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Best Exercises for a Lumbar Herniated Disc

by Jaydee Vykoukal, PT, DPT October 16, 2019 0 Comments

Woman stretching her back on a yoga mat

A herniated disc, or slipped disc, can lead to ambiguous treatment options that leave you unsure of where to start.  This is because of the varied symptoms that can occur depending on the exact location, the size of the bulge, and many other health and psychological related factors. Lumbar herniated disc exercises are a great place to start to get you feeling better as quickly as possible.  Hands down, exercise has been found to be the best nonsurgical treatment option for any type of lower back pain, particularly when it comes to a lumbar disc herniation.

    How Exercises Can Help a Herniated Disc in Your Back

    A lumbar herniated disc becomes problematic when the bulge starts pushing into tissues it shouldn’t be.  This leads to irritation of nearby back muscles, nerve roots, and even the spinal cord if severe enough. The most common complaints that significantly affect quality of life are related to spinal nerve injury.  When spinal nerves are damaged it can lead to sharp, shooting pain, loss of strength and numbness in the legs (known as peripheralization of a nerve injury). Generalized muscle spasms and back aches are common too.  

    Why is movement so important?

    With the right exercises, getting the back moving is essential to recovery for a lumbar herniated disc for several reasons.  Movement promotes circulation for direct healing of the disc itself, in addition to the affected muscles, nerves, and joints. The right postures and positions can take the pressure off injured tissues to allow healing, pain relief, and centralization (meaning symptoms recede from the legs and return to their origin in the spine).  Lastly, it keeps you feeling in control, a huge part of the recovery process.  

    Frustration and fear of movement are common if low back pain becomes chronic, but can be prevented with initiation of a good exercise program!

        Stretches

        Stretching is a crucial part of a lumbar herniated disc exercise program.  The ideal time to stretch is when you have time to relax and breath. Find a quiet comfortable floor space.  In general, stretches tend to be more beneficial if you can hold them for a longer period of time, anywhere from 1-2 minutes.  Make sure you focus on keeping good form and listening to your body. This means not forcing your way into any positions that don’t feel right, causing further muscle spasming or exacerbating your leg symptoms. 

        Two Goals for Stretching: 

        • Promoting relaxation to sore muscles to take pressure off the spine.
        • Moving into positions that literally move the bulged disc away from irritated areas.  This will promote centralization of symptoms and healing when done correctly. 

        NOTE ON CENTRALIZATION:
        Your back pain may increase with exercises. This is okay IF symptoms are moving out of your legs. Imagine all your pain is going back to where it came from (the disc and nerve roots). This is good! If you’re unsure, talk to your physical therapist or doctor.

          Back Stretches

          Side Glide

          Ideally, this will be your first stretch if you find yourself in a poor posture, leaned to one side due to pain (typically away from the painful side). Stand sideways, with your “good” side facing the wall. With your feet about 2 feet away from the wall, touch your shoulder to the wall. Keeping your upper body relaxed, let your hip drop toward the wall into a sideways motion until it touches the wall.

          You can adjust the curve in your low back, slightly flexing forward at first if it’s too painful. To progress, try to further extend (arch the back) as tolerated.

          Repeat 10-15 times. Keep it slow and controlled. Repeat throughout the day up to one time per hour if legs symptoms stay manageable.

          Press-Ups

          This extension exercise is done lying on your stomach, ideally on an elevated surface so you can get up easier when finished. The idea is to move in and out of an extended back position that you can tolerate, so the range will vary with your symptoms. Test your tolerance by simply lying on your stomach. If okay, the progression will go as follows (stop at the level you can tolerate):

          • Resting on your elbows.
          • Gentle lift by pushing into your hands to arch the back.
          • Push higher and higher as tolerated as long as your leg symptoms don’t worsen. The highest position is having the elbows straight.
          • You can also complete a back arch in standing with your hands resting on your hips if you don’t have a place to lie down.

          Start with 10-15 repetitions initially. Then assess your body’s reaction before trying other rounds throughout the day. Try to maintain a more extended, less flexed (hunched) position when finished to maximize your results.

          Lower Trunk Rotations

          Lying down with your legs together, knees bent, and feet flat on the table, gently bring both knees toward the floor on one side by rotating the spine.  Then, return to the starting position and over to the other side. Keep it slow and controlled for a count of three in each direction. Don’t let your spine arch during the stretch (no more than a hand should be able to fit under your lower back). Keep your shoulders on the ground throughout and stay relaxed to prevent cramps.

          Repeat 10 times to each side.

          Leg Stretches

          For all leg stretches: Hold 30-90 seconds 2-3 times on each side.

          Figure Four Stretch

          This is a great stretch for the hips and butt (particularly the piriformis). Lying on your back with the knees bent and feet flat on the floor, bring the outside ankle of one foot to the opposite knee. Initially, this position may be enough of a stretch. You can progress by lifting your legs off the table and reaching behind the thigh of the leg that you aren’t stretching. Bring your thigh up toward the chest. It’s also possible to modify it to a seated position as needed.

