Exercises for herniated disc

When I experienced disc herniation, I desperately searched the internet for information in the hope of finding relief for the horrible pain.  I soon found out that exercises would be my salvation.

As I describe in my herniation story , at first doctors prescribed me lots of anti inflamatories, pain killers, muscle relaxants, corticosteroids (oral and injection), even drugs for nerve pain.

Of course, these drugs were not meant to cure the sciatica, only to provide some pain relief.  In my case though, their effect was either non-existant or extremely short-lived.

So after a few weeks I ended up getting off most of them, except for one medication for anxiety (Lorazepam) which was helping me relax and get a bit of sleep at night.

Dozens of websites talk about disc herniation and exercises for it.  However as I was researching, I got frustrated that none of them synthesized which ones to do and why. 

In this post, I’ll share what I’ve learned about why exercise is the key to recovering from a herniated disc, and what kind of exercise works.

To better understand the impact of exercise, I’ll first do a quick recap of lower back disc herniation mechanics.

What's a herniated disc again ?

If you’re new to this (like I was a couple of years ago), a herniation, or herniated disc, is when the jelly substance inside an intervertebral disc breaks out of its containing membrane and pushes out onto the spinal nerve.

You probably know your spine is composed of 33 vertebrae which are cylinder-shaped bones stacked on top of each other.  The 5 bottom vertebrae, named L1 to L5, make up your lower spine.

Between each pair of vertebrae sits a cartilage disc serving as cushioning pad between the bones.

Intervertebral disc

Your disc is like a jelly donut.   The gel-like substance inside the intervertebral disc moves freely inside the hard outer shell to provide effective shock absorption.

Over time, some of your discs may get weak as a result of aging and/or specific conditions.  With bad positions, a disc may get squeezed on one end, pushing the gel inside it to bulge on the other end or even break through its outer layer.  

If the outer layer gets torn and the gel leaks out, you have a ruptured, aka herniated, aka slipped disc.  

So in the picture below, the bottom disc is being squeezed on its left side by the vertebrae above and below it (vertical yellow arrows).

Exercises for herniated Disc

The gel (blue stuff) is being pushed out to the right (horizontal arrow) into the spinal canal and onto the nerve (in red).

The bulge pressing on your spinal nerve causes sciatica, that horrible pain in your lower back, buttock, down your leg and possibly all the way to your foot.  That’s the pain I’ve experienced myself.

Why does disc herniation happen ?

Sad to say, but discs naturally degenerate.  Over time, your discs get weaker as your body produces less of a certain molecule that normally allows discs to absorb more water, making them super resistant – check out this short video.

Here’s the thing : as your disc gets weaker, it becomes more vulnerable to pressure from the vertebrae around it.

Besides natural aging, disc damage results from repetitve microtrauma, such as pressure triggered by bad posture and movements.  

If you bend forward the wrong way, your weak discs get pinched harder by the vertebrae surrounding it, potentially causing them to bulge (see above picture).

Forward bending

If you regularly carry heavy loads in an incorrect way, or if you are overweight, which also amounts to putting a heavy load on your spine, you’re adding to that pressure.

Here’s a key point though : if your back muscles are weak, all the pressure from your bad movements go onto your discs. Strong back muscles, on the other hand, help take some of the pressure off your discs. 

Therefore, doing the right exercises to strengthen your mucles is essential.  But let’s dig a bit deeper.

 

Why is exercise training so important in disc herniation ?

A fundamental question I was asking myself when researching disc herniation was, why are strong back muscles, and therefore exercise training, so important in overcoming / preventing herniation pain ?

Exercises for herniated disc


Everyone is talking about “core stability” and “core strengthening” as an essential thing in lower back pain relief and recovery.  Not being a doctor or PT, I rolled up my sleeves and dug in deeper to find some serious answers.  

Let me recap my findings for you.  Pay attention, this is key !

According to an in-depth research paper on lumbar stability, disc degeneration results from “poor control over spinal structures”.

In brief, people with lower back pain typically have lumbar instability, which basically means their body have lost some of its ability to automatically and unconsiously protect the lumbar spine from injury when performing risky movements and postures.

When you’re healthy, in case of a fall, sudden load, or quick movement, your spine gets instantly protected through the stiffening of the muscles around the segments (pair of vertebrae) at risk.

It’s an unconscious mechanism involving many of the deep muscles that attach directly on your spine, as well as some other larger and more superficial muscles.  

Your deep muscles are responsible for controlling vertebrae to vertebrae (intervertebral) stiffness, whereas your “global” mucles react to external forces by controlling movement and rotation in your spine.

