Lumbar Disc Herniation - An Exercise Guide to Speed Up Recovery

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The general public is no stranger to lower back pain. It’s the leading cause of activity limitations and missed workdays in the US. Up to 80% of people will experience lower back pain at some point in their lifetime.

There are many causes of lower back pain, including muscle strain, poor posture, and pinched nerves. One common instigator is a lumbar disc herniation. Though it sounds severe, it’s a manageable condition that can recover well with conservative care!

What is a lumbar disc herniation?

Stacked in between each vertebra in the spinal column is a type of specialized tissue known as the intervertebral disc. These discs help to resist compression and facilitate our spinal range of motion. The construction of each disc includes a strong outer ring surrounding a soft and gel-like center. They’re often likened to jelly donuts.

In the instance of a herniation, that gel-like center can protrude from the strong outer band and has the potential to interrupt normal function, causing pain and other symptoms.

Symptoms of a lumbar disc herniation

There are a wide variety of symptoms that can accompany a lumbar disc herniation. They range from completely asymptomatic to great activity limitation and shooting pain. Below are common issues a patient with a lumbar disc herniation experiences.

Radiating pain down a leg
Differences in sensation along the leg
Weakness in the leg or back
Difficulty bending forward
Increased pain with coughing or sneezing
Pain with sitting

As mentioned above, just because someone is known to have a herniated disc, doesn’t necessarily mean they will have symptoms.

Up to 32% of asymptomatic patients have “abnormalities” found on imaging, thus reminding us that spinal imaging isn’t always a reliable source of diagnostic information.

Recovery from a lumbar disc herniation

The ideal treatment for a patient with a lumbar disc herniation is non-operative conservative care. The vast majority of patients that truly needs surgery to recovery is quite low. Patients with lower back pain that participate in physical therapy are less likely to get surgery, take opioid drugs, or miss work. The quicker a patient starts physical therapy, the better and longer-lasting their results will be!

Physical Therapists Tip: The key to speeding up recovery is movement. It helps the body heal and repair itself faster. Try walking, a recumbent bike for a light pedal, or walking in the pool. Being completely sedentary makes things worse.

Healing timeline & Exercise Protocol

Depending on your previous level of activity and current symptoms, you can expect to dedicate a good amount of time to achieve a full recovery. Refer to the below guide and recommended exercises to inform your path of rehabilitation from a lumbar disc herniation.

Week 1: Rest

Avoid aggravating activities and protect your back while encouraging healthy movement.

Be Cautious with Rotating Motions
Be Cautious with flexion (bending forward) motions
Try and walk multiple times a day to tolerance

Exercises To Do Week 1

Glute Isometric sets

Stand comfortably with your back against a wall, heels touching the wall as well.
Press your right heel back into the wall, contracting your glute muscle.
Hold for 5 seconds, then rest.
Repeat on the other side.
Complete 12 reps and 2 sets on each side.

Video Link: https://www.youtube.com/watch?v=LmT6h6YFADk

Transverse Abdominus (TA) Contractions

Laying on your back, with knees bent and feet on the floor.
Draw your belly button in towards your spine – you should feel your core tighten.
Try not to “bear down” during this exercise. Instead, focus on “drawing in”.
Hold this contraction for 5 seconds. Complete 12 reps.

Video Link: https://www.youtube.com/watch?v=wpgmH76J4N4

Press-ups

Laying on your stomach, place your hands on the floor under your shoulders, as if to do a pushup.
Gently press your hands down, lifting your upper body from the floor slowly.
Keep your hips on the floor and only lift your upper body.
Complete 10 press-ups every few hours throughout the day.

* This exercise can feel like it causes more back soreness. That’s ok, just take your time and progress your movement gradually.

Video Link: https://www.youtube.com/watch?v=UqSP7ZrHxRE

Weeks 2-3: Repair

Begin to incorporate stability exercises and address posture deficits. Try and walk more if you can, even if its on a treadmill thats designed for low back pain.

Back Exercises Weeks 2-3:

Lateral leg lifts

Lay on your side, keep your hips stacked over each other and avoid rolling in either direction.
Lift your top leg about 12”, then lower back down.
Complete 12 reps and 2 sets on each side.
Progress this exercise by adding an ankle weight or resistance band.

