Lumbar-Disc

Lower back pain is one of the most common conditions presenting to physiotherapy. A common presentation of lower back pain includes sciatica often caused by a lumbar spine disc injury. These injuries are most common in people between the age of 35-60 years old. Patients often complain of pain in the lower back, buttock, back of the thigh and calf. People may often note pins and needles or tingling in a part of their lower leg or foot. A lumbar spine disc injury can occur often with a bending, twisting or lifting injury or occasionally come on slowly over time. The pain is generally worse with sitting, driving and bending and improved with walking but an acute disc injury may be painful with all positions and activities.

What is the physiotherapy treatment for a lumbar spine disc injury?

As with most conditions the most important aspect of treatment is a comprehensive physiotherapy assessment to determine the exact nature of the injury. Many lower back injuries and even sciatica can present differently and need a different treatment. Your physiotherapist will perform a clinical exam and then explain the injury and course of treatment to you. One of the most important aspects of the assessment will be to determine if you have a true compression on one of the nerves in the lower back. If this is present it will affect your course of therapy and your doctor will be contacted. Treatment at Nose Creek Sport Physical Therapy may include manual therapy, education on what you can do yourself for your injury, anti-inflammatory modalities, traction and occasionally acupuncture or intramuscular stimulation. The latter stages of rehabilitation include progressive strengthening of your lower back and abdominal muscles to prevent re-injury and help you return to your recreational or work activities depending on your goals.

For further information on the Nose Creek Sport Physical Therapy treatment for lumbar spine disc injuries feel free to contact us to arrange an appointment.

Exercises for Lumbar Disc

  • Level 1

    HIP FLEXOR

    • Kneel down on one knee, transfer your weight forward, then squeeze your cheek until you feel a gentle stretch on the front of your hip.
    • Maintain trunk posture upright.
    • Hold for 20 to 30 seconds repeat twice on each side.

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    RECRUITMENT TRANSVERSUS ABDOMINAL

    • On your hands and knees maintain normal breathing while you activate your lower abdominals (draw your belly button inward) and your pelvic floor muscles (by stopping the flow) 20 to 30% of a maximum contraction.
    • Hold for 10 seconds, relax for 10 seconds – Repeat 10 times.

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    STABILIZATION MULTIFIDUS

    • Your back is in neutral position (slightly arched) and your chin must be tucked in.
    • Activate your lower abdominals by drawing in your belly button and your pelvis floor muscles by stimulating stopping the flow., 20 – 30% of maximum contraction.
    • Maintain normal breathing while you simultaneously lift one leg backwards and the opposite arm overhead keeping your back in neutral position.
    • Avoid twisting of the pelvis by putting a magazine on your lower back. The magazine should not fall down while lifting arm/leg. Your heel should be the same height as your hip and your arm the same height as your head. Hold for 20 seconds and repeat 5 times on each side.
    • If this All 4’s position creates pain, then try it on your stomach, and lift one elbow and the opposite knee.

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    ABDOMINAL STRENGTHENING WITH HIP FLEXION

    • Lie on your back with your knees bent and your lower back in neutral position (slightly arched).
    • Activate your lower abdominals by bringing your belly button inward and by activating your pelvic floor muscles 20 to 30% of the maximum contraction.
    • Maintain a steady abdominal breathing while you bring one knee up until the thigh is vertical and your hips are at 90 degrees.
    • Slowly return to the starting position and repeat.
    • Do 5 repetitions on each side for a set of 10 repetitions, then repeat 3 times.

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    FRONT PLANK ON KNEES

    • On your forearms and knees.
    • Lift yourself up, so your hips and shoulders are in a straight line.
    • Contract your glutes and do not arch your lower back.
    • Keep your elbows under your shoulders.
    • Goal is to hold for 60 seconds pain free for one week, then progress to level 2.

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    SIDE PLANK

    • Lie on side with knees bent to 90 degrees and legs in line with body.
    • With your upper body supported on your elbow, make sure the elbow is directly under the shoulder.
    • Lift pelvis until your body is aligned off the knees and maintain the position and hold for 30 seconds.

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    BRIDGE

    • Lying on your back with your knees bent and your feet on the floor.
    • Squeeze buttocks and abdominals/pelvic floor and lift pelvis/hips off floor and hold for 60 seconds. Be careful not to arch your back.

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  • Level 2

    STABILIZATION PRONE PLANK

    • Lying on stomach propped up on your forearms and toes.
    • Lift up until your body creates a straight line.
    • Tilt your pelvis up, while keeping your back straight.
    • Hold for 60 seconds. Repeat 2 to 3 times.

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    SIDE PLANK

    • With your upper body supported on your elbow, make sure the elbow is directly under the shoulder.
    • Lift pelvis until your body is aligned off the sides of the foot and maintain the position and hold for 30 seconds. Repeat 2 to 3 times.

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    BRIDGE

    • Lying on your back with your knees bent and your feet on the floor.
    • Squeeze buttocks and abdominals/pelvic floor and lift pelvis/hips off floor. Be careful not to arch your back.
    • Keep your back straight and hold for 30 seconds. Repeat 2 to 3 times.
    • Slowly return to initial position and repeat.
    • Once you can hold for 60 seconds pain free for one week in level 1 bridge position with both feet on the floor, then you can progress to level 2 bridge by straighten out one leg and hold up to 60 seconds, start off with 10 second holds and gradually hold longer.