Together, deep and superficial muscles make up your trunk or “core” muscles – which everyone talks about these days.

Your muscles are coordinated by your neural control system, which reacts to external forces by triggering the right amount of muscle stiffness around the right spinal segment in order to protect it while still enabling the movement.

If you have low back pain because of a herniated disc (or even another cause) chances are your deep stabilizing muscles are not functioning properly.  Your control system is probably not doing its job correctly either.

The right exercise training will help restore correct function of your muscles and neural control.

Which muscles do disc herniation exercises target ?

Your two most important deep stabilizer muscles that must be retrained are :

  • your multifidus, which controls the movement of your vertebrae to prevent excessing bending
  • your transversus abdominis (TA) which stiffens your spine by raising adominal pressure

Without lower back pain, these two muscles automatically and unconsciously fire up before all other muscles whenever you initiate a movement, to stiffen your lumbar spine and preventively protect it against injury.

These muscles are also active when you’re standing or in other postures involving tiny movements.

With disc herniation, your multifidus is likely to be atrophied, and your TA may be slow reacting, being activated after the muscles that initiate the movement. These indicate low lumbar spine stability.

Your other deep muscles form a cylinder around your spine to stabilize it by adding tension in your abdomen before movement.  These muscles are : 

  • the “quadratus lumborum“, which forms the side of the cylinder
  • the pelvic floor at the bottom, which normally contracts before the abdominal muscles
  • the diaphragm, the roof of the cylinder.  Activated namely when you breathe.

If you have a herniated disc, these other deep muscles are also likely to show dysfunctions, and they should also be targeted in exercise training.

In addition to your deep muscles, many superficial muscles also play a key role in your lumbar stability, by controlling the orientation of your spine when you move a limb or when you must support a heavy load.

These include your abdominal muscles (obliques, rectus abdominus) and the iliopsoas (anterior hip muscle).

As a disc herniation patient, these superficial muscles are also likely to function improperly, since they often compensate for your failing deep mucles.

In doing so, the superficial muscles do help stiffen and protect your spine, but since they’re not designed for this job, this creates other problems including excessive tension which can generate more spinal pain.

Also, using your superficial muscles as stabilizers in place of your deep muscles restricts spine motion and has other unwanted effects, such as involuntary triggering of other muscles.

Another thing is, as a low back pain sufferer, your ability to maintain balance and posture is also likely to be altered, due to slower neuromuscular feedback and muscle response time.  Adequate posture and positioning  exercises can effectively fix these issues though.

So let me recap : 

  • A herniated disc is a degenerated disc that has ruptured under excessive pressure, with its internal get breaking through the membrane and pressing against a spinal nerve
  • The forces that pushed the disc out often result from bad spinal positions on top of lumbar instability
  • Lumbar stability is normally achieved by a combination of deep stabilizer muscles which control spinal stiffness, and large superficial muscles that control spinal motion under external forces
  • If you have a herniated disc and low back pain, your deep and superficial muscles are probably not doing their job correctly
  • Exercises targeting these various muscles are effective in restoring lumbar stability and muscle support, to reduce the risk of further disc slips. 
 

The best exercises I tried for my herniated disc

After understanding the rationale behind exercising for a herniated disc, I set out to give a bunch of commonly recommended exercises a try to see if they would help reduce my pain.

During the 3 months that followed my herniation, moving was extremely painful so I was hardly able to do anything (see my disc herniation story).  Only after the first 3 months could I start experimenting with exercising.

Disclaimer: since I chose to go it alone as opposed to going into physiotherapy, the exercises listed below are based on my own choosing and empirical testing – i.e. I selected those I felt would work best for me and would generate the least pain.  

A PT program would probably better target specific deep muscles in a scientific way.  When it comes to exercising, I like to take things into my own hands and do my own research and experiments, but of course that’s quite different from a PT approach.

If you want to learn more about common PT exercises for lumbar instability, check out this page.  Another way to retrain deep muscles is through “intention” or “imagery” as described in this article

UPDATE: in addition to the exercises I describe below, I’ve decided to invest in an inversion table. A good friend of mine, a very sporty guy a few years older than me, has been using one for years to help alleviate his back pain (multiple herniations), so I went out and got one too. My inversion table gives me a nice feeling of weightlessness and relieves the pressure on my back whenever I feel it again. 

