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How Physical Therapy for a Herniated Disc Can Help

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

Woman sitting on a yoga ball

Physical therapy (PT) for a herniated disc will set you up for success in the recovery process. It is one of the best conservative treatment options for you when dealing with a bulging disc. This is because physical therapists are specially trained to help you identify your specific deficits and create a personalized well-rounded program.

A PT will help design a program that fits your specific needs and body.

With the right balance of strength, stretching, coordination, and education to understand the entire process you will be feeling better in no time. Your physical therapist will know exactly where to start.

What to Expect from a Physical Therapist

Nowadays, our health care system allows you to see a physical therapist directly without a script from a doctor in most states. This saves you time and money getting the treatment you need (check with your insurance first to make sure they will pay). You can expect to be scheduled for an initial visit quickly. It will be a one on one, in depth, hour long session with your PT. Together, you and your PT will make a plan for a home program and in-clinic treatments

Can Physical Therapy Make a Herniated Disc worse?

The short answer is no. However, with any form of treatment, particularly with movement, there is always a change of aggravating symptoms. While you may experience some muscle soreness from trying new exercises, physical therapists are well trained in the injury process of a herniated disc and know what should be avoided. Additionally, they understand how to progress exercise dosage and intensity as tolerated so that you can get back to your normal daily activities as quickly as possible.

Physical Therapy Techniques

Personalized Home Program

The single most important aspect of your physical therapy for a herniated disc is the creation of a personalized home exercise program. This is what sets physical therapy apart from other treatment options and is shown to be the most effective part of treating any type of back pain. Active treatments (rather than passive options) always show better long term results and will benefit fit your overall health and well-being too.

Your program will be based off the in depth initial assessment you have with your PT. It will address any imbalances in muscle strength, flexibility, and coordination of the body with everyday movement. Your home program will start simple and slow to gain the quickest benefits and then gradually progress as you are able to.

You can expect to have an in depth core program focusing on properly using the trunk muscles with your daily activities.

      NOTE: PT has unfortunately gained a bad rap for its “pain and torture” with recovery.  The truth is, movement is essential to recovery. Soreness can be expected with a new program but it should be from using muscles correctly (like you would feel after a good lifting session or run).  NOT from aggravation of back pain symptoms. 

      Ergonomic and Daily Activity Assessment

      Another huge part of the recovery process is analyzing your daily posture and movements (part of the initial visit). Many of us become so habitualized to our routine that we don’t even realize what parts of our daily life our causing our spines detriment. Simply bringing awareness to these problems and offering simple tricks to start retraining things like poor posture and form will make a world of difference. These principles can be applied to any type of movement including squatting, bending, rolling in bed, sitting down, and standing up.

      This assessment is what will make your recovery a long term process. Rather than getting stuck in the typical on and off again cycle of back pain, mere awareness of your weaknesses and bad patterns will help you stay on track long into the future.

      Pain Beliefs Assessment

      Believe it or not, how we perceive how pain greatly affects our ability to heal and recover as well. Chronic back pain commonly leads to issues with anxiety and depression due to the stress of dealing with such as issue. Yet, the opposite is true too (stress can cause injury). Too much stress leads to hormone and other body imbalances (such as poor eating habits, sleep habits, etc). Thus managing your stress effectively and keeping a positive outlook on your recovery will help immensely.

      Simply understanding what your body is going through has amazing power to alleviate anxiety.  Then, learning to trust your body to move again with an exercise program will be the fuel you need to stay positive and maximize the healing process.

      Manual Therapy

      While most people jump to massage as the best treatment option they can get from physical therapy, it is is just one of many tools that can help you on the road to recovery. Massage techniques during physical therapy are typically very focused on tissue impairments related to muscle knots, spasms, and joint stiffness that won’t relent with other treatment options. This may include deep tissue massage, gentle techniques to promote blood flow, or more specialized joint mobilizations to restore function. PTs may use tools to address larger areas, such as the back muscles.

      A PT will typically have a goal of teaching you to independently manage chronic tight spots on your own with self massage tools if needed, such as foam rollers or massage balls.  Once an area is loosened or “released” the goal should be to maximize your exercise program.

          TENS Therapy

          Electrical stimulations, or TENs, is a great option for initially mitigating severe pain. Considered a more passive treatment option, It is used as an adjunct with other treatments to optimize tolerance for activity and restoring body balance. When using a TENS machine, the electrodes stimulate superficial nerves creating a tingling or buzzing sensation. This sensation creates a massage like sensation meant to “scramble” the messages going to your brain about your pain level. This gives you a chance to feel pain relief and break the cycle of tightness and pain.

          This can be done in the clinic or at home. Units for home are inexpensive and easy to set up after an initial consultation. It can also be worn for longer periods of time if needed (talk to your PT).

          Hot and Cold Therapy

          This traditional form of pain relief is another great adjunct to other therapy treatment options. Plus, if they can provide relief they’re significantly better than taking pain medications such as ibuprofen and naproxen (fewer side effects). As a passive treatment, it is not a billable option for PT treatment so it might be something you begin or end your appointment with to promote better relaxation and/or recovery. Heat is best for promoting relaxation and circulation for healing. PT clinics usually use a moist heat that is slightly more effective than traditional heating pads. Ice is best for addressing severe pain, spasms, and swelling. These are easy effective treatment options for home when you want to decrease pain quickly. You may find it beneficial to alternate between the two.

          Hydrotherapy is a more intense option that may be available at some clinics for heat and cold therapy, involving alternating between immersive hot and cold baths.

            Spinal Traction

            This is a great option for relieving pressure specifically on the disc. The literature has mixed reviews on it but patients tend to love it. There are two types of spinal traction: manual and mechanical. Manual techniques involve specific postures that will help “separate” the vertebrae and give the disc and surrounding compressed tissues some much needed relief. Options include hanging from a doorway and pelvic tilts for lumbar spine; and chin tucks for the cervical spine.

            The mechanical option involves a machine that harnesses you in. The PT will select the appropriate position (back or stomach), length of time, and weight for you. The goal is to progress the amount of pull and time if you tolerate it well. This is most typically used for patients with significant peripheral symptoms (into the arms or legs) with the goal of decreasing them with each treatment session. Lumbar traction is particularly useful for sciatica to relieve leg pain.

            Get similar relief at home. Try a neck and shoulder relaxer or back stretcher to achieve gentle traction.

            How Long Does it Take to Recover From a Herniated Disc?

            How long you are in PT depends on the severity of your injury. Additionally, your comfort level with your treatment program and motivation to maintain your program on your own will play a role. A typical frequency for a herniated disc program is an initial visit followed by 12 visits over the span of 6-12 weeks. You may need more visits if surgery is planned or you are recovering from a surgery. While the injury itself may take longer than six weeks to heal, you should be well on your way to recovering by then and understand exactly what you need to do to stay on track for a successful recovery.

              When to Visit a Physical Therapist

              If at any point you are unsure of what you should be doing, physical therapy treatments are a great place to start. They can help you prevent and treat injury so there is no such thing as seeking help “too soon.” However, putting it off for too long can be cause for longer recovery and decreased quality of life, especially when nerve damage is involved.

              Symptoms that require immediate attention include sudden loss of strength, poor coordination, loss of bowel or bladder function, and severe shooting pain. They usually mean that nerve root or spinal cord damage are involved.

              Taking Precaution

              If you are suffering from pain caused by a disc herniation, it’s definitely time to see a PT for nonsurgical treatment.  They can help relieve your anxiety about your back pain and quickly get you on track. They are experts in movement restorement, just what you need to maximize your quality of life and get back to enjoying it to the fullest. 





              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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