What to Expect From Herniated Disc Physical Therapy

A spinal disc herniation is a relatively common diagnosis that occurs when the gel-like inner portion of a disc (called the nucleus pulposus) protrudes out through a torn portion of the outer disc layer (called the annulus).

This issue 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.

Fortunately, physical therapy may be able to combat the symptoms of this sometimes challenging diagnosis. This article will discuss how you may be assessed for herniated disc, initial and ongoing physical therapy, exercises, and prevention.

Assessing a Herniated Disc

Finding a disc herniation on a magnetic resonance imaging (MRI) scan does not automatically mean that you will be in pain. However, this issue can lead to a variety of symptoms.

A herniation in the lumbar spine may or may not cause you to have low back pain, depending on its location. It can also lead to pain in the buttocks, legs, or feet if the disc material makes contact with one of the spinal nerves in this region. If pinching or nerve compression occurs, you may have weakness, tingling, or numbness in your legs.

A herniated disc in the cervical spine can cause pain or spasm in the neck and shoulder blade (scapula). If the condition progresses to the point where the herniation pinches a nerve in the region, the pain may shoot down one of your arms and cause numbness, tingling, or weakness in the arm, hand, or fingers.

Thoracic (mid-back) disc herniations are rarer, and their symptoms are a bit more diffuse. Most commonly, a herniation in this area causes abdominal, upper back, or lower back pain. The symptoms can also shoot down into one or both of your legs and lead to weakness in the extremity.

Because of the wide variety of locations where symptoms can occur, a physical therapist (PT) needs to begin with a thorough assessment. In addition to asking you about the origins of your condition, a PT will examine your spine to assess your mobility and the location of your pain.

They will also usually check the strength in your arm and leg muscles to see if these have been affected. In addition, they need to evaluate your sensation and reflexes, as these can provide insight into the presence of a herniation.

Once they gain a better understanding of your individual problem, they can provide beneficial treatments to help improve your pain.

Pinched Nerves

In many cases, a disc herniation will pinch or compress against an adjacent spinal nerve. When this occurs, the resulting pain, numbness, tingling, or weakness will typically spread into the extremities (the arms for a cervical herniation or the legs for a lumbar or thoracic herniation).

When evaluating your pinched nerve, your physical therapist will typically 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 dictate the type of exercises your PT prescribes. Along the same lines, if moving in certain directions causes the pain to worsen in your extremity (called peripheralization), exercises involving this type of movement are usually avoided early on in therapy.

Unfortunately, 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 to stabilize the affected spinal segment.

Physical Therapy for a Herniated Disc

After you have been diagnosed with a herniated disc by your doctor and therapy has been deemed appropriate, it is important to find a PT experienced in treating this type of condition.

Typically, either an orthopedic or a neurologic physical therapist will be well versed in helping patients with this diagnosis. The American Physical Therapy Association’s website can help you find an orthopedic clinical specialist (OCS) or a neurologic clinical specialist (NCS) in your area.

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.

Next, core stabilization exercises are typically prescribed to help stabilize the spine. Aerobic conditioning is added to help with your endurance. Finally, stretching and manual work by the therapist will assist in improving your overall flexibility.

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.

First 24-48 Hours

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, your physical therapist will typically educate you on the importance of staying active and avoiding 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.

In addition, a machine called lumbar traction 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.

Ongoing Treatment

Once you are through the acute phase of a disc herniation, your therapist will typically focus on progressing your initial home program.

Core strengthening exercises are typically made more challenging to ensure that you have adequate strength in these important support muscles. Your therapist will also monitor your form while you exercise to safeguard against potentially harmful compensations.

In addition, while early physical therapy typically sticks to movements that lead to symptom centralization, the later phase of rehab typically involves slowly reintroducing motions that were previously irritating.

When your condition has been successfully managed and symptoms have subsided, your PT will usually create an individualized program for you to continue with after you are discharged.

Herniated Disc Exercises

A disc herniation can occur in several different directions and in any of the 23 individual spinal discs. Because of this, the program that a therapist provides is unique to your specific condition.