For those new to disc problems, gravity is your worst ennemy if you have degenerating discs as it compresses your spine and makes your vertebrae squeeze together and eventually push out the disc against the nerve. An inversion table basically lets you get into a reversed position with your head down and your feet up, reducing spinal compression due to gravity.     

I typically don’t invert more than about 60º.  Since I try to exercise almost daily for my back, it’s hard to know the exact contribution of my inversion table to my back health. I just know it feels really going going inverted when I start feeling pressure due to stress, bad posture, of excessive workouts.

The table I picked is the Ironman Gravity with Airsoft ankle holders (Amazon link). Not the cheapest but I wanted something really sturdy and comfortable, and something other persons around me (including an overweight woman) could use as well without fear. I could have gotten the cheaper version but for me, the ankle holders alone are worth the difference, my feet and ankle are comfortably held without the strain you get on other models. 

I typically invert anywhere from 5 to 20 minutes per day. That, and hanging off my pull-up bar, gives me a very soothing spinal decompression and helps keep buttock soreness away even after some high-impact movements.  

Herniation exercise : bird dog

Given the permanent strong pain in my buttock and leg from my herniated disc (which dragged on long after the first few weeks of maximum pain), getting on my hands and knees was a feasible thing, with low or no pain.

From that apparently safe base position, lifting one arm horizontally, then one leg, then both an arm and opposite leg, then switching to the other side, felt OK for me.  Supporting myself on one knee and hand, I can control the amount of tension from the lifting in the back and hip. 

The exercise works the back extensor muscles and supposedly activates the multifidus.  It also involves the ab muscles, glutes and hip flexors.

Doing it temporarily relieved some of the nagging pain in my buttock.  It gave me a nice feeling of having my whole posterior chain active again after weeks of paralysis, in a safe way.

Herniation exercise : supermans

The superman exercise is also supposed to strengthen your back extensor muscles and glutes. 

I did it initally, even though it triggered quite a bit of pain in my butt and leg, as I was convinced it was good for me and would strengthen my back.

I ended up stopping doing it, namely because lying down on my stomach (prone position) at the beginning of the exercise caused be extreme pain – during the first 3 months of my hernia getting into a prone position was outright impossible.

Once I put my back in tension by lifting my arms and legs off the floor, however, the pain would decrease somewhat.  I still felt the load on my back was too strong and  so I decided to stop it.  

Reading this article confirmed my impression that the exercise over-extends the back mucles.

When I later found the Foundation Training program – which ended up being my ticket to recovery – I replaced the superman with anchored back extensions, a much safer and more effective alternative (the video below shows a quick version of it).

If you don’t already have one, you’ll need a good exercise mat for doing anchored back extensions.  I found the one I had too thin and very uncomfortable for prone exercises, so I ordered this one from Amazon:

I like it a lot because it’s 1/2″ thick, comfy and well-padded but not too soft, water/moisture repellent (those exercises make me sweat a LOT) and non-slipped thanks to the ribbed design (for the standing exercises). Very sturdy, I’ve been using for months on a daily basis.

Herniation exercise : McKenzie prone press-ups (not good for me)

This back extension exercise, part of the decades-old McKenzie approach, is prescribed by many PTs. 

The simplified rationale is that, since, in most cases, disc herniation involves a disc being pushed backwards because of spine flexion (forward bending), doing spine extensions (backward bending) can push the disc back into place.

I tried this exercise early while my pain was still quite acute, in the hope of finding some relief.  I tried it for over a week. In my case however,  it caused more pain than relief. 

As I mentioned above, the simple fact of starting in a prone position triggered strong pain in my lower body. 

From there,  lifting my torso up would sometimes drive the the pain down a bit if I focused hard enough on relaxing my hips and legs. I would try to stay in that lifted position for up to 30 seconds.

It wasn’t pain-free though, and I could feel this position was not beneficial in my case.  After some research, it may have been due to my stenosis (narrow spinal canal) which made hyperextension a nerve compressing event.

In general, the McKenzie approach includes both hyperextension and forward flexion of the spine.  I personally tried them and they felt unsafe for me.   This PT’s analysis of the McKenzie approach seems to confirm that feeling.

Herniation exercise : ab crunches

Before my disc herniation, I was doing crunches every single day.   

Not only did I NOT have cut 6-pack abs, but I suspect over time this may have created imbalances between my front and back muscle chains (I never used to work my back muscles) and a forward pull on my spine that’s likely to have been an additional factor in my disc slip.

When my body went into a complete halt with a herniated disc, I eagerly waited, though in acute pain, to be able to go back to crunches and “strengthen my core” again.

