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Battle of the Bulge

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Understanding Disc Bulges

Disc bulges can be caused by immediate trauma or injury (sports injury, auto accidents, etc.), as well as long-term trauma such as improper posture.  Discs are located between each of the vertebral bodies of the spine. The discs are the shock absorbers of the body. They also help to give the spine more movement and flexibility as we twist and bend.

The discs are shaped like a hockey puck and are made up of cartilage, which is tough and leather like. Each of the discs is constructed like an onion, layered in rings. At the center of each disc is a watery, gelatin-like center called the nucleus. The discs have a high content of water and this is what makes them flexible. As we age, the discs lose some of their water content and become less flexible. This makes the layers of the “onion skin” more brittle and weaker.

What Is Causing the Bulge?

As we do activities that place us in a bent or “flexed” position (sitting, driving, reading, or watching TV), the low back can lose its natural curve, and pressure from the nucleus can be exerted on the back side of the discs. Over time, one layer at a time of the “onion skin” splits or cracks and the gelatinous center moves closer to the outside. Eventually this nucleus begins to distort the shape of the disc, causing the disc to bulge. This can happen to the direct back side but most often is slightly to one side or the other. (In rare cases, the bulge can be on the front side.)

The pain is caused because the back side of the disc has many nerves. Another factor is that the spinal cord is directly behind the disc and, as the bulge increases, it begins to irritate the nerves that are attached to the spinal cord. In the low back, these nerves travel down the leg. This can cause feelings of pain as far down as the foot and toes, as well as numbness or tingling in the leg and foot. This is called sciatica.

Fixing the Problem

One way to help with this problem is by beginning flexion or extension exercises.  If this is done often, the layers of the annulus can begin to heal and can form scar tissue. As the disc heals, the bulges reduce in size and take the pressure off the nerves, decreasing or eliminating the sciatica.

“Traction” may also help relieve the sciatica. Consult your doctor or health professional to see if this is an option for you.

Another item that can keep the low back in its proper curve is a lumbar roll. The lumbar roll is placed behind the low back while you sit, and helps keep the back in its proper curve.

In some cases, surgery may be necessary if the exercise, traction, and lumbar roll do not resolve the condition. Your doctor or therapist will show you the exercises best suited to your situation.

Post Written By: Travis Rohner, PT

Piriformis Syndrome

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The Piriformis muscle is located in the buttocks area, underneath the gluteus maximus. It’s one of the muscles that helps rotate the thigh bone outward, like you do when you cross your ankle over your knee. The muscle runs from the tail bone and attaches at the hip bone.The sciatic nerve is a major nerve that begins in the low-back area and travels down the back of the thigh and continues down, branching off in the lower leg and foot. The sciatic nerve usually runs directly through the Piriformis muscle, although it may lie above or under the Piriformis.

The cause of Piriformis Syndrome is not entirely clear and may be a result of several different things. It is often associated with sacroiliac (SI) problems. Trauma, such as falling on the buttocks may incite the symptoms. Extended sitting can be a factor, as in the case of professional drivers or office workers. Other problems, such as hip bursitis, back strains, or gluteal tendonitis may bring on the condition.

Symptoms include pain and tenderness in the buttocks area. The problem may be on one or both sides. Sitting is often uncomfortable. Walking, running, and climbing or descending stairs is often painful. In some cases radiating pain may shoot down the back of the thigh and into the lower leg because of irritation to the sciatic nerve.

There are many treatment options for Piriformis Syndrome. Moist heat can help relieve and control pain. Ultrasound may be beneficial since it is a method of deep heating. Certain therapeutic exercises may greatly help to recondition the muscle. There are several stretches for the muscle that can help relieve the tightness. Avoidance of irritating factors is crucial. Manual techniques such as soft tissue mobilization are often helpful. In severe cases, anti-inflammatory injections may be needed.

With proper treatment and follow through, this condition can be resolved. In some cases it will resolve quickly, while in others it may be a lengthy rehabilitation. For more information consult your physical therapist.

Post written by Travis Rohner, DPT

But I Don’t Even Play Tennis…

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Aches and pains are a common problem in life, regardless of our activity level. In fact, most of us can point out something that is bothering us right this very second. Pain caused by repetitive stress is more common than that caused by a traumatic injury. Repetitive stress can occur in a lot of places on the body. Because we use our hands a lot during the day, especially in our work lives, it can cause discomfort in the elbow. Whether you have a desk job in an office, or if you’re an electrician, or a hair stylist. Our hands are very important and are essential to completing every day tasks.

