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Low back pain affects 4 out of 5 adults at some point in their lives [1, 2]. In many cases, the cause of low back pain is a herniated disc.
Herniated discs are most prevalent in people 30 to 50 years old. In older people, disc herniation is often due to degenerative changes, while younger people typically experience herniated discs as a result of an acute injury.
There are a number of simple exercises for a herniated disc that can be performed at home under the supervision of a physical therapist. When performed regularly under medical supervision, these exercises can help to improve symptoms associated with a herniated disc.
Here, we will cover what a herniated disc is, symptoms of a herniated disc, what causes a herniated disc, and exercises for herniated discs.
Before discussing what a herniated disc is, let’s review some basic human anatomy.
The spinal column is made up of 24 distinct vertebrae, and 9 fused vertebrae that make up the sacrum and the coccyx. Each distinct vertebrae is separated by a disc, or intervertebral disc (IVD). The spinal cord runs down the canal in the middle of the column of vertebrae and spinal discs.
The purpose of spinal discs is to provide shock absorption and stabilization to the spine during movement [1, 2]. Each spinal disc has two parts: an inner nucleus pulposus and an outer annulus fibrosis. The nucleus pulposus is a toothpaste-like substance made of water and collagen and the annulus fibrosis is made of concentric rings of collagen that provide tensile strength .
At each vertebrae, a pair of spinal nerves originate from the spinal cord and exit the spinal column. These spinal nerves run through our arms and legs, providing sensory and motor innervation to our entire body. They allow us to experience sensations and control our movements.
A herniated disc occurs when the inner part of the disc (nucleus pulposus) leaks or protrudes out of the disc due to a tear in the outer annulus fibrosis.
The annulus fibrosis is thinner in the back part of the disc, which is why most tears occur on the backside of the disc and out to the side . This is known as a posterolateral herniation and often brings the herniated material in direct contact with the spinal nerve. When the disc material pinches a nerve, it can cause pain and other neurological symptoms.
If you suspect you have a herniated disc, you should always consult with your primary care physician.
Disc issues can cause back pain and neck pain. Radiating arm and leg pain can also result from a herniated disc when it is compressing a nerve. Herniated discs in the low back (lumbar spine) will cause radiating symptoms in the legs, while herniated discs in the neck (cervical spine) will cause radiating symptoms in the arms.
Here are some possible symptoms of a herniated disc, that can range from mild to severe [2, 3]:
● Intermittent or continuous pain (usually in the neck or back)
● Radiating pain in the arms or legs
● Numbness or tingling in the arms or legs
● Muscle weakness
● Muscle spasm
● Diminished reflexes
● Bowel and bladder control issues
● Difficulty walking or poor coordination
It is important to note that imaging results may be misleading. Many people have herniated discs but experience no symptoms whatsoever.
Specifically, 20-30% of imaging tests show evidence of a herniated disc in otherwise healthy people . An MRI or CT scan may reveal a disc herniation, however, if the patient is not experiencing pain or dysfunction, there is no reason to treat the herniation.
Herniated discs can arise acutely from trauma or injury, or can be the result of age-related degeneration.
Poor posture and body mechanics can significantly increase the risk of disc herniation. Some examples of postural shortcomings that can impact spinal discs include improper lifting mechanics, repetitive bending or twisting motions, and prolonged sitting, such as while driving or at work.
An example of poor lifting mechanics is lifting with your back (bending at your spine) instead of with your legs (bending at your hips with a straight spine).
Muscle weakness can also play a role in increasing the risk of a disc herniation, specifically weak abdominals and back muscles (“core muscles”). When the core is weak, the spine cannot be properly stabilized during physical activity.
Disc dehydration occurs with increasing age and can cause disc herniation. When the nucleus pulposus dehydrates, it places stress on the annulus fibrosis. With time, this can reduce disc height, weaken the annulus fibrosis, and increase the risk of herniation . Studies have also shown that smoking can increase the likelihood of lumbar disc herniation .
