Treating a Herniated Disc With Physical Therapy

Authored by: Larry Grine

What is the fastest way to heal a herniated disc?

First and foremost, you want to avoid activities that trigger pain.  You want to promote a healing environment in order for the inflamed and injured tissue, in this case a herniated disc, to begin to heal.  So, the first step sounds simple, but is often challenging for individuals to figure out what movements, postures, and positions cause pain and inflammation and then to avoid them.   You will not need to avoid them forever, but you will need to modify what you do in the short-term to promote the best chance for your body to heal.

It is highly recommended to connect with a physical therapist who specializes with treating spinal disorders to help guide you with activity modifications and tailor a program that helps you reduce inflammation and stress to your injured intervertebral disc and spinal joints. 

There is a good chance your body has been compensating in a way to avoid pain for a while and run out of its ability to hold up under the stress and strain of your daily movement patterns.  So, you will need to also make sure your physical therapist is a good body mechanic that can sort out the compensations your body has been dealing with, and improve these adjacent areas, to help you reduce stress on your spine from poor biomechanics with your daily functional movements.  

Many herniated discs will heal to some degree over a period of weeks to months, depending on the individual. Movement and treatment directed at decreasing symptoms, improving functional deficits, and improving observed deficits is the quickest way to promote the healing of a herniated disc. Some patients will observe a decline in symptoms within a couple weeks, while some others may observe continued symptoms for months to years (Benoist, 2002). In general, herniated discs have a good prognosis for conservative treatment via physical therapy. 

What physical therapy is good for a herniated disc?

This is a tricky question to answer, as many people have different symptom presentations from a herniated disc.  Herniated discs often are caused by overloading the spine beyond its limits.  There is often a degree of disc degeneration and adjacent spinal joint issues that accompany a herniated disc.  

In short, back extension exercises that are tailored to the patient’s specific needs have been shown to provide a good foundation to a herniated disc program; especially an acute disc herniation.  However, good physical therapy will also address adjacent areas that have poor movement patterns that are contributory to why the disc herniated in the first place. 

Evidence supports the use of manual therapy techniques to decrease pain and improve deficits in patients with herniated discs. This includes joint mobilizations to the lumbar spine, thoracic spine, and hip, nerve glides to the lower extremity, soft tissue mobilization, and trigger point dry needling. 

The evidence also supports the use of various forms of therapeutic exercise to improve muscular strength, flexibility, endurance, pain, and disability. This includes trunk coordination, core stability, resistive exercise, strength training, endurance training, and cardiovascular training all of which are progressive in nature. Initial exercises should be aimed at moving into the motions that are more tolerable. As healing occurs, inflammation decreases, and symptoms improve, the exercises should progress into movements that were more challenging at the beginning of your treatment.  

How long does a disc herniation take to heal?

Intervertebral discs are primarily made up of water, Type I collagen, and Type II collagen.  As a result, it can take 6-8 weeks for a herniated disc to heal; due to the healing times of Type I and II collagen.   The healing times are a function of promoting a healing environment around the damaged tissue.  If you promote healing early, the healing times will reduce, but if you do not protect the herniated disc, the healing times will extend longer.  Healing times will also be a function of how well the physical therapy addresses the adjacent areas around the herniated disc.  This could include looking at adjacent spinal segments or even adjacent joints like the thoracic spine, hips, knees, or ankles and feet.  You should see improvements in your symptoms within 4-6 physical therapy visits, depending on the severity.  

The timeline of healing for a disc herniation depends largely on the extent of the herniation itself, and what structures may also be impacted by the herniation (e.g. compression of a nerve root or “radiculopathy”).  Some patients who present with a symptomatic disc herniation may exhibit a reduction in symptoms without any improvement or reduction in the herniation size, but the symptoms improve as the acute inflammation improves.  In general, as the body’s normal healing process takes place, herniated discs can heal in a matter of a couple weeks, or in some cases a few months. 

Can you fix a herniated disc with physical therapy?

Physical therapy can play a major role in improving the pain, disability, mobility deficits, and healing response of a herniated disc. As mentioned above, not all herniated discs will reduce in size, but physical therapy can help to reduce the symptoms experienced as a result of the injury. 

The term “fix” is a little more challenging.  A herniated disc is final resultant injury that is usually the result of repeated stress and injuries to the annular layers of an intervertebral disc; causing the inner aspect of the disc to rupture outward beyond the outer disc layer.   Physical therapy can reduce the inflammation and dysfunction that occurs with a herniated disc, and once the inflammation is reduce enough, healing can take place.  When the inflammation is removed the disc can heal and pain will resolve.  There will still be a physiological change to the disc form, but the pain and inflammation will be gone. For disc injuries that have progressed too much, and conservative management with physical therapy does not help, the best options can be Regenerative Medicine or surgery to (treat the herniated disc, correct the herniate disc) the inflammation. 

Is walking good for a herniated disc?

Yes, walking is an excellent physical activity for a herniated disc as long as walking does not repeatedly inflame the symptomatic area.  The human body is built to move and walking is a natural functional movement.  The goal is to keep the human body moving and functioning at the highest level without causing additional pain or inflammation.  My rule of thumb is to have all patients continue moving and working out as long as their pain does not increase by more than 2 points out of 10 in one of three categories:  1) Increase during the activity, 2) increases after the activity, or 3) increases the next day.  

In the beginning the activities that are restricted, because they cause pain and inflammation, will become therapeutic once the body is trained to take on stress more successfully with proper strengthening and physical therapy

In general, herniated discs occur in the posteriolateral direction (think back left or back right when looking at a disc from above) and the mechanism that typically cause a disc herniation is spinal flexion with rotation on a loaded spine (e.g. bending over and twisting to pick up a box). Therefore, flexion movements will typically increase symptoms associated with a herniated disc. An activity like walking places the spine in general extension, unless you are walking uphill, and therefore, should be a good activity for individuals presenting with a HNP. 

What exercises are bad for a herniated disc?

As mentioned above, most HNPs occur in the posteriolateral direction and are caused by flexion + rotation under load movements. Therefore, any movements or exercises that mimic this position or place the spine into flexion (bending forward) should be avoided IF they increase your symptoms. Therapeutic exercise is typically aimed at initially moving into positions that the patient can tolerate while the HNP takes it’s time to heal, this is called directional preference. Therefore, movements or exercises that cause pain should be avoided initially and progression into those aggravating movements will occur as symptoms and deficits improve. 

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