          Knee to chest

          Lying on your back, bring one knee toward you and hug it into your chest. Keep the other knee bent with the foot flat on the floor for comfort. You can progress to stretching your opposite leg out on the floor (if comfortable) for an extra pelvic stretch.

          Hamstring Stretch

          Lying on your back, reach behind one thigh with your arms (the other leg can stay out straight on the floor, unless it’s more comfortable bent). Gently extend the knee and bring your straight leg up until you feel a stretch in the back of the leg.

          To address nerve symptoms in the leg, you can try pumping your ankle (bring the toes towards the shin and then point the toes, back and forth). This works particularly well for sciatic nerve symptoms. Only try this if it is tolerable and it doesn’t worsen leg symptoms.

          Exercises

          The main focus when starting exercise for a lumbar herniated disc is core stability. When there is back pain present, our normal spine posture and ability to use our muscles properly get compromised. These effective specific exercises are meant to restore muscle activation and strength while also promoting circulation and confidence in your back.

          A note about your posture during exercise:

          With any exercise for the back, focus on keeping the spine in “neutral. The lumbar spine is naturally slightly arched but varies a bit with each individual. The back does not have to be “flat” but shouldn't be arched either. If confused, physical therapy is a great way to get a full understanding of this concept.

          Core Activation Lying Down

          This is the first building block to ALL other core exercise. 

          The biggest issue with low back pain is poor abdominal muscle activation, exacerbating the issue. The most important ab group is the lower abdominals, or transverse abdominals. To retrain these muscles, start by lying on your back with the knees bent. Then tighten your entire core as if someone was about to punch you in the stomach. This should make the abs feel flat and tight with no bulging. A common cue used is to “engage the core.”

          Focus on holding these muscles tight for up to 10 seconds, while also keeping the upper back and neck relaxed and breathing steadily (holding your breath may be common at first so don’t forget to breath). Repeat 10 times. As you get the hang of this muscle activation, you can progress to tightening these muscles with other core exercises and daily activities.

          Seated pelvic tilts

          Comfortably seated on the edge of a sturdy surface, tilt the entire pelvis forward and backwards. Imagine you are balancing a book on your head to minimize movement in the upper body and spine. Don’t force the movement in either direction and build range as you can tolerate. As you complete this exercise you should notice a “middle ground” that feels most comfortable to you, this is the area you want to try to keep your back in throughout the day when you aren’t exercising.

          Repeat the movement 10-20 times. You can progress this exercise by sitting on a yoga ball or doing them on your hands and knees.

          Bridges

          Lie on your back with the knees bent and feet flat on the floor, about hip width apart. Engage the abdominals and lightly squeeze the gluts as you lift your entire spine off the floor. If you experience a hamstring cramp, focus more on the butt squeeze.

          Complete the exercise 10 times for 2-3 sets. You can progress by holding up to 3 seconds at the top of the movement.

          Quadruped alternate arm and leg

          On your hands and knees, start by lifting and extending one leg along with the opposite arm. Make sure the abs are tights and the spine is in neutral. Keep the motion slow, controlled and fluid. If you feel unsteady or can’t control the motion, start with just arm or leg movement and progress when possible.

          Hold the fully extended position for up to 5 seconds before switching to the other side.  Repeat 10-15 times on each side.

            Practical Tips

            Most people struggling with a herniated disc have chronic stiffness that needs to be adequately addressed before an effective stretch and exercise routine can be implemented. 

            Here are some simple tools to help you get started:  

            • Massage tools to promote circulation and relaxation before and after your program
              • Foam rollers are most ideal for the large affected muscle groups in the legs and back.
              • Try a massage ball for more focused areas of pain in the butt, as is common with sciatica.

            Avoiding Unsafe Lumbar Exercises

            There are particular movements that should be avoided initially when recovering from a herniated disc. These include extreme ranges of bending and twisting, high impact movements, and heavy lifting. These motions have been shown to put the most amount of strain on the discs and should be avoided to allow healing. Additionally, any motion that perhiperalizes your leg pain should be avoided.

            *It’s possible to return to certain movements when ready.

            Any functional exercises you hope to add back to your routine as you heal that requires these specific movements can be done so slowly when you are ready, potentially with the help of a medical professional, such as a physical therapist (PT). However, a combination of these movements is never safe. You will benefit from learning proper movement techniques for lifting, bending, and other daily activities from your PT.

              Precautions When Exercising

              Pay attention to your symptoms! Never force an exercise that doesn’t feel right or exacerbates your symptoms. If you’re symptoms worsen, such as severe pain, progression of neurological symptoms (loss of bowel or bladder function, tingling, numbness, shooting, weakness, etc) seek medical advice immediately.

              With these precautions in mind, remember It’s always best to have a medical professional on board to guide you in your recovery process.

                Sources:

                https://content.iospress.com/articles/journal-of-back-and-musculoskeletal-rehabilitation/bmr00114

                https://hohmanrehab.com/centralization-vs-peripheralization/

                https://www.stack.com/a/how-long-to-hold-a-stretch

                SHOP HERNIATED DISC PRODUCTS
                Jaydee Vykoukal, PT, DPT
                Jaydee Vykoukal, PT, DPT

                JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.



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