What is a herniated and bulging disc and how Pilates can help

A herniated or bulging disc is a condition that occurs more frequently in the lower back. This can cause pain in the back and changes in sensitivity to the thigh, leg and foot. The most common location of lumbar disc herniation is on the disc between the fourth and fifth lumbar vertebra (L4 / L5) and the disc between the fifth vertebra and the sacrum (L5 / S1).  In most cases, the symptoms improve naturally after three months, but can be aided with clinical and physiotherapeutic treatments.  Even if the patient feels well without treatment, it is important that he/she make a treatment program that focuses on the normal functionality of the spine and its strengthening. 

Although herniated discs do not have a cure, people can get better from pain and return to normal life most of the time.  Rest and medications alone will not return functionality or strengthen muscles that have become weak due to the injury,  so it is critical to undertake physical activity in an appropriate place with specialized professionals, for example, a Pilates Studio.


What is a disc herniation?

The term "hernia" means projection or exit through a fissure or orifice of a contained structure.  The intervertebral disc is a fibrous and cartilaginous structure that contains a gelatinous liquid at its center called the nucleus pulposus. The disc lies between one vertebra and another of the spine. This fibrous ring, when cracked or worn, allows the gelatinous liquid that is maintained at its center to expand or bulge its structure and may also leak out. When this phenomenon occurs in small proportions, we call the disc protrusion. If the lesion in the fibrous ring that holds the nucleus is large, the liquid contained in the nucleus may exit into the external medium, and when this happens, the disk may become smaller and flatter.  This is called a bulging disc.  Depending on the location of the "gel", the patient may experience severe pain or not. 


Causes and risk factors

Common causes of disc injuries include:

  • poor sitting and standing postures, especially when maintained for long periods
  • poor lifting techniques, especially when twisting and bending
  • prolonged periods in slouched or forward bending postures

Some people are more susceptible to disc injuries than others. Risk factors that may increase your risk include:

  • advancing age
  • obesity – carrying extra weight increases the stress on the lumbar spine
  • poor muscle tone
  • gender – men have approximately twice the risk of disc injury compared with women (although this is most likely because men generally tend to have more physical jobs than women)
  • lack of regular exercise
  • physically demanding work – pulling, pushing and twisting actions can add to risk if done repeatedly
  • poor posture
  • incorrect lifting techniques


Symptoms of a herniated /bulging disc

The most common symptoms are localized pains in regions where there is a disc injury and these pains can radiate to other parts of the body.  When the hernia is in the cervical spine, pain or sensitivity changes radiate to the upper shoulders, arms, hands, and fingers. If the herniated or bulging disc is located in the lumbar spine, the pain radiates to the legs and feet. The patient may also feel tingling, numbness, burning and pain in the inner thigh.  Some patients report that they get worse at bed time and this happens because the body becomes relaxed when sleeping and the discs rehydrate, increasing their volume, and consequently compress the nerve roots. In more severe cases, compression may cause loss of leg strength and even urinary incontinence.


The symptoms of a lumbar disc injury can vary according to its location and severity and some common signs can include:

  • low back pain
  • pain radiating down one or both legs
  • increased pain associated with bending or sitting down for a prolonged period of time
  • increased pain with activities such as coughing or sneezing


How can Pilates help in the treatment of a herniated/ bulging disc?

The aim of Pilates for a client with a bulging disc is to improve posture, correct spinal alignment and enhance the strength of muscles (including deep-tissue muscles) in order to prevent a recurrence.   Pilates exercises involve controlled movements which keep the body in a safe range of movement while strengthening the muscles, mobilising the spine and stabilising the condition of the body.  Over time, the exercises force the jelly cushioning to deviate away from the nerve and to return to its natural placement.


Pilates promotes understanding and awareness of the body as well as healthy postural alignment. Being consciously aware of the posture builds and maintains a healthy lifestyle since the body starts to adjust to the correct alignment as a result of having this awareness.


Other considerations for those diagnosed with a herniated /bulging disc 

  • Sleeping – Choose a good semi-hard mattress or foam to distribute well the body weight, a good pillow and adopt some correct postures in bed. If you usually sleep on your back, use a pillow under your knees. If you are sleeping on your side, use a folded pillow between the legs. Sleeping on the stomach is not recommended, but if you must sleep this way, use a pillow under the belly and not the head in order to decrease the lumbar curvature in that position.
  • Sitting - Sitting properly is also very important for good posture.  When seated, keep your feet flat on the floor with your thighs touching the largest possible seating area, avoid crossing your legs and leave them slightly apart and keep the spine upright in order to maintain its natural curves.  Adopting a correct sitting posture avoids back pain and serious spinal injuries because when you sit properly, there is a uniform distribution of the pressures on the intervertebral discs and the ligaments and the muscles work in harmony, avoiding unnecessary wear and tear.
  • Working - At work it is also important to adopt less harmful postures.  If you work sitting down, your forearms should be resting on the desk so the shoulder muscles do not have to continually hold the weight of the arms.  If you work with a computer, try to adjust the screen so that you can look straight ahead at the screen without having to tilt your head up or down to look at the screen and keep the chin parallel to the ground. When reading try to avoid as much as possible to lower your head and if you need to, get a book holder.




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