I then learned about stabilizer and other core muscles, and realized doing nothing but crunches wasn’t a good thing.  

After my injury and several weeks of being stuck, however, I did need to get my abs (rectus abdominis and obliques) working again.  So I started by doing what I knew, crunches.

Doing crunches triggered some pain in my buttock and leg – although not as much if I focused on keeping my spine straight, with no upper body bending nor pulling my hands on my neck.

I made sure to look at the ceiling above me during the whole movement.  

Still, it was hard to completely avoid spine flexion.  

So I switched to doing crunches on a physio ball.  This was a better approach for me since the movement started with my spine in neutral position and then, as I lowered my torso backwards, my spine went into extension, and then back up to neutral.

This exercise involves no spine flexion, only a reasonable extension (not hyperextension) in the lowered upper body position.

If you don’t have a Swiss ball, you can easily get one from Amazon.  I ordered this popular one from Amazon because it’s not too cheap nor expensive ($18-·$28 depending on size), there are over 2000 reviews for that thing (almost 80% 5-star!), I could choose the size and color (being 6″1 I picked the 65cm), and it seemed to be very robust based on user reviews – which turned out true.  For simple products like this, I tend to rely on user opinions and avoid spending hours comparing.

 

Herniated disc exercise : planks

Planks are probably the most often recommended exercise for building core strength in a safe way.

In my case, since getting on my hands and knees was a relatively low pain proposition, I was able start with a kneeling plank (half plank, with knees on the floor) and later work my way up to a full plank (on my toes and elbows or hands).

The most important part is to keep a neutral spine, i.e. a straight back (no hunching nor belly sagging).  The exercise requires bracing your abs, activating your glutes (butt) and your lat muscles.

It’s a great exercise because it promotes recruitment of all the key spinal stabilizers.

In my case initially, after holding the plank position for more than a few seconds, the pain did sometimes kick in in my buttock and leg.  When that happened I just paused and relaxed for a moment.

As time went by, the pain from doing the plank lowered, and I even ended up using a stability ball under my feet and/or elbows to create more demand on the deep stabilizer mucles.

Planks can be potentially harmful if you don’t maintain your spine, abs and glutes fully braced at all times, namely when you start fatiguing and letting your stomach sag.

Foundation Training’s version of the plank, the 8-point plank (the 8 points are you feet, knees, elbows and hands) is safer and highly effective.  That’s the one I’ve been doing ever since I switched to FT.

This version is better suited for working around pain.  With time, after my pain started to recede, I was able to make the exercise stronger by pulling my elbows and knees towards each other.  That creates a very strong tension in my core muscles.

If you need a good exercise mat for doing planks, I use this one from Amazon – see my earlier section on Supermans.

Herniated disc exercise : bridging

Bridges make you work your posterior muscle chain, glutes, abs (rectus abdominus), back extensors, hamstring and adductors. They also engage hip flexors and quadriceps.

The way to do bridging is to elevate your pelvis by pushing onto your heels until your spine is in neutral position, bracing your abs and glutes.  

In my case, raising my pelvis triggered pain in my buttock and leg. In fact, moving my pelvis or hips in any direction (back, forward or sideways) almost always caused some pain, probably a sign of dysfunctional SI (sacroiliac) joint.  

Once the pelvis was in the elevated position the pain was lower though.

Hamstring curls on an exercise ball felt better for me, allowing me able to strengthen my hamstrings, glutes, lower back and hips without stirring up pain.

These are actually a more advanced exercise and it would seem they would be harder on your back and more likely to hurt if you have a herniated disc.  In my case, however, they were less painful than simple bridges.  

It all depends on the specifics of your injury, so make sure to use caution and test the waters before you do it.

When I adopted Foundation Training, I replaced both of these exercises with the anchored bridge, which I once again found to be a safer and more effective exercise for strengthening my deep muscles.  

It’s like a normal bridge but the anchoring addition stiffens the pelvis and lower spine.  In my case that simply prevented the pain from triggering.

 

Herniated disc exercise : squats

Squats strengthen your glutes, hamstrings / quadriceps and hips. In addition to the trunk muscles, muscles that attach to the pelvis, such as the large ones around the hip, also play a key role in lumbar stability.

When doing squats correctly, you use your glutes (butt muscles) to lower yourself down and push yourself back up.  

The most important thing in squatting with an injured back is to keep a neutral spine by hinging at the hips instead of flexing at the lower spine.  

That’s why squats are great : they educate you on to use your hips and lower back mucles correctly.  See this great paper about athlete rehabilitation after disc herniation (“suspension assisted squats” section).

