muscle tightness which can be treated by a manual therapist and also with a mouth guard from the dentist. A mouth guard can help off load pressure from the jaw and protect the enamel on your teeth. If the main cause is possibly psychological, then relaxation techniques and regular stretching is a good  approach to manage this.

Intra-articular disc issues can be very painful and can be more complicated. The disc can become displaced or can degenerate which can alter the smooth movement of the jaw.

If simple treatments are not helping then sometimes surgery is required. Before this is considered though, a full consultation with a doctor is required.

Check our Instagram and Facebook pages throughout the month for our Top Tips for exercises that might help give some relief for TMJ pain.





Giving pain the elbow

Earlier this month we discussed two common conditions associated with the elbow. In today’s blog we look at some stretching and strengthening exercises you can try yourself at home.

STRETCHING EXERCISES for both golfer’s elbow and tennis elbow

Wrist active range of motion, flexion and extension:

Bend the wrist of your injured arm forward and back as far as you can. Do 2 sets of 15.


Wrist stretch: Press the back of the hand on your injured side with your other hand to help bend your wrist. Hold for 15 to 30 seconds. Next, stretch the hand back by pressing the fingers in a backward direction. Hold for 15 to 30 seconds. Keep the arm on your injured side straight during this exercise. Do 3 sets.

Forearm pronation and supination: Bend the elbow of your injured arm 90 degrees, keeping your elbow at your side. Turn your palm up and hold for 5 seconds. Then slowly turn your palm down and hold for 5 seconds. Make sure you keep your elbow at your side and bent 90 degrees while you do the exercise. Do 2 sets of 15.

For tennis elbow specifically

Active elbow flexion and extension:  Gently bring the palm of the hand on your injured side up toward your shoulder, bending your elbow as much as you can. Then straighten your elbow as far as you can. Repeat 15 times. Do 2 sets of 15.

You can do the strengthening exercises when stretching is nearly painless.

STRENGTHENING EXERCISES for both golfer’s elbow and tennis elbow

Eccentric wrist flexion: Hold a can, bottle or hammer handle in the hand of your injured side with your palm up. Use the hand on the side that is not injured to bend your wrist up. Then let go of your wrist and use just your injured side to lower the weight slowly back to the starting position. Do 3 sets of 15. Gradually increase the weight you are holding.

Eccentric wrist extension: Hold a can, bottle or hammer handle in the hand of your injured side with your palm facing down. Use the hand on the side that is not injured to bend your wrist up. Then let go of your wrist and use just your injured side to lower the weight slowly back to the starting position. Do 3 sets of one and gradually increase the weight you are holding.

Forearm pronation and supination strengthening:

Hold a can, bottle or hammer handle in your hand and bend your elbow 90 degrees. Slowly turn your hand so your palm is up and then down. Do 2 sets of 15.

For tennis elbow specifically

Wrist radial deviation strengthening:  Put your wrist in the sideways position with your thumb up. Hold a can, bottle or a hammer handle and gently bend your wrist up. Do not move your forearm throughout this exercise. Do 2 sets of 15.


Wrist exension with broom handle:  Stand up and hold a broom handle in both hands. With your arms at shoulder level, elbows straight and palms down, roll the broom handle backward in your hand. Do 2 sets of 15.

For Golfers Elbow Specifically

Grip strengthening:  Squeeze a soft rubber ball and hold the squeeze for 5 seconds. Do 2 sets of 15.



Resisted elbow flexion and extension: Hold a can of soup with your palm up. Slowly bend your elbow so that your hand is coming toward your shoulder. Then lower it slowly so your arm is completely straight. Do 2 sets of 15. Slowly increase the weight you are using.


If despite these exercises you are still experiencing pain. Contact one of our team on either fleet@durhamhousechiropractic.co.uk or farnham@durhamhousechiropractic.co.uk