Have you woken up one morning and all of a sudden felt an intense pain that starts in your back and travels down one or both of your legs? As many of us have been culprits to low back pain, a specific cause of this pain is a disc herniation, which is when one of the discs that sit in-between the bones (vertebrae) in your spine is ‘pushed’ out of its normal position, and can potentially irritate a nearby nerve root, which leads to a burning, intense pain that can travel down one or both legs. Although this pain is very real and can be quite intense, the good news is that it IS treatable, often without the need for medications, injections, or other passive interventions. We are also here to educate you that terms including ‘degenerative disc disease’, ‘stenosis’, or ‘arthritis’ do not always translate to pain or disability! Active problems require active solutions, and we are here to show you excellent exercises for disc herniations to ultimately manage your OWN back pain!
Exercises For Disc Herniations
Let’s Start With The Basics
We want to provide a framework of what exactly a ‘disc’ in the human body is, and moreover, what a disc herniation is so that you have a better idea of understanding the WHY behind exercises for disc herniations. Each bone (vertebra) within your spine is cushioned by an intervertebral disc. These discs are responsible for dissipating and absorbing the load that your spine takes each day, and most of that load is in the lower segments of our lumbar spine (low back), hence why low back pain is so common!
Fun fact: Our discs are derived highly from water. Naturally, as we age, the ability to retain that fluid declines, which is why we get shorter as we age (sorry grandpa!)
Disc Herniations Respond Very Well To Exercise! Own Your Movement Today!
Like many other common ailments that occur in the low back, disc herniations respond very well to exercise! No matter how long you have suffered from back issues, it is never too late to start feeling better. We get it, we have dealt with low back issues too! The Low Back Rehab Program is a physical therapist developed, step-by-step program that blends exercise science, current evidence, our clinical expertise, and our personal experiences to provide you with the ultimate solution! Learn moreHERE!
So What Is A Disc Herniation and How Does It Happen?
You may have heard a slew of various terms for a disc herniation, such as “ruptured disc”, “slipped disc”, or “bulging disc”. When there is excessive stress placed through our spine, either at one specific time (acutely), or repetitively over time (chronically), that stress can lead to the outer components of the disc bulging or tearing. As previously stated, the quality of our discs naturally declines with age, and a combination of the decrease in quality of the tissue as well as other risk factors can lead to a herniated disc.
Some risk factors for the development of a herniated disc include:
Involvement in manual labor as a profession
Improper lifting mechanics
Prior injury to the low back
Remember, You Are Not Your MRI!
Before we get too far into disc herniations and low back pain, we want to clear the air regarding ‘labeling yourself to a specific diagnosis’. Just because a medical professional may have told you that you have ‘degenerated discs’ or ‘stenosis in your spine’ (narrowing of your spine), does NOT mean that you will experience pain or limited function as a result! These changes in our body that occur as we get older are NORMAL! Just take a look at this graph below.
With all of this information being presented, we ultimately want to educate and empower you to NOT feel dictated by a ‘labeled diagnosis’. Yes, in some instances, conditions such as a disc herniation for example can cause significant pain and loss of function. However, there is also another side of that coin where in many instances, individuals with small disc herniations or degenerations within their spine are running half marathons, playing with their granddaughters, and doing what they love without pain at all.
Before I dive further down this soapbox, read more on our article below!
What Does It Feel Like If I Have A Herniated Disc?
If someone truly has a hot and irritated disc that is pushing on a nerve, it is difficult to miss. Some of the most common signs and symptoms include:
Increased pain in the low back, which commonly is worse with sitting, as this increases pressure on our discs by up to 40%
Pain that may increase when there is more pressure placed within our spinal canal can be caused by sneezing, coughing, or straining
A poor ability to bend forward from the low back also reproduces pain
Potential for burning, numbness, and tingling sensation within a distribution of one or more of the nerves in the spine that can travel down the leg
Potential weakness as well as changes in sensation (ability to feel light touch) and altered reflexes
One may potentially shift their hips and back away from the side of pain, which is known as a lateral shift
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How Do I Get Rid of Disc Herniation Pain?
Now that you understand what a disc herniation is and what may potentially cause it, let’s get into how to get rid of that pain! One strategy that has been supported within the literature and is utilized by many physical therapists is The McKenzie Method. The etiology of this method started back in the year 1958 when a physical therapist by the name of Robin McKenzie was evaluating a patient who had low back pain with leg symptoms. Robin asked the gentleman to lay on the table before the evaluation, and after a period of time, the individual told Robin this was the best his low back and leg had felt in weeks! It just so happened that the position the gentleman was laying in, which was on an elevated plinth on his stomach, helped improve his symptoms dramatically.
