PT on the Net Research

Herniated Disc


Question:

I have a client who has a herniated disc in her spine. Where can I find modifications for her and information on this condition?

Answer:

One of the first questions that needs to be addressed is "where" is the herniated disc located? The neck (cervical area), the thoracic (mid-back) or the most common area, lumbar-sacral region (low back). Next, how did this problem occur? Was it from trauma (a frank herniation) or an accumulation of small traumas or chronic injuries? Which direction is the "bulge" pointing? Are they symptomatic (pain is present)? Could it be from extreme deconditioning (which seems to be the main reason for most low back pain)? One study estimated that 97 percent of back pain is from deconditioning.

Just guessing, I will go with the low-back, herniated disc problem. Training someone with this problem can be challenging but rewarding. The McKenzie System recommends working the extension phase of the spine. Other specialists also recommend spinal extension training. This starts with a limited ROM and works into a greater and greater ROM. Loads are nonexistent until an appropriate ROM is established.

Other suggestions include improve flexibility in the hip flexors, hamstrings, quads, low back, IT band, adductors (groin) and the mid-upper back and chest areas including the shoulder girdle. Strength training may follow low reps/low weight to start and increase the work load by increasing reps, not weight, at first. For exercise, you may want to try standing work first, which will help alleviate the pressure in the lower lumbar. Seated positions create the greatest pressures in the lower spine.

The type of exercises should probably follow straight lines. Eliminate twisting under tension, little or no over head pressing, limited abdominal flexion and emphasize good posture. Another suggestion is to LISTEN to your client. When she "feels" pain, believe her. Try to establish exercises that the client "feels" a position of comfort with. This helps the client psychologically over come the "fear of pain."

References:

  1. Donelson, R. Identifying appropriate exercises for your low-back pain patient. Journal of Musculoskeletal Medicine. (1991): 8(12).pp 14-29
  2. McKenzie,R. Treat your own back. 6th edition. Spinal Publications. New Zealand (1996)
  3. Kuritzky, L and J. White. Low back pain: Consider extension education. The Physician and Sports Medicine (1997) vol.25, no.1
  4. Nachemson, A. In vivo discometry in lumbar discs irregular nucleograms. Acta Orhtopedia Scandinavia (1965) vol.36.no.125