Exercises and techniques

Together with the therapist, strategies are worked out how the patient can protect his back in everyday life (workplace design, back-friendly lifting…). The correct handling of the back is developed in the back school. Possibly this can also take place in group therapy.

The mobility of the back should be restored in all directions as well as possible. Mobilisation techniques (stretching, manual therapy, gymnastic exercises) can be considered. In order to protect the back from further incorrect strain, stability is also important.

A targeted strengthening program is therefore part of the physiotherapeutic treatment for a slipped disc. Depending on the status of the patient, specific muscle groups are strengthened. The abdominal muscles stabilize the back from the front and can counteract a hollow back.

The back muscles stabilize the back from behind. The cervical spine can also be mobilized through targeted movements, and here too there are strengthening exercises that improve posture. Shortened muscles (e.g. shoulder-neck muscles) can be stretched.

The so-called autochthonous back muscles go from vertebra to vertebra and play an important role in stabilizing the spine. It is very difficult or impossible to control it arbitrarily. However, the back muscles can be strengthened through targeted coordinative training.

It is important to build up a strong, functional trunk musculature, or core musculature. The choice of exercises is versatile, but should be discussed with the therapist, since incorrect execution can quickly lead to overloading of damaged structures. Our spine makes it possible for us to stay in an upright body position all day long and to bend, stretch and rotate during countless everyday activities.

Our intervertebral discs, which act as a buffer between the individual vertebral bodies and passively move with every movement, are a weak point in this system. With repeated one-sided movements and long-lasting static loads, such as when sitting for long periods of time, the gelatinous core of the intervertebral disc evades the one-sided pressure and moves in the opposite direction.Also bent activities such as gardening or “wrong lifting” over longer time lead in the long run to a pressure load on the rear fiber ring, in which the disk core lies embedded. Constant overweight, a weak trunk musculature and weak connective and supporting tissue can be added as risk factors.

At some point, the fibrous ring can no longer withstand the pressure load, only small tears occur, until a sudden movement or lifting process usually causes an acutely painful herniated disc. This acutely painful event is therefore preceded by a long process, which has usually already made itself felt through recurring back pain attacks. However, a herniated disc can also be detected as a chance finding during an MRI (magnetic resonance imaging) without the person concerned having any complaints or having had them in the past.

The pain picture is therefore dependent on the location of the herniated disc, among other things. More than 100,000 people are operated on a herniated disc every year in Germany, many of whom unfortunately continue to complain of pain after the operation. Therefore, the decision to undergo surgery should only be made after a targeted conservative therapy and exact consideration of all factors, if there are no acute paralysis symptoms or a bladder and rectum weakness.

In any case, regardless of whether the herniated disc has to be treated conservatively or surgically, patients require immediate and consistent medical pain therapy to eliminate the acute pain and prevent its chronicity. In addition, physiotherapeutic treatment should be initiated as early as possible, so that the patient can actively participate in the healing process and in the long run prevent late damage and recurrence (relapse).

Precise diagnostics and consistent pain therapy by the doctor
Temporary relief – the emphasis here is on temporary relief for a few days – lying down in a most comfortable position.
It is not important whether the patient is lying on his back in a stepped bed, on his side or even on his stomach, which depending on the location of the herniated disc can also bring relief. Experience has shown that it is best to change the positions frequently depending on the perceived relief and to start with light movement exercises as soon as possible while lying down.
Heat applications in the form of hot-water bottles, grain bags or one-time use fango packs are often perceived as pleasant and pain-reducing due to the increased blood circulation and muscle relaxation achieved.
Walking, normally the bed can be left after a few days and the lying phases can be interrupted by walking. By moving around in a more or less upright position due to the pain, even a slight mobilization of the pelvic joints and the lumbar and thoracic spine is initiated.
The movement sensors in the joints and muscles that are activated by movement overlay pain-inducing nerve receptors and provide pain relief in the back. If possible, climbing stairs and walking outside should also be performed.
Taping of the lumbar spine From the beginning it makes sense to apply a tape in the lumbar spine. This serves primarily for muscular relaxation and to improve the metabolism.
The so-called kinesiotapes do not have the task of supporting the spine. Because the Kinesiotapes constantly trigger a stimulus through the skin by the movement it comes to a pain relief without side effects and a facilitation of movement is achieved.

Taking the medical history = pain history: often there is a long “back career” Taking the visual findings: here a clear pain relief can often be observed Palpation findings: here one often feels a strong, often unilaterally emphasized protective tension of the musculature During the physiotherapeutic examination of the findings, the medical history, visual findings and palpation findings are carried out first. This is followed by functional, provocation and nerve tests, which are checked at regular intervals during the treatment series in order to monitor progress and document any improvements. The patient is thus more motivated to continue his treatment and his active exercise program intensively.