It was from this initial experience that Robin McKenzie began to develop a new method for treating low back pain. On a very basic level, this method helps strategize if an individual has a directional preference for their back movements. For example, standing and walking places will put one’s spine in a more extended position, which is also mimicked by lying prone on one’s stomach. On the contrary, bending forward and sitting places will put one’s spine in a more flexed position, which is the same position the spine is in when laying on one’s back. By deciphering these directional preferences upon an initial examination, it can help guide treatment decision-making.
One of the best courses of action you can take when experiencing back pain is to seek treatment EARLY! Numerous studies have shown early treatment for low back pain results in improved outcomes and a decrease in overall healthcare costs. This is achieved by performing exercises for disc herniations.
Centralization Versus Peripheralization
Centralization of Symptoms – This is an important concept to understand when initiating these exercises. Centralizing symptoms means returning symptoms back to the origin of where the pain started.
Here is an example:
You have pain in your back that travels down the back of your left leg to your calf
You start performing a specific repeated movement exercise, such as a prone press up
After a series of these movements, you feel more pain in your back, but less pain at your calf. Maybe the pain is only traveling to your knee. This is a GOOD sign! It means the pain is returning back to where it started
Now, the pain in your back may become more intense when first starting these exercises, but do not be alarmed if that occurs. What we would NOT want is peripheralization of symptoms, meaning the pain is traveling further away from the origin of where it started. If that occurs, the low back needs to be re-evaluated and you may need to go back to the drawing board.
Exercises For Disc Herniations
Below is a progression of force that one can perform when treating their own back pain. Progression of force is needed to restore range of motion and reduce symptoms. The key with repeated movement exercises is to take your spine to end-range. The theory behind getting to end-range is helping move the disc back to its original position within the spine.
The McKenzie Method is NOT just extension exercises (bending backward or performing a press up). Although it is more common for one to prefer movements in the extended position, others may have directional preferences in other directions. Moreover, The McKenzie Method is just ONE way to treat back pain. Evidence tells us that low back pain is multimodal, and there are other components that need to be considered when treating low back pain, including progressive core stability exercises, manual therapy, education, and activity modification.
HOW: Begin by lying on your stomach with your elbows bent at your side and your palms down on the ground with your hands by your shoulders. From here, exhale as you push into the ground lifting your chest off of the ground while keeping your hips on the ground and body relaxed.
FEEL: You should feel a stretch in your back.
COMPENSATION: Let your arms do all of the work, keep your back and lower body relaxed.
Prone Press Up – Sag And Lock
With this exercise, think about sagging your belly button down towards the table as you deeply exhale, as this will add more pressure through your back.
Prone Press Up – Belt Mobilization
To progress to the next step, add in a belt mobilization! You can use a stretch strap, belt, or even a dog leash.
Standing and performing extension naturally will add more load through the spine due to the effect of gravity in an upright position versus laying down when your spine is more unloaded.
What if I Am Shifting Away From My Pain?
In the case of what is known as a lateral shift, this MUST be addressed first before moving in the sagittal plane (anatomical boundary that exists between the left and right sides of the body). This can be done by performing what is known as a side glide against a wall. The same principles of what you should feel in regards to centralizing symptoms is the same!
Side Glide Against Wall
Low back pain is one of the most disabling conditions throughout our world; however, many cases are self-limiting and will improve conservatively without medications, injections, or surgery
The McKenzie Method is just ONE way of treating back pain. Evidence tells us that low back pain is multimodal, and there are other components that need to be considered when treating low back pain, including progressive core stability exercises, manual therapy, education, and activity modification
The McKenzie Method is NOT just extension exercises (bending backward or performing a press-up). Although it is more common for one to prefer movements in the extended position, others may have directional preferences in other directions
After mobility has been restored and pain has decreased through a systematic progression of repeated movement exercises, other exercises must also be integrated into treatment plans to address any remaining deficits, such as poor strength, poor core stability, etc.
Take Control of Your Low Back Pain!
The low back is the centerpiece to our movement foundation and is the most adaptable and resilient area of the movement system. Since it takes on so many responsibilities it can at times become overwhelmed and request a change be made. Those requests tend to say: “Can you use your hips more?” and “Can you build up more core strength for this activity?” After this program, your back will be happy to know that these requests have been attended to!
Sherif graduated from Temple University with a Bachelor’s of Science Degree and a concentration in Kinesiology. He then received his Doctorate of Physical Therapy Degree from DeSales University, graduating with honors of the professional excellence award and research excellence award. After his graduate studies, he served as Chief Resident of the St. Luke’s Orthopedic Physical Therapy Residency Program. Sherif is a Board Certified Orthopedic Clinical Specialist. Sherif focuses on understanding how movement impairments are affecting function while also promoting lifestyle changes in order to prevent recurrences of injury. His early treatment interests include running related injuries, adolescent sports rehab, and ACL rehab in lower extremity athletes. He also has been involved in performance training for youth soccer players. Outside of working as a physical therapist, he enjoys traveling, running and cycling, following Philadelphia sports teams, and spending time with his family.
Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.