Video Link: https://www.youtube.com/watch?v=mxWissvKVj0

Back Bridge

Lay on your back with knees bent and feet on the floor.
Complete a TA contraction and lift your hips from the floor into a back bridge.
Aim to keep a straight line from your shoulders to your hips to your knees, and avoid letting your hips dip.
Hold for a few seconds, then lower back down.
Complete 12 reps and 3 sets.

Video Link: https://www.youtube.com/watch?v=Q_Bpj91Yiis

Plank

Start from your hands and knees and extend your feet back to assume a plank position.
Keep your body in a straight line from your shoulders to your ankles.
Hold for 20 seconds.
Repeat for 8 reps.

Video Link: https://www.youtube.com/watch?v=yeKv5oX_6GY

Hip flexor stretch

Kneel on your left knee.
Keep your body upright and shift your hips forward, slightly leaning your shoulders back.
You should feel a stretch in your right hip. Hold for 20-30 seconds then switch legs.
Complete 3 reps on each side.

Video Link: https://www.youtube.com/watch?v=7bRaX6M2nr8

Weeks 4 & beyond: Recover

Focus on strengthening your core and developing a maintenance plan.

Back Exercises Weeks 4 and Beyond:

Monster walk

Loop a resistance band around your ankles.
Take a side step, keeping your toes pointing forward.
Be sure to control your motion and don’t let the resistance band snap your feet back together.
Complete 20 side steps in each direction.

Video Link: https://www.youtube.com/watch?v=7bRaX6M2nr8

Lat pull-downs

Using a weight machine or resistance band, hold one end of the bar or band in each hand, shoulder-distance apart, and slightly in front of your body.
Keep your chest upright and pull your hands in towards your shoulders, pinching your shoulder blades together.
Keep your core tight and posture present throughout the exercise.
Complete 12 reps and 3 sets.

Video Link: https://www.youtube.com/watch?v=0oeIB6wi3es

Resisted Trunk Rotations

Start in a half kneeling position with
Using a weight machine or resistance band, hold one end of the bar or band in both each hands. shoulder-distance apart, and slightly in front of your body.
Keep your chest upright and pull your hands in towards your shoulders, pinching your shoulder blades together.
Keep your core tight and posture present throughout the exercise.
Complete 12 reps and 3 sets.

Video Link: https://www.youtube.com/watch?v=dEy6KCAyH74

Returning to Sports After Surgery

Returning to a Sport

Establish a maintenance routine to implement going forward. Your conditions for returning to your sport should be painless movement in all directions and your participation should be gradual.

Continue a regular habit of strengthening your core, hips, and glutes. After the activity, be sure to include a recovery session and stretch your hip flexors and hamstrings.

Tips for a Speedy Recovery

Seek out care from a Physical Therapist.

This care can progress and supplement your home rehabilitation plan. A physical therapist can provide hands-on treatment in the form of manual therapy and tactile cueing that can assist your recovery and improve your body mechanics.

Pay attention to your form and posture.

Sitting

Avoid slouching! Sit in the chair with your hips and back against the back of the seat. You can use a small lumbar pillow in the small of your back to provide extra comfort.

Lifting

Use your legs! Be sure to keep your back straight (versus rounding out your spine) and perform a squat to lift. Even if you’re just retrieving a pencil from the floor, always use good form! Lift things straight on – meaning, do not rotate and lift at the same time.

In Review

Lumbar disc herniations and the associated low back pain symptoms that accompany it are common. With intentional care and management, this injury can respond fantastically to conservative treatment. When in doubt, seek out the help of a physical therapist to help manage and guide your progress.

Works Referenced:

Amin R, Andrade N, Neumann B. Lumbar disc herniation. Current Review of Musculoskeletal Medicine. 2017; 10(4):507-516. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685963/

Deloitte A, et al. Low back pain. Journal of Orthopaedic & Sports Physical Therapy. 2012. https://www.jospt.org/doi/pdf/10.2519/jospt.2012.42.4.A1

VanGelder L, Hoogenboom B, Vaughn D. A phased rehabilitation protocol for athletes with lumbar intervertebral disc herniation. International Journal of Sports Physical Therapy. 2013; 8(4): 482-516. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812831/