That said, several of the most commonly issued 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.

Prone Extension

To do this exercise:

1. Begin by lying on your stomach for five minutes. If this exercise is beneficial, this position should alleviate some of the symptoms in your legs.
2. Once this position is comfortable, progress the exercise by propping yourself up on your elbows. Try to hold this pose for up to five minutes.
3. The technique can be advanced further by pressing your upper body off the ground with your arms. Complete three to five sets of 10 press-ups if you are able.

While this exercise may cause some low back soreness, it should not make your leg symptoms any worse.

Dying Bug

To do this exercise:

1. Lie on your back with your knees bent and your feet on the floor.
2. Contract your abdominal muscles so that your low back is flat against the ground.
3. Keeping the core squeezed, march your legs off the ground and slowly back down one at a time.
4. Then, alternate lifting your arms overhead and back to your side.
5. Continue to cycle between your arms and legs. Complete three sets of five repetitions each day.

Standing Row

To do this exercise:

1. Secure a resistance band in a door, and hold each end of the band in your hands.
2. With your arms by your side, pull backward on the band with both hands as you squeeze your shoulder blades together.
3. Keep your shoulders from shrugging and do not crane your neck forward as you complete this motion.
4. Perform three sets of 10 repetitions of the rows per day.

Bird Dog

To do this exercise:

1. Get onto your hands and knees, and begin by squeezing your stomach muscles so that your low back is flat like a tabletop.
2. Without allowing your pelvis to tilt, raise one arm over your head as you extend the opposite leg behind you.
3. Hold this position for five to 10 seconds before returning to the starting position and repeating with the opposite extremities.
4. Try two to three sets of 10 repetitions daily.

Physical Therapy Following Surgery

The physical therapy that you receive following spinal surgery is similar to the treatments described above, although there are a few unique differences.

Early on after a procedure, your therapy will focus on getting you up and moving again. Light aerobic and core strengthening exercises are frequently prescribed, though your surgeon may give you a lifting restriction which can limit the amount of weight utilized in therapy.

In some situations, a fusion procedure (which uses a metal plate to stabilize a section of the spine) may need to be completed by your surgeon. 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.

Prevention

There is no way to completely 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 weight can reduce the strain placed on the spinal discs and decrease the likelihood of herniation. Utilizing proper body mechanics (using your legs and avoiding rounding the spine) when lifting heavier objects can also be helpful.

Finally, avoiding high-heeled shoes and smoking may further decrease your chances of experiencing this spinal issue.

Summary

If you have a herniated disc, you may be referred to physical therapy. The therapist will assess your condition and set goals. You will be given exercises to relieve nerve compression and stabilize the spine. Therapy progresses to improving your aerobic condition and flexibility. If surgery is needed, physical therapy may also be done afterward.

A Word From Verywell

Dealing with a herniated disc in your spine can be frustrating and quite painful at times. This condition can dramatically hinder your ability to go about your day, and it can make everyday activities extremely difficult.

Fortunately, the treatments provided by a physical therapist can help improve your pain and set you on the road to recovery. If you are experiencing any of the symptoms detailed above, be sure to ask your doctor about a referral to a qualified physical therapist.

Frequently Asked Questions

How does physical therapy help with a herniated disc?

Physical therapy can help improve the symptoms of a herniated disc by reducing the pressure that it places on your spinal nerves. It can also build strength and increase flexibility in the muscles that support the affected area of your spine.

How long does physical therapy take for a herniated disc?

The initial treatments that a PT utilizes 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.

How much does physical therapy cost for a herniated disc in the neck?

Analyzing the cost of physical therapy can be challenging. Insurance reimbursement varies depending on insurance coverage and the location where the service is delivered. Most policies have unique co-pays, deductibles, and out-of-pocket amounts that can significantly impact the amount billed.

To help find appropriate therapy care that is both in network and cost effective, be sure to contact your insurance provider. Many clinics and hospitals have billing resources listed on their website to help estimate the cost. Self-pay plans or discounts may be available for individuals who are in financial need or who are uninsured.