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How to most successfully treat a lumbar herniated disc injury

How to most successfully treat a lumbar herniated disc injury

Between 60% and 80% of adults will experience low back pain at some point over their lifetime. A high percentage of people will have low back and leg pain caused by a herniated disk pushing on a nerve root. Although a herniated disk can sometimes be very painful, and can cause life to slow down incredibly, most people feel much better with just a few weeks or months of nonsurgical treatment through physical therapy.

Oh, and by the way, discs don’t slip, that is a misnomer. Discs bulge, rupture, herniate and dessicate. So, There is no such thing as a slipped disc! This article will teach you what to do and what to stay away from when suffering with a herniated disc in your lower back.


Do

Do find lumbar neutral / posture of L/S

When we talk about posture, we think about standing at attention, but the posture of the lumbar spine alone is vital. For the lower back to function properly and to offer relief from LBP (Lower Back Pain) from a herniated disc, we must first find lumbar neutral. This is the safest non-stress position for the lower back and once learned trying to maintain this position in life is vital for lumbar health.

To find the position of least resistance or lumbar neutral, place both hands on your hips. Now tuck your hips in and under as far as you can, this is called a posterior pelvic tilt. Now, arch your back as your hips drop forward. That is called an anterior pelvic tilt. The position exactly in the middle of both of those movements is your lumbar neutral. Not too far forward and not too far back the central position is key.

Do remember core strength is key

To keep the back protected and to prevent further re-injury to the discs of the lower back, core strength is a must! This does not mean doing weighted side bends and sit-ups. To strengthen your core, initially become aware of some of the more unknown muscles like transverse abdominis and multifidus then work through a logical and safe progression of core exercises.

Begin with understanding the abdominal vacuum exercise performed by using muscle not breath. This is accomplished by drawing in and pulling your navel to your spine. Literally sucking in your gut but achieved with muscles not air. This cinches tight those two muscles named above which are some of the deepest muscles of the core. Then progress to isometrics, like planks and bridging and performed for time not reps. Start with a few sets of 10 seconds holds then trying to work up to maintaining the positions for 3-5 minutes each! Once mastering lumbar posture and isometrics, one can advance to some more dynamic movements from the plank position like knee to chest and elevated legs. Finally, evolving into standing core work and more functional and possibly sports based activities and always being aware of the core as your center of gravity.

Do practice flexibility

I cannot overstate the importance of total body flexibility for body, and specifically, the lower back. A herniated disc is a compression type injury. Be that as it may, stretching of the lower back proper and all the related muscles creates space in the body. By keeping muscles, tendons, ligaments and fascia pliable, one can aid in preventing many ailments related to the forces of gravity on the body in addition to experience smooth and freedom of movement.

The muscles to focus on that directly relate to the lower back are hamstrings, hip flexors, abdominals, piriformis, llats, groin and small spinal muscles. Your athletic trainers and physical therapists can teach you the best stretches for all these muscles involved. Just remember with stretching, duration is more important that intensity. So, hold a gentle stretch for 30-60 seconds is better that 10 seconds intense.

Do consider spinal decompression and lumbar traction

There are so many treatment modalities for a herniated disc. Everything from anti inflammatory medication to Acupuncture. In physical therapy, we know the evidenced based treatment for an herniated disc is decompression/traction therapy. Of course, many other treatments may be of benefit, many researchers found traction to a vertebral disc can have greater than 80 percent success if caught at the correct time. With traction and decompression therapy, one lays either face down or face up while a mechanical machine will stretch the spine. This stretching decreases the pressure in the discs and intern, take pressure off of a nerve. An excellent choice of treatment.

Do aerobic work

Another key treatment for a herniated disc is aerobic exercise. Aerobic exercise increases the flow of blood and nutrients to the lower back structures which supports healing. Aerobic exercise can decrease the stiffness in the back and joints that can lead to continued back pain. It also works like a flushing mechanism for blood and lymph flow which speeds up recovery. Start with non-impact or low-impact exercises walking then overtime progress to more challenging forms of aerobic exercise like swimming.


Don't

Do not do lumbar flexion and rotation

Most injuries happen from flexion, rotation, and even worse, flexion combined with rotation. Unsupported forward flexion or bending over to touch your toes puts an incredible amount of force on the lumbar spine. Overtime, these forces wear away the disc and the pressure from that motion can damage and potentially cause a herniated disc. You must bend your knees as you move and maintain your center of gravity within your base of support.

Do not run

Since this is a compression type injury, the high impact stress of running can stress a herniated disc. This is not to say that all people with a disc injury will never run again, but initially, running is contraindicated exercise and must be monitored extremely and carefully by your sports medicine professional.

Do not perform traditional sit-ups or bilateral leg raises for strength as core exercises

First off, these don’t even work the core muscles properly and the potential danger in these exercises far outweighs the benefits. Although these exercise have been around since the dawn of time, they do not strengthen the core in they way that is needed to protect the lumbar spine from injury. Think of core strength in layers. You must first strengthen the inner or deeper layers and work your way out to the more superficial layers.

Do not forget to be cautious of laughing, coughing and especially sneezing

When a disc is herniated and very irritable, any stresses placed upon it can cause immediate pain. Pressure from a sneeze, cough or laugh increases the pressure in your spine and can make the pain in your back unbearable. Unfortunately, the disc is so sensitive and almost raw that pressure caused from sneezing, laughing or coughing can make it worse. One way to minimize the tremendous increase in pressure and forces of one of the above is by bracing yourself in order to transmit or minimize the forces into something else. Try one hand on your back, tighten your stomach while your other hand should support on a table or bench.

Do not sit for too long

Sitting for short and long periods of time is usually very stressful to a herniated disc. The sitting position puts direct stress on the discs of the lower back. Believe it or not standing has less stress on the lower back than sitting! If you can modify or minimize sitting while healing a herniated disc it would be optimal. If you do have to sit, try using a rolled up towel in the small of the back and take several walking breaks.


Summary
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A herniated disc is a serious medical issue and should be dealt with properly by seeing your doctor and taking part in any diagnostic studies needed to confirm this diagnosis. If you experience any muscle weakness, tingling, numbness or an increase in pain it may be a sign of a worsening conditioning and imperative that you tell your physician, physical therapist, or trainer immediately. By following the rules above you can ensure that you are taking the necessary steps to maintain a healthy lower back after sustaining a herniated disc in your lower back.


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Dr. Scott A. Weiss DPT LATC CSCS FACSMLicensed Physical Therapist and Board Certified Athletic Trainer

Dr. Scott Weiss is a licensed physical therapist and board certified athletic trainer in the state of New York. He is also a registered exercise physiologist, strength and conditioning specialist and advanced personal trainer with over twenty ye...

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