Most of the muscles in our wrist, fingers, and forearm originate on the lateral aspect of our elbow. The everyday trials of life can often cause overuse of these muscles, causing us to feel pain. This is called Lateral Epicondylitis, but the more common term is “Tennis Elbow”. Tendons are at the ends of our muscles, attaching them to the bone. Despite the name, you don’t have to be a tennis player to have this problem. Anybody who uses their arms, especially their dominant arm, can be at risk. This condition usually causes pain when you grip or carry items, or rotate your wrist and forearm. Because this is typically an overuse injury, these muscles can weaken, which causes pain and makes it difficult to perform everyday tasks.

That feeling when you realize your elbow pain isn’t going to get better on its own.

 One of the problems with this type of injury is that people tend to just grin and bear it until they can’t stand it anymore. Rather than seeking treatment, they reduce the pain with Advil. This is not a bad idea, but there are many additional ways to address the issue. Modalities like ice are good to reduce pain due to the anti-inflammatory properties they provide. Braces called Chopat Straps help to reduce daily pain with activity. Correct application of stretching is extremely helpful. To improve strength in the elbow, exercises can be performed. Posture and correct form are also very important. Another thing that can be extremely helpful is a treatment called ASTYM. This treatment is performed by a skilled physical therapist to help heal and remodel the soft tissue.

Regardless of what the underlying specific causes are, I recommend talking to a physical therapist. They can evaluate your symptoms and help you address them by setting up a plan of care that is specific to your injury. If you would like additional information, we would love to assist you and get you feeling better!

Post written by: Rod Walker, DPT

Proper Posture Prevents Pain

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Attention all desk jockeys! Bad posture getting you down? Do you find yourself with a sore neck, back or shoulders following your typical workday, especially at the end of the week? Studies show that 60-80% of the work force in the United States spends more than half their day sitting at a desk. That equates to AT LEAST 20 hours per week sitting in a chair. That’s more time than some of us sleep in those five working days! For most of us, body aches are inevitable. However, there are ways to prevent bad posture and curb some of the tension that builds throughout the day. Are you taking these three necessary steps to help?

One of our PT techs at the Mesa office generously offered up his modeling skills to demonstrate how you should NOT be sitting at your desk. Shoulders rounded, head forward. This encourages the body to lean and hunch over which causes muscle soreness and discomfort.
  1. Set up a good ergonomic desk space. Some companies have a designated ergonomic supervisor or team member that will help assess your sitting posture and give suggestions. For those who aren’t so fortunate, keep in mind that everything matters: chair type, chair height, desk height, monitor placement, keyboard and mouse placement. So many factors are essential in postural alignment while sitting at a desk. Luckily there are many resources out there to prevent postural faults!
  2. Get up and walk. Sometimes the best way to prevent prolonged sitting….is to stop sitting! Set an alarm on your phone to get up and walk every 30 minutes to 1 hour. A short walk to the bathroom or water fountain would suffice, or if you are able, take a walk outside for some fresh air. In the physical therapy world, we use the phrase “motion is lotion.” Move often, you won’t regret it!
  3. Perform a short exercise routine throughout the day. Bad posture accumulates with a combination of weaknesses and tightness in the body. Pushing your chair back from the desk to perform a few stretches or exercises throughout your day will significantly improve the symptoms you have as the day progresses. A short routine of specific exercises won’t take up too much of your time. After all, you don’t want the boss to think you are sloughing off! Performing exercises 2-3 times during your work day will be sufficient to help your body feel better at the end of the day.

Make sure to keep moving throughout the day and take a look at your ergonomic set up. This will minimize the symptoms you get as the day progresses. It will also encourage good posture and leave you feeling better at the end of the day. If you are experiencing any symptoms that you can not fix on your own, we’d love to help you. Contact our office and set up a consultation so we can further assist you.

Post written by: Casey Badder PT, DPT

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Areas Served:

Mesa, Gilbert, Chandler, Phoenix, Queen Creek, Apache Junction, Tempe, Globe, Gold Canyon

Postal Address

Gilbert Office
2550 E. Guadalupe Rd. Suite 111
Gilbert, AZ 85234
Phone: (480) 633-0666

Mesa Office
342 N Val Vista Dr. Suite 106
Mesa, AZ 85213
Phone: (480) 325-3310