Multimodal Physiotherapy for Chronic Lumbar Disc Bulging: A CARE Case Report

Abstract

Background: Chronic lumbar disc bulging can cause persistent pain, reduced lumbar mobility, muscle weakness, and functional limitations. Multimodal physiotherapy combining TENS, the McKenzie method, and ESWT may support pain relief and functional recovery.
Objective: To describe clinical outcomes following multimodal physiotherapy in a patient with chronic lumbar disc bulging.
Methods: A CARE compliant case report involved a 35-year-old man with L4 to L5 lumbar disc bulging confirmed by MRI. Six physiotherapy sessions over three weeks included TENS, progressive McKenzie exercises, posture correction, home exercises, and ESWT. Outcomes were assessed using NPRS, ODI, trunk ROM, MMT, and WMST.
Results: NPRS decreased from 6/10 to 3/10 and ODI from 16/50 to 9/50. Trunk flexion ROM increased from 30° to 80°, while lumbar mobility improved from 1.5 to 4.5 cm. Trunk muscle strength also improved, with no adverse events reported.
Conclusion: Multimodal physiotherapy was associated with improvements in pain, lumbar mobility, muscle strength, and functional capacity. Findings should be interpreted cautiously due to the single case design and absence of long term follow up.