An effective treatment for severe, pain-inducing sciatica caused by a herniated disc is controlled exercise and rehabilitation. A pain management intervention such as medication or an injection of lumbar epidural Steroids may be necessary if the pain becomes too severe to allow you to continue with your exercise program.
Targeted exercises designed to relieve sciatica from lumbar herniated discs typically have two primary goals.
- Reduces severe sciatic pain
- For longer-term healing, rehabilitation is provided
Lumbar herniated Disc exercises activate and strengthen abdominal, deep spinal and gluteal muscles. It will depend on the duration of symptoms and severity of the pain to determine how much physical therapy or exercise is required for lumbar herniated spine.
What is the McKenzie Method and how can it help you?
Robin McKenzie (a New Zealand physical therapist) developed the McKenzie Method. The main purpose of McKenzie’s method was to alleviate symptoms caused by herniated discs. He created a series if progressive exercises to decrease symptoms radiating into the arms and legs.
The McKenzie Method
Robin McKenzie was a Physical Therapist who discovered that stretching the spine could offer significant pain relief to some patients. He developed a series of exercises and maneuvers that allow patients to play a greater role in their ongoing health.
The McKenzie Method long-term goal is for patients with back or neck pain to learn how to care for themselves. Other goals include
- Reduce pain quickly
- You can return to normal functioning in your daily activities
- Minimize the possibility of recurring painful situations (eliminate painful postures and movements).
- Reduce the number return visits to your spine specialist
McKenzie offers a variety of positions to help with back pain. Your back pain may be particularly acute so you might not be capable of working through all stages immediately. This is a case where you should go through every stage and continue to work until your pain subsides. McKenzie has four stages to help you get through the exercises: prone lie, prone lying while resting your elbows on your elbows and prone push-ups. Also, there are progressive extensions with pillows and standing extensions. There are many versions of McKenzie’s exercise sequence that add or remove different stages depending on what you think of the original sequence.
What is a herniated or bulging disc?
Imagine holding a disc that is a part of our spine and feeling it feel like a jelly. It’s like a jelly sandwich, but wrapped in thick ligaments. Continue to squeeze the jelly between your palms on each side. The jelly will eventually push off on the opposite side. It is basically the same thing happening in our spine.
The disc can become pushed into its protective outer ring by sudden injury, compression from above and below, or wear and tear over time. This bulge, or as it is called, can cause certain movements to be restricted and put pressure on nearby nerves. It’s important to bring the disc back into its center. The McKenzie Method works in the opposite direction to injury.
Centralizing the Disc
If there is a bulge pressing posteriorly, then bending forward or sitting and trying to get from one place to the next will cause more pain. The lumbar spine naturally extends when we stand or walk. Because the extension of the lower spine is different from being bent over or hunched, it reduces disc bulge. It pushes the disc pressure forward, creating suction. This can also pull the disc material into the disc.
Depending on the severity, we will help you choose the best exercises to start and then progress to. These exercises will help to not only centralize the disc but also strengthen the surrounding muscles. Patients can choose the direction they prefer that minimizes leg symptoms. During the acute phase (the first seven to 10 days after a new injury), we recommend going in the direction your body prefers. We suggest doing 20 reps each hour. To put it another way, gentle cobra extensions of 20 reps should be done every hour if you have an anterior lumbar disc herniation. Start slow and build up slowly as the pain diminishes.
Exercises for Sciatic Nerve Pressure Caused By a Herniated Lumbar Disc
For sciatica due herniated disc, there are many strengthening exercises and stretching options. The following categories of exercises are:
- McKenzie method
- Exercises to strengthen your abdominal and back muscles
- Abdominal and Back Stabilization Exercise
- Nerve mobilization exercise
Nerve mobilization treats nerves suffering from adhesions. These are fibrous soft tissue bands that become stiffened due to inflammation. The adhesions eventually cause pain from the spinal nerve root, and can travel down the leg, as sciatica.
Exercises to Strengthen Abdominal Muscles
When lying on the stomach, exercises to build stability and strength in the abdominal muscles can be done.
Curl-ups are for the upper abdomen muscles
- Start by lying on your back with your knees bent, and your feet flat to the floor.
- Turn your arms in a cross-over fashion and place your pelvis on the floor.
- Gently lift the shoulders and head off the floor.
- Hold the position for between 2 and 4 seconds. Then slowly return to the original position.
- Your strength will increase and you will be able to do two sets of 10 curls.
- Do not lift your head too high. To alleviate neck pain, rest your hands behind your neck.
Single leg lifts for the lower abdominal muscles
- Start by lying on your back and tightening your stomach muscles.
- Slowly raise one foot 8 to 12 inches above the floor without bending the knee.
- Place your opposite leg against the floor and keep your back low. Slowly lower your leg to the starting position by holding it up for 8-10 seconds.
- Your strength will increase and you can complete two sets of 10 lifts.
Water therapy can be used if the exercises are too painful. The buoyancy water provides assistance, which can reduce the pain. Water exercises can be especially helpful for strengthening the hip and lower abdomen muscles.
Sciatic Nerve Glide Exercise
Nerve mobilization (nerve stretching) and glide exercises (nerve mobilization) are intended to release nerve tension and make nerves more flexible. Follow these steps to mobilize sciatic nerves.
- To straighten your knees, place one leg on a chair. The other must be flat on the ground.
- Slowly bend the ankle until your toes point up.
- Continue to bend your ankle backwards, pointing your toes up and outward.
- As tolerated, try to increase tension on the sciatic nervous by gliding with the head bent forward. Bring the chin towards your chest.
- Repeat the movement with the other leg.
- Each leg should be completed at least 3 times per day.