Table of ContentsView AllTable of ContentsAssessmentLocation of a Herniated DiscPinched NervesFinding a PTBenefits of PTFirst 24-48 HoursOngoing TreatmentHerniated Disc ExercisesAfter SurgeryPreventing Herniated Discs
Table of ContentsView All
View All
Table of Contents
Assessment
Location of a Herniated Disc
Pinched Nerves
Finding a PT
Benefits of PT
First 24-48 Hours
Ongoing Treatment
Herniated Disc Exercises
After Surgery
Preventing Herniated Discs
Aspinal disc herniationoccurs when the gel-like inner portion of a disc (thenucleus pulposus) protrudes through the disc’s outer layer (theannulus), often causing pain and disability. Physical therapy (PT) is one of the most commonly used and effective ways to relieve the symptoms of a herniated disc.
This article will discuss how a herniated disc is diagnosed and how physical therapy is used to relieve pain in the short term and over the long term. It includes instructions for performing four commonly prescribed exercises, as well as tips on preventing a herniated disc.
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Assessing a Herniated Disc
Because of the variety of locations where symptoms can occur, a physical therapist (PT) will begin with a thorough assessment. They’ll examine your spine to assess your mobility and the location of your pain.
They will also check the strength in your arm and leg muscles to see if these have been affected. In addition, they will evaluate your sensation and reflexes.
Imaging tests such as X-rays andmagnetic resonance imaging (MRI)are also used to determine the severity and location of a herniated disc.
A herniated disc can occur in any of the three spinal sections (cervical, thoracic, or lumbar), though it is most common in the lower lumbar spine. While discs normally help absorb the stresses placed on the spine, a herniation may make daily life difficult and painful.
Symptoms of a herniated disc vary depending on which area of the spine it occurs.
Aherniation in the lumbar spinemay cause:
A herniated disc in thecervical spinecan cause:
Thoracic (mid-back) disc herniations are rarer, and their symptoms are a bit more diffuse. Most commonly, a herniation in this area causes:
Theresa Chiechi / Verywell
In many cases, a disc herniation will pinch or compress an adjacent spinal nerve. Symptoms of apinched nerveinclude:
When evaluating your pinched nerve, your physical therapist will examine whether moving in a specific direction causes the symptoms in your arms or legs to improve or resolve completely (called centralization).
This is known as a directional preference and will help your PT decide the best exercises for you. Along the same lines, if moving in certain directions causes the pain to worsen (called peripheralization), exercises involving this type of movement are usually avoided early on in therapy.
In some cases, conservative treatments like physical therapy and medications are not enough to relieve the pain that can accompany a pinched nerve. In these situations, surgery may be necessary to remove the herniated disc and stabilize the affected spinal segment.
How to Fix a Pinched Nerve
Finding a Physical Therapist
An orthopedic or a neurologic physical therapist can create a program of exercises suited to you. Your healthcare provider can often provide a referral to a PT.
TheAmerican Physical Therapy Association’s websitecan also help you find an orthopedic clinical specialist (OCS) or a neurologic clinical specialist (NCS) in your area.
How Physical Therapy Can Help
Once you are enrolled in physical therapy, your sessions will have several specific goals. First, you will be given exercises that attempt to relieve pressure on any nerves that are compressed based on your directional preferences.
In general, receiving physical therapy along with pain medication and education about your diagnosis has been found to be equally effective in treating a lumbar disc herniation when compared to surgery after three months.
The first 24 to 48 hours after a disc herniation are often the most painful, and you may be afraid of making your condition even worse. While it is normal to be fearful, it is important to stay active and avoid bed rest.
Light aerobic exercise, like walking or swimming, can help alleviate muscle spasms and relieve some of the pain you are experiencing.Gentle core strengthening and mobility exercises are also frequently recommended to lend support to the spine.
Alumbar tractionmachine that helps relieve the pressure on your spinal nerves may also be useful in the short term.Each of these techniques can help you return to normal more quickly without aggravating your symptoms.
Initial PT treatment in the acute stages of a disc herniation may provide some immediate symptom relief, but it can take some time before physical therapy leads to significant and lasting improvement.
One study found improvements in pain and overall function after six weeks of physical therapy for a lumbar disc herniation. That said, the improvements did not equal those of surgical intervention until the 12-week mark.
Once you are through the acute phase, your therapist will typically focus on intensifying your home-based program. Your therapist will also monitor your form while you exercise to prevent injury.
In addition, while early physical therapy sticks to movements that lead to immediate symptom relief, the later phase of rehab typically involves slowly reintroducing motions that had been painful.