Conservative care, such as physical therapy, exercise, lifestyle modifications (i.e., posture and ergonomics), and over the counter medications, can be successful in treating the symptoms of a herniated disc. Surgery should be saved as a last resort as it has mixed outcomes, unless the patient has severe neurological symptoms or the herniation is the result of trauma .
Here are 7 exercises for herniated discs that can be performed at home as part of a physical therapist- prescribed exercise program.
Maintaining this position for a couple minutes may help to centralize the pain related to a herniated disc in the lumbar spine.
Pain centralization means decreasing pain in the extremities and shifting it closer to where the disc pathology exists. For many people, spinal extension reduces the disc herniation, releases pressure from the spinal nerve, and reduces pain
Similar to the prone prop, the purpose of this dynamic spinal extension exercise is pain centralization. While performing this exercise, keep your hip bones pinned to the ground. If you are having difficulty extending your arms fully, move your hands further in front of you.
In this exercise, the patient performs spinal extension in a standing position. The hands can be used to help stabilize the low back. The purpose of this exercise is also pain centralization.
In lumbar disc herniations, a tight piriformis muscle may make neurological symptoms worse, since the sciatic nerve runs underneath this hip muscle. Hold this stretch for 30 seconds to help increase the length of your piriformis muscle. Don’t forget to breathe!
This exercise helps to increase mobility and reduce stiffness throughout the cervical, thoracic, and lumbar spines. Use your breath during this exercise by inhaling as your belly drops and you look up, and exhaling as your spine curves and you look down.
This exercise is a core stabilization exercise that will help to strengthen the abdominal and back muscles. Before beginning, find a neutral spine with your abdominals engaged. As you move the opposite arm and leg, imagine there is a glass of water sitting on your low back that you must keep level. Keep your abdominals engaged to avoid arching your low back as you lift your leg. Use your breath- inhale while in all fours and exhale as you lift your opposite arm and leg. If moving both your arm and leg together is too difficult, try moving your arm and leg separately while maintaining a neutral pelvis and spine.
Low plank is an advanced core stabilization exercise that can strengthen the abdominals and back muscles. Keep your bottom tucked under and your glutes engaged. If low plank is too difficult for you, try high plank. Remember to breathe! Start by maintaining this position for 20 seconds and slowly add time as you gain strength.
Always consult with your physical therapist or primary care provider when beginning a new exercise program. If any exercise or physical activity causes new or worsening symptoms, stop immediately and contact your healthcare provider.
Motion is lotion for the body and any physical activity may help to decrease the pain associated with a herniated disc. You should always consult with your physical therapist or healthcare provider before beginning a new physical activity or exercise program.
Some examples of physical activity that may be helpful for a herniated disc include walking, yoga, and swimming. Any household task that gets you moving such as gardening, yard work, or cleaning may also be beneficial.
Always be cognizant of your posture and body mechanics during all physical activity to reduce the chance of a pain flare-up or another injury.
In most people, a flexed posture, or curved spine and forward head, can exacerbate herniated disc symptoms, so this type of posture should be avoided during physical activity.
Some other postures to avoid include sitting for long periods of time and sitting on hard surfaces. Depending on your medical history, your physical therapist may educate you on other postures or activities to avoid.
In addition to general physical activity, your physical therapist can prescribe tailored strengthening and stretching exercises to treat your particular condition. If any physical activity causes you pain or worsens your pain, stop immediately and contact your physical therapist or physician.
Herniated discs are a common cause of back pain and can be managed effectively with conservative care. Disc herniations can be the result of an acute injury or age-related degenerative changes.
Poor posture and body mechanics can exacerbate the symptoms associated with a herniated disc, so improving these should be the focus of a rehabilitation program, in addition to stretching and strengthening exercises.
There are a number of simple exercises for herniated discs that can be performed at home under the supervision of a physical therapist.
Always consult with your physical therapist or primary care provider when starting a new exercise program or physical activity. If any exercise or physical activity causes new or worsening symptoms, stop immediately and contact your healthcare provider.
4. Dutton, Mark. Dutton’s Orthopaedic Examination, Evaluation, and Intervention, Third Edition. New York: The McGraw-Hill Companies, Inc., 2012. Print.