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    OBLIQUE REACH

    • Lie on your back and bend your knees, extend your arm and reach towards your opposite knee. Only your shoulder blade is coming off the floor, your lower back does not lift from the floor.
    • Reach to 3 inches below the outside of your knee 5 times, then reach to the back of your hip bone 5 times, hold for 10 seconds. Do 10 on the left, then repeat on the right side. Do 3 sets of 10 repetitions.

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    ABDOMINAL STRENGTHENING WITH HIP FLEXION

    • Lie on your back with your knees bent and your lower back in neutral position (slightly arched).
    • Activate your lower abdominals by bringing your belly button inward and by activating your pelvic floor muscles 20 to 30% of the maximum contraction.
    • Maintain a steady abdominal breathing while you bring your knees up until the thighs are vertical and your hips are at 90 degrees.
    • While the first leg is held still, lift the other leg in the same position without moving your lower back.
    • Slowly return to the starting position and repeat starting with the other leg.
    • Do 5 repetitions on each side for a set of 10 repetitions, then repeat 3 times.

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  • Level 3

    WALK OUT WITH BALL

    • Lie stomach on ball.
    • Walk out with the hands, so that the ball lines up with the thighs, shins or feet. The farther the ball is down your legs the harder it is to hold your position.
    • Hold 10-15 seconds and walk back.
    • Repeat 10-15 times.

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    LEG LIFT

    • As above.
    • When in walk out position lift one leg while keeping trunk straight.
    • Hold balance 5 seconds.
    • Switch to the other leg and hold 5 seconds.
    • Repeat 3-5 times each leg and walk back.

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    KNEE TUCKS

    • Start in walk out position.
    • Walk out onto the knees then tuck legs up into the chest by rolling up ball. Don’t let your back arch on the way down.
    • Repeat 10-20X 1-2 sets.
    • Can also do obliques with diagonal tuck on either side.

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    BRIDGING ON BALL – BEGINNER & ADVANCED

    • Sit on ball.
    • Walk out with feet and with back on the ball.
    • Rest your head, neck and shoulders on the ball and hold a bridge position with trunk straight.
    • Hold 10 seconds and repeat 5 – 10 times.

    Advanced:

    • Adopt bridge position as above.
    • Life one leg off the floor without letting your pelvis sag. Hold trunk muscles very tight.
    • Hold position 5 seconds and repeat 3-5x for each leg. 3-5 sets.

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    HAMSTRING CURLS – BEGINNER & ADVANCED

    • Place feet shoulder width apart on ball.
    • Hold trunk muscles tight then lift hips off the ground.
    • Pull ball up to hips with heels and then lower. Repeat 10 – 15 x, 1 – 2 sets.

    Advanced

    • Repeat as above but with one leg (very hard). 10 x 1 – 2 sets

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    LEVEL 3 SIDE PLANK

    • With your upper body supported on your elbow, make sure the elbow is directly under the shoulder.
    • Lift pelvis until your body is aligned off the sides of the foot and maintain the position and hold for 30 seconds.

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    ABDOMINAL STRENGTHENING WITH HIP FLEXION

    • Lie on your back with your knees bent and your lower back in neutral position (slightly arched).
    • Activate your lower abdominals by bringing your belly button inward and by activating your pelvic floor muscles 20 to 30% of the maximum contraction.
    • Maintain a steady abdominal breathing while you lift both knees up until the thighs are vertical and your hips are at 90 degrees.
    • While the first leg is held still, straighten the leg to 50% of full extension while keeping the back flat.
    • Slowly return to the starting position and repeat with the other leg.
    • Do 5 repetitions on each side for a set of 10 repetitions, then repeat 3 times.

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  • Level 4

    ABDOMINAL STRENGTHENING WITH HIP FLEXION

    • Lie on your back with your knees bent and your lower back in neutral position (slightly arched).
    • Activate your lower abdominals by bringing your belly button inward and by activating your pelvic floor muscles 20 to 30% of the maximum contraction.
    • Maintain a steady abdominal breathing while you lift both knees up until the thighs are vertical and your hips are at 90 degrees.
    • While the first leg is held still, straighten the leg to 75% of full extension while keeping the back flat.
    • Slowly return to the starting position and repeat with the other leg.
    • Do 5 repetitions on each side for a set of 10 repetitions, then repeat 3 times.

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    DEAD BUG

    • Lie on your back with your knees bent and your lower back in neutral position (slightly arched). Have your arms resting above your head. Then perform a Kegel contraction.
    • Under control, pull an elbow and the opposite knee together (beginner) or a foot and opposite hand together (advanced).
    • Keep the pelvis still and stabilized at all times.
    • Repeat with the other side.
    • Do 5 repetitions on each side for a set of 10 repetitions, then repeat 3 times.

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  • Level 5

    ABDOMINAL STRENGTHENING WITH HIP FLEXION

    • Lie on your back with your knees bent and your lower back in neutral position (slightly arched).
    • Activate your lower abdominals by bringing your belly button inward and by activating your pelvic floor muscles 20 to 30% of the maximum contraction.
    • Maintain a steady abdominal breathing while you lift both knees up until the thighs are vertical and your hips are at 90 degrees.
    • While the first leg is held still, straighten the leg to 100% of full extension while keeping the back flat.
    • Slowly return to the starting position and repeat with the other leg.
    • Do 5 repetitions on each side for a set of 10 repetitions, then repeat 3 times.

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