How Much Does PT Cost?The cost of physical therapy varies widely and depends on your specific insurance coverage.To find a PT that is both in-network and cost-effective, contact your insurance provider. Many clinics and hospitals have resources listed on their website to help estimate the cost. Self-pay plans or discounts may be available for people who are in financial need or who are uninsured.
How Much Does PT Cost?
The cost of physical therapy varies widely and depends on your specific insurance coverage.To find a PT that is both in-network and cost-effective, contact your insurance provider. Many clinics and hospitals have resources listed on their website to help estimate the cost. Self-pay plans or discounts may be available for people who are in financial need or who are uninsured.
The cost of physical therapy varies widely and depends on your specific insurance coverage.
To find a PT that is both in-network and cost-effective, contact your insurance provider. Many clinics and hospitals have resources listed on their website to help estimate the cost. Self-pay plans or discounts may be available for people who are in financial need or who are uninsured.
A disc herniation can occur in several different directions and in any of the 23 individual spinal discs. A PT will tailor exercises based on your specific needs.
Some common exercises are listed below. These techniques focus on improving the strength in your posture and core muscles, and relieving any pressure on your spinal nerves.
16 Exercises for Herniated Disc (Back or Neck) Pain
Prone Extension
jmstock / Getty Images
To do this exercise:
While this exercise may cause some low back soreness, it should not make your leg symptoms any worse.
Dying Bug
Ben Goldstein / Verywell
Standing Row
Brett Sears, PT, 2012
Bird Dog
Physical therapy followingsurgeryto treat a herniated disc will focus on getting you up and moving again. Light aerobic and core strengthening exercises are frequently prescribed, though your surgeon may restrict how much weight you can lift safely.
In some situations, afusion procedure(which uses a metal plate to stabilize a section of the spine) may be necessary. If this is the case, certain stretches or movements that place more stress on the surgical site may be contraindicated.
Your PT may also need to instruct you on modified ways to transfer between sitting, standing, and lying down to make these activities less painful.
About Lumbar Disc Replacement Surgery
There is no way to guarantee that you’ll never experience a spinal disc herniation, but there are several steps you can take to prevent one.
One of the first ways is to regularly perform a strengthening regimen that targets the spine—supporting core and posture muscles. This, along with regular aerobic exercise, helps keep the spine healthy and stabilized.
In addition,maintaining an appropriate body weightcan reduce the strain placed on the spinal discs and decrease the likelihood of herniation. Bending your knees and avoiding rounding the spine when lifting heavier objects off the ground is also recommended.
Wearing high heels can also increase the risk of back pain and injuries over time.
10 Things to Stop Doing If You Have Low Back Pain
Summary
A herniated disc occurs when the inner, gel-like part of a spinal disc (whose purpose is to provide a cushion between the vertebrae) protrudes through a tear in the outer layer of the disc. Symptoms of a herniated disc include pain, tingling, and numbness in the extremities. Physical therapy, which involves doing specific exercises over time to strengthen key areas of the body, is an effective way to relieve the pain of a herniated disc.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Amin RM, Andrade NS, Neuman BJ.Lumbar disc herniation.Curr Rev Musculoskelet Med. 2017;10(4):507-16. doi: 10.1007/s12178-017-9441-4American Association of Neurological Surgeons.Herniated disc.University of Maryland Medical Center.Herniated thoracic disc.Mayo Clinic.Pinched nerve.American Physical Therapy Association.Find a physical therapist near you.Gugliotta M, da Costa BR, Dabis E, et al.Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.BMJ Open. 2016;6(12):e012938. doi:10.1136/bmjopen-2016-012938Ahmed S, Khattab S, Haddad C, Babineau J, Furlan A, Kumbhare D.Effect of aerobic exercise in the treatment of myofascial pain: a systematic review.J Exerc Rehabil. 