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How to Effectively Manage Low Back Disc Herniations and Pain

Written by Michael Thompson


When returning from a herniated disk to the lower back it is important to understand the goal and intention behind the exercises provided. The overall aim returning from this type of injury is to create stiffness and stability around the spine through the surrounding muscles of the spinal column. Increasing the stiffness of the surrounding muscles thus increases the stability and improves the ability to support larger loads without buckling.


When the muscles of our core contract, stiffness is created. Think of the core as guy-wires and the spine as a radio tower/ship masts or even a tent. Without the guy wires the free standing structure would collapse when a force is applied. The same applies to the spine. The core muscles surrounding the spine need to create tension and stiffness in order for the spine to have strength to withstand external loads.


The intention and goal of the exercises is normally to stress both the injured tissue and healthy supporting tissues to aid in the tissue repair while avoiding further excessive loading to the site of injury. Please note that certain lower back injuries may require different exercises during rehabilitation programs.


That being said, when choosing specific exercises for a rehabilitation program, it is suggested that exercises that challenge the surrounding muscles but that have minimal joint loads should seem to be most effective. Whilst ensuring that the exercises chosen elicit muscle co contraction which is necessary for maintaining stability and preventing buckling of the spine.


Due to know one exercises being able to target all the muscles of the core at once it is suggested that more than one exercise needs to be used to challenge the core


With that in mind research has found that isometric exercises are key in enhancing spinal stiffness and stability.


Dr. McGill has spent years studying the spine and found there to be three specific exercises that adequately challenge the surrounding structures of the spine without placing excessive load on the parts of the back that may be injured or aggravated due to the injury. The exercises are known as the Big 3, which are:


Curl up


  1. Lie on your back with one knee bent and the other straight, put one hand under your back to maintain a neutral spine

  2. Pick your head off the ground only a few inches and hold that position for 10 seconds

  3. When increasing the intensity of the exercises it is recommended to keep the hold at the same time and increase the sets. For example, perform five reps at 10 seconds a rep. then rest 20-30s, then perform three reps (rest), and then one to end.


The Side Plank


  1. Lie on your side with your legs bent and upper body supported through your elbow. Place your free hand on your opposite shoulder or resting on your side

  2. Raise your hips so that only your knee and arm support your body weight.

  3. Hold this position for 10 seconds before returning back down. Perform the same descending pyramid rep-scheme for each side as stated previously for the curl up

  4. To progress this exercise you can go from your knees to your feet, making sure there is no pain when doing so.


The Bird Dog:


  1. Start in an ‘All 4’s’ position (hands under shoulders, knees under hips) keeping your back in a neutral alignment.

  2. Make sure there is no movement at the low back (imagine a glass of water on your back, you don't want it to fall), send one of your legs backwards until straight while simultaneously raising the opposite side arm.

  3. When your leg and arm are both out straight, maintain this position for 10 seconds. Then bring your arm and leg back simultaneously to the start position, maintaining a neutral spine at all times, and perform the same descending rep-scheme as the previous two exercises.


References:

  1. Alves Filho, A.C., Gonçalves, A.L.F. and Barbosa, A.D.M., 2021. Conservative versus surgical treatment in patients with lumbar disc herniation. BrJP, 4, pp.357-361.

  2. Dan-Azumi, M.S., Bello, B., Rufai, S.A. and Abdulrahman, M.A., 2018. Surgery versus conservative management for lumbar disc herniation with radiculopathy: A systematic review and meta-analysis. Journal of Health sciences, 8(1), pp.42-53.

  3. Lurie, J.D., Berven, S.H., Gibson-Chambers, J., Tosteson, T., Tosteson, A., Hu, S.S. and Weinstein, J.N., 2008. Patient preferences and expectations for care: determinants in patients with lumbar intervertebral disc herniation. Spine, 33(24), p.2663.

  4. Molinari, R.W., 2006. Lumbar disk herniation. Current Opinion in Orthopaedics, 17(3), pp.189-194.

  5. Park, D. 2022 Herniated Disc in the Lower Back

  6. Qaseem, A., Wilt, T.J., McLean, R.M., Forciea, M.A. and Clinical Guidelines Committee of the American College of Physicians*, 2017. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 166(7), pp.514-530.

  7. Reid, J.E., Meakin, J.R., Robins, S.P., Skakle, J.M.S. and Hukins, D.W.L., 2002. Sheep lumbar intervertebral discs as models for human discs. Clinical Biomechanics, 17(4), pp.312-314.

  8. Sabnis, A.B. and Diwan, A.D., 2014. The timing of surgery in lumbar disc prolapse: A systematic review. Indian Journal of Orthopaedics, 48(2), pp.127-135.

  9. Sonntag, V.K., 2010. Treatment of the herniated lumbar disc: persistent problem. World neurosurgery, 6(74), pp.574-575.

  10. Stewart, M. and Loftus, S., 2018. Sticks and stones: the impact of language in musculoskeletal rehabilitation. journal of orthopaedic & sports physical therapy, 48(7), pp.519-522.

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