Disc bulges: symptoms, causes and treatment

A disc bulge is a spinal injury. It is also known as a protruded/slipped disc. When the bulge is significant enough to cause the gel-like fluid in the centre of the disc to come out – this is called a herniation.

It can occur anywhere in the cervical spine (the neck), the thoracic spine (mid back) or the lumbar spine (lower back).

What is a disc?

The spinal discs are rings in between the vertebra which act as shock absorbers.

The outer area of the disc consists of fibrocartilagenous fibres (the annulus) which surround a gel like glycoprotein centre (the nucleus).

Disc injuries include:

  • strains
  • internal derangements
  • mild to moderate bulges
  • complete rupture and herniation of the nucleus through the annular wall.
  • If the annulus is injured, the nucleus can press or irritate the exiting spinal nerve through the weakened annular wall. This can cause:
  • pain
  • pins and needles
  • cramping in the legs, feet, arms and hands

The cause of bulges can come under 3 headings:

Repetitive Microtrauma

This is when the discs are put under repeated pressure. The best example of this is through posture. The way you sit, stand and walk can effect the outer fibres of the annulus, causing them to overstretch and become weak. Osteopathic postural correction can help prevent bulges and aid healing of an existing bulge. Research shows that changing your posture very 15 minutes is more effective than having  perfect posture constantly.

Sudden load

A sudden load when catching something heavy or heavy lifting with poor posture, can cause the annulus to rupture. It is important to lift in a safe way while maintaining your core stability.

A road traffic accident can also cause the annulus to rupture by a sudden unexpected force.


You can be genetically predisposed to disc injuries. Higher amounts of elastin in the fibrocartilagenous component of the annulus are thought to make it more susceptible to tearing. This can be passed down in our genes.

Environmental factors that are known to have an effect are excessive abdominal fat, poor core strength, poor buttock and leg strength and occupation (one which requires heaving lifting or pulling).


  • Pain in the back legs or feet which is aggravated by sitting, sneezing, coughing, straining, bending forwards or lifting.
  • Pins and needles
  • numbness or weakness in the legs are suspected by more serious injuries.
  • Bowel and bladder problems (diarrhoea or incontinence)  are caused by severe nerve compression. Immediate medical attention is needed in this case.


An osteopath, chiropractor or physiotherapist will diagnose your back condition based on your:

  • symptoms
  • signs
  • special tests results
  • general movement test
  • MRI or CT scan (X rays will not show a disc bulge) They do however show degenerative disc disease and disc narrowing.


Good news – the annulus can heal. Treatment with an osteopath, chiropractor or physiotherapist aims at encouraging you fluid back into the disc which will allow fibres of the annulus to knit back together.

A back brace or support belt may be given to you to help keep your spine in the best position to allow healing. This will help scar tissue form the correct structure. This may take 6 weeks, so avoiding aggravating postures, exercises and positions is important.

Ice therapy will reduce inflammation.

When the pain has subsided, your therapist will turn the focus on realigning structures by doing certain techniques such as stretching, soft tissue massage, joint mobilisations and adjustments. They should try and find the root cause of the problem.

Core stability is crucial in prevention of disc bulges. Contact a recommended Pilates instructor. A god osteopath should be able to provide you with core stability exercises.

Please contact me if you have any questions.


Foot pain – causes and treatment

It can be so debilitating when you’ve got foot pain. This article will explain the possible causes and treatment of foot/feet conditions.

Basic foot anatomy

The foot consists of the following bones: the fibula, tibia, talus, calcaneus (heel), navicular, cuboid, three cuneiforms, 5 metatarsals and 3 phalanges on each of the little toes and two on the big toe. The foot has tendons, muscles and ligaments that allow us to run, jump and dance. The Achilles’ tendon attaches the calf muscle to the calcaneus. It is named after the Greek hero “Achilles” who was said to have been dipped into holy water by his mother in order to protect him but as she held him at the heel, the Achilles remained the only area of vulnerability as it did not come into contact with the water. This tendon is the thickest in the body and allows for jumping and standing on tip toes.

Conditions organised by areas of pain

Heel pain

This could be a condition called plantar fasciitis. This is inflammation of the long ligament that connects your heel to your toes. The pain is often felt in one foot or both feet first thing in the morning and is painful with the first few steps.


– Often good arch support can help or even prevent this condition. Seek advice from a recommended and qualified osteopath or physical therapist.

