Introduction
After a herniated disc in the lumbar spine, it is important to relieve the burden on the loaded structures and to avoid incorrect posture and strain. This can be achieved by specific exercises for strengthening and mobilisation, gymnastics or even equipment-supported training at home as well as in physiotherapeutic treatment. At the beginning it is important to make a detailed diagnosis to find out exactly which structures cause individual problems for the patient or which postures or activities led to the herniated disc.
Gymnastics
Gymnastic exercises are recommended for herniated discs, as they are easy to perform and do not require special equipment. You can train with your own body weight and thus improve your perception of certain postures, which may damage the lumbar spine. First of all it is essential to train a good body perception.
This can be practised in front of a mirror. The physiotherapeutic exercises for a slipped disc in the lumbar spine are relatively easy to implement, but must be carried out precisely and correctly in order to prevent further damaging incorrect loading. Body awareness can be practiced well in an upright position.
The patient places himself frontally in front of a mirror and closes his eyes. Next, he directs his attention to his feet, which are about hip-width apart, and shifts the weight from the forefoot to the heel and from right to left. The aim is to put equal weight on both feet.
The right and left foot press equally hard into the ground. Now we direct our attention to the knees, which should never be completely pushed through when standing upright, but rather slightly bent. Here too, it is easier to find the correct position by testing, by first pressing the knees very firmly backwards and then deliberately bending them slightly.
A comfortable middle position should be found. In between, the patient observes his posture in the mirror. Now we approach the lumbar spine.
The patient now concentrates on his pelvis. It often helps to place the hands on the protruding pelvic bones at the beginning. Now the pelvic tilt is practiced.
The movement of the pelvis is accompanied by a movement of the lumbar spine. Often the mobility after a herniated disc is restricted by pain or relieving postures and must be regained. However, a lack of mobility can also lead to constant incorrect loading of individual spinal column sections and thus be one of the causes for the development of the herniated disc.
Our lumbar spine can perform several movements. Via the pelvis, the ventral and dorsal pelvic tilt can be practiced particularly well. This means the forward tilting of the pelvis (ventral), in which an increased hollow back is created in the lumbar spine, and the rolling of the pelvis backwards (dorsal), in which the lumbar spine makes itself round and bends.
During this movement, the patient feels how the pelvic bones first move forward and down and then backward and up. It is important that the thorax does not move with the movement (self-control mirror) and that the movements come from the lumbar spine. If the exercise is difficult in a standing position, it can also be performed in a sitting position.
Here the ischial tuberosities serve as a control point, which move forward and backward over the chair surface when the pelvis rolls (hollow back – ischial tuberosities point backward, hunchback in the lumbar spine – ischial tuberosities point forward). These movements are fundamental for conscious and correct training and should be well practised and internalised. Depending on the findings, a specific exercise program for the herniated disc in the lumbar spine can then be developed.
A frequent component is the so-called basic tension or core activity. This exercise serves to strengthen the muscles in the back, i.e. the buttocks, the back of the thigh and the back muscles. The patient lies on the mat in a supine position and assumes a neutral spinal position (try again, first make an increased hollow back, then press the lower back into the mat – the middle position is the correct starting position for this exercise).
The patient puts his legs up and pulls his toes up so that he has contact only with his heels. About two fists fit between the knees. The hands lie next to the body with the palms facing upwards, the head rests on the floor in extension of the spine, the gaze goes to the knees (so that one does not get into over-extension of the cervical spine).
This is the starting position for this and many other alternative exercises. Now the patient builds up his basic tension with the exhalation, that means he tries to tense his muscles in such a way that the whole body is firm and, if you would turn him to the side at the knees, the whole body would follow. We build up this tension systematically by pressing the heels firmly into the pad, tensing the buttocks, pulling the navel star-shaped towards the spine, pressing the shoulder blades and arms firmly into the pad and making a slight double chin with our head.
The tension is held for 2-5 breaths and released bit by bit. From this position, if the basic tension can be safely assumed, many exercises can be done for coordinated strengthening of the lumbar spine, e.g. lifting the buttocks out of the basic tension (bridging), lifting a leg, lifting the arms, possibly with a rod, without releasing the tension. The individual exercises should be adapted to the patient and should first be discussed and practiced with his physiotherapist or trainer in order to avoid a possibly incorrect and damaging execution.
Since a herniated disc in the lumbar spine is often accompanied by insufficiently strong abdominal muscles, it is also important to train them specifically. For this purpose, holding exercises from the starting position of the basic tension in supine position are recommended. For example, you can press your slightly bent arms against your erect thighs while exhaling, while your legs do not want to give in to the pressure.
This creates tension in the straight abdominal muscles. The increased pressure on one side allows you to train the lateral abdominal muscles specifically. Variations of crunches and sit-ups should be practiced urgently with a therapist, many unfavorable mistakes can be made here.
Another good exercise is the forearm support, which, similar to the basic tension in the supine position, now leads to strengthening for the front muscle chain (i.e. abdominal muscles, front thigh, chest muscles). The patient is in the prone position and lifts the upper body. The elbows are below the shoulders, the forearms are parallel and side by side.
The knees remain on the floor at the beginning and can be lifted later to reinforce the exercise. The spine forms a straight line with the thighs, the view points towards the floor, the cervical spine is long and stretched. Also from this position many exercise variations can be built up, which should be worked out in an individual training plan.
For example, “supporting pillars” (i.e. an arm or a leg) can be lifted off the floor while the patient tries to keep the trunk in balance and does not allow any movement there. Other favourable positions are the four-footed position, the seat, the knee bend and many more. If the basic tension is mastered, exercises in all possible positions can be adapted to the patient.
Furthermore, the gymnastic exercise program after a herniated disc of the lumbar spine naturally also includes the training of any muscle weaknesses or pareses that may have resulted from the prolapse. In case of weakness of dorsiflexion of the foot, the tightening of the foot can be practiced, and in case of weakness of the thigh muscles, knee bends, for example, can train the weakened muscles. Later, the gymnastics can be supplemented by small devices such as dumbbells or a Thera-band. Also the improvement of the sensitivity, if it should have been limited, can be achieved in the gymnastics. The patient trains with his own body weight and has a lot of contact with the floor or performs exercises that require a high degree of self-perception.
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