Exercise program for herniated disc

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.

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Pain that comes as a result of a pinched nerve and runs down the leg from the low back is called sciatica.

The most common cause of sciatica is a bulging or herniated disc. The aim of exercises to treat sciatic nerve pain is to cause the symptoms to move up the leg into the low back.

For many patients, this is done by getting into a backwards bending position.

•The low back is placed into extension by lying on the stomach and propping the upper body up on the elbows, keeping the hips on the floor. This should be done slowly. Some patients cannot tolerate this position initially. This position is held from five to 30 seconds per repetition, for 10 repetitions.

After this exercise, the physician or therapist may recommend a more advanced form of the extension:

•From the prone position, press up on the hands while the pelvis remains in contact with the floor. In yoga this is called the "cobra" pose. This position is typically held for 1 second and repeated 10 times.

A similar exercise can be done standing by arching backward slowly with the hands on the hips if the patient is unable to lie flat. However, the prone position is preferred.

These “extension” exercises are done often, about every two hours. More importantly, the person with sciatica should avoid getting into a forward flexed (bent over) position. This tends to negate the effects of the extension exercises.

As the pain works out of the leg, the patient will receive new exercises to help strengthen the low back and abdominal muscles This will prevent recurrences of sciatica caused by a herniated disc. To strengthen the low back muscles:

•In the prone position and hands clasped behind the lower back, raise the head and chest slightly against gravity while looking at the floor (stay low). Keep the eyes down so the neck is not extended.

•While in the prone position with the head and chest lowered to the floor, raise an arm and opposite leg slowly, with the knee locked in extension, 2-3 inches from the floor.

To strengthen the abdominal muscles:

•For the upper abdominal muscles, lie 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 about 4-6 inches. Do not lift too high. For patients with neck pain, place the hands behind the head. Do not pull on the neck.
•For the lower abdominal muscles, 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. Hold for 10 seconds. Repeat with the other side. Do 5-10 repetitions.

Aerobic conditioning may also be encouraged for general fitness. Walking is an excellent form of exercise for the low back.

Aerobic exercise is one of the most effective means of speeding recovery, preventing re-injury to the back, and reducing the risk of disability from back pain.

•Walking, swimming, and bicycling are all good forms of exercise. Non–weight-bearing exercises, such as swimming and cycling are also good, particularly if the pain is still present.
•Aerobic exercises can usually be started within 1 or 2 weeks after symptoms have begun to subside.
o Increase the amount of aerobic exercise gradually.
o Start with 5 to 10 minutes a day and gradually work up to 20 to 30 minutes of continuous activity per day.

•Consult your physician or therapist before beginning an aerobic exercise program.

Isometric exercises also strengthen the core muscles.

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