– Leg and foot stretches can help alleviate the condition

– Rolling a golf or tennis ball, on the sole of the foot

– Rest

Heel spurs

Heel spurs are another cause of foot pain and they often go hand in hand with plantar fasciitis. Pain is usually felt in the heel. The spurs are abnormal bony growths on the heel of the foot which can occur when you overuse your feet (excessive walking and running). You can also get them from abnormal foot wear or running/walking posture. People with high or flat arches may be more likely to suffer from heel spurs. Many people have heel spurs but don’t feel any foot pain.


– Wear a heel pad
– Rest your foot
– Wear insoles or arch supports
– Wear good trainers that have a cushioned shock-absorbing sole.

Stone bruise

This is an impact injury to the fat pad of the heel usually caused by a jumping injury.

– Rest
– Ice
– Cushioned shoes

Mortons neuroma

This is the thickening of neural tissue in between the third and fourth toes and can cause pain, numbness and tingling over the ball of the foot.


– Wear an insole which reduces the pressure around the nerves
– Minimise time spent wearing heels or shoes with narrowed toe space
– Physical therapy from an osteopath, chiropractor or physiotherapist.


Near the big toe, there are two bones connected by tendons called sesamoid bones. If the tendons become inflamed this results in pain around the big toe which is called sesamoiditis. This is a form of tendonitis which is common among ballet dancers and runners.

– Wear flat, cushioned shoes
– Rest
– Ice
– Wear a foot pad under the big toe
– Tape the big toe to immobilise the joint and allow healing


This is a form of arthritis which commonly effects the big toe causing excruciating pain, swelling, discolouration (purple toe).

– avoid food that make gout worse such as fish, meat, poultry, high purine veg, alcohol. An osteopath will be able to discuss this in more detail.
– rest
– ice
– medication


A bunion is a bulge at the side of the big toe. It is usually caused by ill fitting shoes or shoes which do not have enough toe space. Ageing is a risk factor. Try switching to more comfortable shoes, and wear shoe inserts too (see a recommended orthotic specialist). Remember prevention is better than cure so wear wide, comfortable shoes to avoid bunions. See a podiatrist for further advice.

Hammer toes usually occur in the second third and fourth toes, when the middle of the toe bends and creates a hammer like appearance. It can come from a muscular imbalance and also from wearing ill fitting shoes.


– exercises to stretch and strengthen toe muscles
– wear shoes with a wide berth at the toe end

Claw toe

This is a condition where the toes are unable to straighten. It is usually the result of alcoholism or diabetes and the consequential nerve damage which causes weakening of the joints, ligaments and muscles.


– wear better fitting shoes
– do stretches for your feet and legs
– seek treatment for alcoholism and diabetes
– try orthotics

Ingrown toe nails

This is when the skin of the toe or toes grow over the nail. It can be painful and lead to infections.


-soak the feet in warm water 4 times a day.
-apply gauze between the skin and the nail once a day
– see your doctor if the above does not help

Turf toe

This is when you feel pain at the base of the big toe. It’s an overuse injury usually caused by a strain. The typical symptoms are pain, swelling and restriction at the base of the big toe. A differential diagnosis may be sesamoiditis or a sesamoid fracture.

-immobilisation with a boot or by taping or strapping
-crutches so no excess weight is put on the toe

It can take 2-3 weeks for the pain to go. After this, therapy with an osteopath or another physical therapist is recommended to regain the strength and movement of the toe and foot.


A fracture can occur anywhere in the foot. If you have any pain when standing or walking, or if you’ve had an accident, it may be best to get an x ray. Small breaks may only require rest and ice.

Hallux rigidus

This is an arthritic condition which causes stiffness in the base of the big toe, making it difficult to walk run, jump or squat. Usually there’s a problem with upward movement of the big toe. It can get be alleviated with stretching and exercises.


-shoe inserts to improve the alignment in your feet
-lifestyle changes
-different types of shoes

Diabetic neuropathy

The feet may be affected in diabetes. Symptoms can include:

– loss of sensitivity to pain and temperature in the feet.
– tingling burning or prickly feeling in the feet
– sharp pain or cramps
– extreme sensitivity to even light touch

All of these symptoms are usually worse at night.

If you have diabetes, a foot examination should be carried out each year.

In summary, always seek help from a GP and osteopath/podiatrist of you are experiencing any pain in your feet. A prompt diagnosis should be made and subsequent treatment.

If you have any questions on the above please contact me. I’ll be happy to help.