Conservative treatment is the first-line approach for managing disc herniation, and the majority of patients experience significant improvement with these treatments without the need for surgery. Conservative treatment includes lifestyle modifications, medications, and physical therapy sessions. (1)

Physical Therapy for Herniated Disc 

Physical therapy for disc herniation involves a thorough assessment of the patient’s condition and the development of a personalized treatment plan and exercises tailored to the location of the herniated disc and the symptoms experienced. The goal of physical therapy is to strengthen the muscles and reduce pressure on the spine, ultimately relieving pain and improving the patient's quality of life. (1)

Additionally, physical therapy plays a crucial role in the recovery and rehabilitation process after disc surgery.

What Does Physical Therapy for disc herniation Include?

The physical therapy plan for disc herniation is customized based on your condition and health needs and may include various techniques and exercises, such as: (2)

1. Pain Relief Techniques:

• Cold and heat therapy
• Electrical stimulation (e.g., TENS device)
• Hydrotherapy to reduce pressure on the joints and improve mobility

2. Stretching Exercises:

• Gentle stretching exercises to relieve pressure on the affected nerve
• Exercises to improve flexibility in the hamstrings, lower back, and hips

3. Muscle Strengthening Exercises:

• Exercises aimed at strengthening core muscles to support the spine

4. Posture Training:

• Educational guidance on proper sitting, standing, sleeping, and daily activity postures
• Avoiding movements that may worsen symptoms

5. Massage and Manual Therapy:

• Hands-on techniques by the physical therapist to massage and stretch muscles, improving blood circulation and reducing muscle tension

6. Aquatic Therapy:

• Exercising in water to minimize pressure on the spine and joints, making movements easier and more comfortable for the patient.

Herniated Disc Exercises

Your physical therapist will guide you through simple and safe exercises that you can perform at home. However, it's important not to attempt any exercises without your therapist's approval to ensure they are suitable for your condition. Some commonly recommended exercises include: (3)

1. Prone Extension

This exercise helps alleviate symptoms of disc herniation in the lower back and legs. The steps are as follows:

• Lie flat on your stomach for 5 minutes, allowing yourself to relax and feel comfortable (keep your head in a relaxed position – you may place a small pillow under your forehead).
• Prop yourself up on your elbows and hold this position for another 5 minutes.
• Push up further by extending your arms fully while keeping your hips in contact with the floor. and hold this position for a few minutes
• Repeat each movement 10 times in sequence.

For best results, try performing 3 to 5 sets of this exercise

2. Back Stretch

This stretch targets the spine and back muscles:

• Lie on your back and bend your knees toward your chest.
• Gently lift your head forward until you feel a light stretch in your mid and lower back.
• Hold the position for 15-30 seconds.
• Repeat the exercise multiple times.

3. Bird Dog

This exercise strengthens the core and improves spinal stability:

• Get on your hands and knees, ensuring your back remains straight.
• Engage your core muscles by pulling your stomach inward.
• Extend one arm forward while simultaneously extending the opposite leg backward, keeping your pelvis level.
• Hold the position for 5-10 seconds, then return to the starting position.
• Switch sides and repeat.

Perform 2-3 sets of 10 repetitions per side.

4. Piriformis stretch

This exercise targets the piriformis muscle, which can contribute to sciatic nerve pain. Steps to perform it:

• Lie on your back with your knees bent and feet flat on the floor.
• Cross one leg over the other by placing your ankle on the opposite knee (forming a “figure 4” shape).
• Hold the stretch for 15-30 seconds.
• Switch sides and repeat.

Exercises to Avoid

While some exercises are beneficial for individuals with a herniated disc, others can be harmful and may worsen the condition. It is important to avoid the following: (2)

• Any exercise that causes pain or increases discomfort
• Heavy weightlifting exercises
• All types of strenuous exercises
• High-impact activities such as jumping and running

In general, individuals with a herniated disc should not engage in any exercises without the supervision of their doctor or physical therapist.

Physical Therapy After Disc Surgery

If conservative treatments do not provide relief and disc symptoms continue to interfere with daily life, the doctor may recommend surgery to treat the condition and alleviate symptoms.

After surgery, physical therapy becomes a crucial step in the recovery process, helping the patient achieve full recovery. The rehabilitation plan is customized to suit the patient's needs and typically includes walking along with specific physical therapy exercises designed to strengthen muscles and restore full mobility. (4)

When Does Physical Therapy Relieve Disc Symptoms?

Recovery from a herniated disc through physical therapy typically takes a few weeks, depending on the severity of the condition. However, most patients respond well to therapy, making it a suitable alternative to surgery or an effective complement to post-surgical care. (2)

Start your recovery journey with us in the Physiotherapy and Rehabilitation Department, where we offer the latest treatment techniques and personalized exercise plans.

References

1. Mayo Clinic - Herniated disk - Diagnosis and treatment 
2. Physiopedia - Disc Herniation
3. verywellhealth - Herniated Disc Physical Therapy: What to Expect and Exercises
4. OrthoInfo - AAOS - Herniated Disk in the Lower Back