The squat exercise helped me a lot in recovering from my herniated disc.  Even before the pain allowed me to stand upright, I tried doing small squats, supporting myself on a table or a door handle to control the pain.

 Hip imbalances were probably a big factor in my herniation, so regaining hip motion was crucial for me.  The squat movement re-taught me to use my glutes and hips in the right way to offload my spine.

Hip hinging is a central practice of Foundation Training.  Even before squats, the Founder exercise is the base movement for learning hip hinges :  

FT’s version of the squat extends the Founder movement : you also start by shifting your hips back, engaging your hip mucles, glutes, hamstrings, and lower back.  But in the squat, you then bend your knees and begin to “sit back” and lower yourself down.

While you squat, you lift your arms forward at chest level – as opposed to hands behind neck – to counterbalance the backward movement of your hips.  This greatly helps in hinging at the hips and “sitting back” correctly.

 

Herniated disc exercise : pull-ups / rows

You’re probably thinking : “pull-ups ? With a herniated disc ? Yeah sure  …”

In the post on my herniation story , I explain how hanging on a pull-up bar was the first step I took toward exercising as a way to cure myself.

Just letting my body hang off a bar (in my case a low bar allowing me to partly support myself with my feet on the floor) provided me some pain relief by decompressing my spine.

Note that I would NOT have been able to hang off a bar during the first 8-12 weeks following my herniation.

As time went by I naturally and gradually started pulling myself up gently, giving my posterior muscle a stronger stretch and workout.

Still, full-blown pull-ups felt unsafe because it was easy to forget to brace my abs, hips and glutes when  pulling myself up, and end up in a pain-triggering lower body position.

I then found a safer way to do “pull-up equivalents” by purchasing a suspension kit (“TRX”) and doing inverted rows.  Like pull-ups, they involve a pulling movement, albeit more of a horizontal one.

According to the article on rehabilitation of athletes with disc herniation (“inverted row progressions” section), these inverted rows, a sort of controlled inclined pull-up, have a low spinal load while providing a significant workout for the back muscles.

Doing these, I had much better control of my lower body position while pulling myselft up and down.  I was able to keep my spine neutral and my abs, glutes and pelvis tight at all times as my feet stayed on the ground.

I could vary the angle between my body and the floor and hence progressively increase the difficulty, all in a safe manner.

I could feel not only my upper body working, but my trunk muscles constantly stabilizing my position, without triggering pain.

Today I’m back to my (almost) full exercising capabilities so I alternate between pullups and rows.  For pull-ups, I have been using this doorway workout bar that works fine for me – feels much safer than a classic screw-on bar which I always feel might end up slipping off.  However, I wish I would have had something like this pull-up stand to help me hang comfortably while I was still in pain. I’m now seriously considering buying it for my home office to give me extra motivation for taking short pull-up breaks.  There’s a dips station as well that will come in handy for me, and even a crunch station though I won’t be using that part.

For my inverted rows I use these suspension straps which work really well – I didn’t want to spend $150 on original brand TRX straps.

Depending on your specific condition, you may or may not be able to do this exercise without pain.  

If not, you can start with Foundation Trainning’s prone decompression exercise, as shown in the video below. 

 

Wrapping up

So yes, many of these exercises, bird dogs, crunches, planks, bridges, squats, pull-ups, in one form or another, helped me get my stabilizer and global muscles working again, as many of them had been “deactivated” following my herniated disc.

If you’re like me, you can use your pain as your main measuring stick for evaluating each exercise and the best suited variant for your own condition.

After weeks of experimenting, I ended up replacing most of these classic exercises with related but more specific exercises from the Foundation Training program.

These exercises are designed to re-train and strengthen your deep muscles with a specific focus on the posterior chain, whose weakness is often the main cause of back pain.

It’s quite astonishing that such simple, seemingly unimpressive isometric exercises – as opposed to spectacular dynamic moves such pull-ups, push-ups or deadlifts – prove to be so effective in regaining spinal and overall body health.

Two years later, while completely pain free and back to sports, I have permanently integrated these exercises into every move and activity I do. 

It’s such an exhilirating feeling to know you can do pretty much anything you want with your body as long as you move in the right way and keep your deep core muscles trained.

 
References :

 

  1. Barr, Karen P. MD; Griggs, Miriam MD, FAAPMR, PT; Cadby, Todd MS, PT, ATC – American Journal of Physical Medicine & Rehabilitation: June 2005 – Volume 84 – Issue 6 – p 473-480