Best exercises for bulging and herniated discs

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

There are exercises for prevention and there are exercises for treatment.

For prevention, it’s important to strengthen the paraspinal muscles (the muscles that surround the spinal column) and the abdominal muscles as well. Collectively, these are known as part of the "core" muscle group. The entire core extends from just below the nipple line down to the thighs. The reason for strengthening these muscles is because they are the key structures that permit movement and also protect the spine.

For patients with acute disc herniation, it’s probably best to rest for 24 hours to help with pain reduction. After that, a gentle graduated exercise program can be started.

Exercises for sciatica are aimed at trying to have the pain move more centrally. In other words, improvement is seen if the pain leaves the leg and settles in the low back.

The following should not be started until you have checked with your physician or physical therapist...

The key to improvement are extension exercises.

• The low back is gently placed into extension by lying on the stomach (prone position) and propping the upper body up on the elbows, keeping hips on the floor. This should be started slowly.

• This position is typically held from five to 30 seconds per repetition, for 10 repetitions.

After going through these exercises, a patient can start more advanced exercises:

• From the prone position, press up on the hands while the pelvis remains in contact with the floor. In yoga this is known as the "cobra pose."

• This position is typically held for 1 second, repeated 10 times.

If a patient is unable to lie on the floor, a similar exercise can be done standing by arching backward slowly with hands supported on the hips.

These extension exercises are done regularly at least three-four times a day to start. The patient should avoid getting into a flexed (bent forward) position. This tends to negate the benefits of the extension exercises.

As the pain leaves the leg, exercises are advanced to strengthen the low back and abdominal muscles to prevent recurrences of sciatica pain caused by a herniated disc. To strengthen the low back muscles:

• In the prone position with hands clasped behind the lower back, raise the head and chest slightly against gravity while keeping the head down looking at the floor in order to prevent neck issues.

• In the prone position with the head and chest lowered to the floor, gently raise an arm and opposite leg slowly, with the leg straight (knee locked), 2-3 inches from the floor. Repeat with the opposite arm and leg.

To strengthen the abdominal muscles:

• For the upper abdominals, lay on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the floor. Do not attempt to lift too high. Do not stress the neck.

• For the lower abdominals, tighten the lower stomach muscles and slowly raise a straight leg 8 to 12 inches from the floor, keeping the low back held flat against the floor. Repeat with the other leg.

Aerobic conditioning may also be encouraged for general fitness. Walking is an excellent form of exercise for the low back, working up to three miles per day.

Later on, a patient may wish to do other types of non-impact aerobic exercise such as an elliptical trainer. Rowing machines and cross-country ski machines should be avoided because these may cause the back problem to become worse.

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