2018 Dec 27;14(6):902-910. doi:10.12965/jer.1836406.205Khanzadeh R, Mahdavinejad R, Borhani A.The effect of suspension and conventional core stability exercises on characteristics of intervertebral disc and chronic pain in office staff due to lumbar herniated disc.Arch Bone Jt Surg. 2020 May;8(3):445-453. doi: 10.22038/abjs.2019.40758.2102Vanti C, Panizzolo A, Turone L, et al.Effectiveness of mechanical traction for lumbar radiculopathy: a systematic review and meta-analysis.Physical Therapy. 2021;101(3):pzaa231. doi:10.1093/ptj/pzaa231Kaiser Permanente.Herniated disc: exercises.American Osteopathic Association.The real harm in high heels.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Amin RM, Andrade NS, Neuman BJ.Lumbar disc herniation.Curr Rev Musculoskelet Med. 2017;10(4):507-16. doi: 10.1007/s12178-017-9441-4American Association of Neurological Surgeons.Herniated disc.University of Maryland Medical Center.Herniated thoracic disc.Mayo Clinic.Pinched nerve.American Physical Therapy Association.Find a physical therapist near you.Gugliotta M, da Costa BR, Dabis E, et al.Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.BMJ Open. 2016;6(12):e012938. doi:10.1136/bmjopen-2016-012938Ahmed S, Khattab S, Haddad C, Babineau J, Furlan A, Kumbhare D.Effect of aerobic exercise in the treatment of myofascial pain: a systematic review.J Exerc Rehabil. 2018 Dec 27;14(6):902-910. doi:10.12965/jer.1836406.205Khanzadeh R, Mahdavinejad R, Borhani A.The effect of suspension and conventional core stability exercises on characteristics of intervertebral disc and chronic pain in office staff due to lumbar herniated disc.Arch Bone Jt Surg. 2020 May;8(3):445-453. doi: 10.22038/abjs.2019.40758.2102Vanti C, Panizzolo A, Turone L, et al.Effectiveness of mechanical traction for lumbar radiculopathy: a systematic review and meta-analysis.Physical Therapy. 2021;101(3):pzaa231. doi:10.1093/ptj/pzaa231Kaiser Permanente.Herniated disc: exercises.American Osteopathic Association.The real harm in high heels.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Amin RM, Andrade NS, Neuman BJ.Lumbar disc herniation.Curr Rev Musculoskelet Med. 2017;10(4):507-16. doi: 10.1007/s12178-017-9441-4American Association of Neurological Surgeons.Herniated disc.University of Maryland Medical Center.Herniated thoracic disc.Mayo Clinic.Pinched nerve.American Physical Therapy Association.Find a physical therapist near you.Gugliotta M, da Costa BR, Dabis E, et al.Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.BMJ Open. 2016;6(12):e012938. doi:10.1136/bmjopen-2016-012938Ahmed S, Khattab S, Haddad C, Babineau J, Furlan A, Kumbhare D.Effect of aerobic exercise in the treatment of myofascial pain: a systematic review.J Exerc Rehabil. 2018 Dec 27;14(6):902-910. doi:10.12965/jer.1836406.205Khanzadeh R, Mahdavinejad R, Borhani A.The effect of suspension and conventional core stability exercises on characteristics of intervertebral disc and chronic pain in office staff due to lumbar herniated disc.Arch Bone Jt Surg. 2020 May;8(3):445-453. doi: 10.22038/abjs.2019.40758.2102Vanti C, Panizzolo A, Turone L, et al.Effectiveness of mechanical traction for lumbar radiculopathy: a systematic review and meta-analysis.Physical Therapy. 2021;101(3):pzaa231. doi:10.1093/ptj/pzaa231Kaiser Permanente.Herniated disc: exercises.American Osteopathic Association.The real harm in high heels.
Amin RM, Andrade NS, Neuman BJ.Lumbar disc herniation.Curr Rev Musculoskelet Med. 2017;10(4):507-16. doi: 10.1007/s12178-017-9441-4
American Association of Neurological Surgeons.Herniated disc.
University of Maryland Medical Center.Herniated thoracic disc.
Mayo Clinic.Pinched nerve.
American Physical Therapy Association.Find a physical therapist near you.
Gugliotta M, da Costa BR, Dabis E, et al.Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.BMJ Open. 2016;6(12):e012938. doi:10.1136/bmjopen-2016-012938
Ahmed S, Khattab S, Haddad C, Babineau J, Furlan A, Kumbhare D.Effect of aerobic exercise in the treatment of myofascial pain: a systematic review.J Exerc Rehabil. 2018 Dec 27;14(6):902-910. doi:10.12965/jer.1836406.205
Khanzadeh R, Mahdavinejad R, Borhani A.The effect of suspension and conventional core stability exercises on characteristics of intervertebral disc and chronic pain in office staff due to lumbar herniated disc.Arch Bone Jt Surg. 2020 May;8(3):445-453. doi: 10.22038/abjs.2019.40758.2102
Vanti C, Panizzolo A, Turone L, et al.Effectiveness of mechanical traction for lumbar radiculopathy: a systematic review and meta-analysis.Physical Therapy. 2021;101(3):pzaa231. doi:10.1093/ptj/pzaa231
Kaiser Permanente.Herniated disc: exercises.
American Osteopathic Association.The real harm in high heels.
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