You have a herniated lumbar disc your doctor says, and shows you a picture of an MRI. Well, that explains the symptoms youve been feeling the sharp back pain, the pain along your sciatic nerve, and the numbness/tingling. The treatment: surgery (if it bothers you enough). And although youre not terribly enthusiastic about going under the knife, you dont want to keep experiencing the symptoms of it, either. So you give yourself a deadline: let me see if I can improve this with exercise in X number of months, and if I cant, then Ill get the surgery. Smart choice
Unfortunately, if youve looked online, you probably havent seen any great resources on how to exercise with a hernia. Fortunately for you, youre a reader of my articles, and here, you will get some helpful information on working out with a hernia.
And if you dont have a hernia, but know someone who does, forward this article to them, because it can help them relieve their pain, and recover from surgery quicker (if they decide to have it).
If youre the one with the hernia, and want advice specific to you, we have a special program for that. If you want to see whether this program is for you, just email me with the words Hernia Help in the subject line.
What is a Hernia?
The general term hernia means protrusion. Some part of your body is protruding through some other part of your body. A hiatal hernia is when your stomach is protruding through your diaphragm. An umbilical hernia is when your intestines are protruding through your abdominals. The same applies to other hernias.
This article specifically is about lumbar hernias (hernias in the lower back). Thats when the fluid inside the discs between the spine (called the intervertebral discs) protrudes outside the spine.
Herniated Disc vs. Bulging Disc
Very often, a hernia (AKA herniated disc AKA slipped disc) is used interchangeably with a bulging disc. But the two should not be used interchangeably, as theyre 2 different things.
Lets make some distinctions.
A herniated disc (a hernia) is when the fluid inside the disc oozes out of the disc. The reason that it oozes out is because the walls of the disc tear. When it oozes out, if it oozes out far enough, it will touch a nerve, and then you get all those nervy symptoms, from numbness and tingling, to full-blown sciatica. Since a picture is worth a thousand words (or in this case, 11 words, since thats how long it took me to describe what a herniated disc is), heres what that looks like.
With a bulging disc, nothing is torn, and nothing oozes out. The fluid in the disc is still in the disc, but the whole disc bulges out of place. Heres what that looks like.
But in terms of exercise for herniated disc and bulging disc, its the same.
What Causes Herniated Lumbar Discs
If you read mainstream websites, theyll list aging as a cause of herniated discs. But thats not good enough for me. What is it about aging that causes discs to herniate? And why do 2 people of the same age have differing probabilities of herniation? Why can one 70-year-old herniate their disc, and another 70-year-old of equal strength be just fine? Because of the thickness of the disc. The more collagen you have, the less likely you are to have the wall of the disc tear.
What influences how much collagen you have?
- The protein content of your diet (collagen is a protein) the more protein, the more collagen, to a point. As I wrote in my article on nutrition over 60, people over 60 need more protein than people under 60, because their absorption isnt as good.
- The vitamin C content of your diet. Vitamin C contributes to the production of collagen.
- Genetics
The other factor that plays a big role in your risk of lumbar disc herniation is your mechanics in whatever activities you do, whether its job-related, sport-related (tennis, golf, etc.), or exercise related (poor lifting technique). If your mechanics are not correct, youll be more likely to herniate a disc. Hence, for job-related activities, its good to check with an ergonomist and occupational therapist if your equipment at work is set up properly, and if youre moving properly.
If you participate in a sport, its good to hire a quality coach to check on your technique, and nag you when you dont do it properly.
And for exercise, its not a bad idea to work with a good trainer (emphasis on good. Over 90% of trainers are not in that category) to correct your technique if it starts to slip.
So combine poor mechanics, with nutrition that isnt supportive of connective tissue health, and you have the perfect environment for a lumbar disc herniation.
Biggest Mistakes When Exercising with a Lumbar Hernia
You already know that you have a herniated disc, and you think that exercise will help. And youre correct. Partially. The right exercises will help. The wrong exercises will make it worse. In this section, well go through some of the most common mistakes people make when trying to improve their hernia with exercise.
In no particular order:
Mistake #1: Toe Touching Exercises
Whether youre doing a sitting toe touch, a standing toe touch, or a single-legged toe touch, it could increase your risk of a lumbar hernia (and if you already have one, itll make it worse), because itll push the disc even further out.
Either dont do it, or if youre going to do them, hinge at your hips, not at your spine.
Mistake #2: Twisting Exercises
These can also push the disc further out. Its worse if youre doing high-velocity twisting (like golf and tennis).
Mistake #3: Complete Rest
Complete rest may seem like a good idea, but it actually takes longer to recover from a herniated disc with complete rest than with some light activity.
Mistake #4: Crunching-based Abdominal Exercises
Every crunch and situp you do pushes the disc farther and farther out.
Mistake #5: Slouching
Slouching is essentially a forward bend, so whether youre slouching when sitting or slouching when standing, it can make your hernia worse. So listen to your mom stand up straight!
Mistake #6: Only Using Passive Therapies
While massage, chiropractic, acupuncture, etc. may be very helpful, theyre rarely a complete treatment. As I mention in my article on dealing with injuries mentally, you need to be an active participant in your own rehabilitation.
Mistake #7: Not Getting Assessed
As I say in many of my articles, if youre not assessing, you are guessing. What I mean by that is that in all likelihood, there are muscular imbalances that predispose someone to a hernia. And although there are general imbalances that we can speak about, you may not be general, and they may not apply to you. Or they may. But you dont know, until you get an assessment.
How to Exercise with a Hernia
You now know what causes hernias, the biggest mistakes people make when trying to recover from hernias, but you dont yet know what to do. So Ill teach you in this section.
Probably the two most effective exercises for a herniated disc are variations of back bends (like the cobra stretch from yoga), and spinal decompression (like hanging off a chinup bar).
The reason that back bends are effective is they move the disc back to where it came from, since the disc usually protrudes backwards. I would aim to do these 1-2 times per day for 30-120 seconds each.
Spinal decompression is effective because it opens up the space between the vertebrae. Id work up to accumulating 2-3 minutes throughout the day.
These are just two examples, and general categories. There are other exercises that fit the categories of back extension and spinal decompression, so if my example from this section dont work for you for whatever reason, there are other options.
In addition to these two, it would be beneficial to do general core stabilization exercises, like planks, side planks, Pallof presses, stir the pot, and others.
I usually steer clear of recommending one-size-fits-all exercises, since nothing works for everyone. These exercises will be beneficial for some people, useless for others, and yet damaging for a third group. You can take your chances, or if you want something more precise, you can get an assessment. My team and I can help with that
What to Expect
What can you expect as a result of the right exercise program? Can a herniated disc heal on its own? I never want to say never, but its highly unlikely (although a bulging disc can just go back in its place spontaneously after a few months). Fortunately, it doesnt need to heal necessarily to stop causing problems in your body.
So if it wont necessarily heal, what can you expect?
- A decrease or elimination of pain
- Better strength
- More energy levels
- Avoid or delay surgery
As mentioned early in this article, if youd like some help with those, just email me with the words Hernia Help in the subject line.
