Exercise after disc surgery for sciatic nerve pain

For Dr. Gomez

Lower back surgery to relieve pain along the sciatic nerve caused by a herniated disc is becoming more common with minimally invasive microdiscectomy. With the shorter recovery, less pain and increased success rates, the recommendations for post-surgery recovery have changed, particularly with regard to exercise. (published site)

The traditional advice after surgery has been to limit bending, lifting or twisting for six weeks to prevent recurrent herniated disc. Studies however have found that limiting movement may not necessarily prevent recurrence and moving earlier after microdiscectomy may actually help patients heal sooner.

In a study published in the journal Physical Therapy, researchers showed that an early intensive graduated exercise program of conditioning, stretching, and strengthening can help patients restore physical function, return to normal activities sooner, reduce their disability scores and increase their walk distance scores.

The exercises used in the study followed the 12-week USC Spine Exercise Program, which is a progressive exercise program aimed at back extensor strength. The back extensor muscles are the large muscles attached to the spine that allow humans to stand and lift objects, hold up the spine and gluteal muscles.

It is important to note that the program focuses on increasing strength and endurance training, and that mat exercises and therapeutic exercises were performed under the guidance of physical therapists to ensure the exercises are done properly to avoid injury. If you are planning microdiscectomy followed by exercise-based rehabilitation, you should consult your doctor for a referral to physical therapy.

Benefits of exercise
In general the rationale for exercise for back pain is based on an abundance of research showing that exercise improves parts of the body associated with back pain. These include:
* Increased blood flow to the back, which increases availability of nutrients and oxygen and a reduction of toxic metabolites
* Strengthening muscles that relieve pressure from bones
* Increased flexibility, which reduces strain from tight muscles that pull and torque the spine
* Reduces weight that can worsen back pain
* Increases the release of endorphins that help block pain, and improve mental outlook and reduce stress

Exercise Do’s and Don’ts to relieve back pain
Just as with any prescription for better health there is a right and wrong way to exercise to relieve your back pain. Always ask your doctor or therapist before doing any exercise for back pain. The type and cause of your back pain makes a difference and some exercises may not be recommended, or could be outright harmful.
Do stretching and strengthening exercises
Increasing the strength and flexibility of the muscles that support and stabilize the spine is key to relieving back pain, but some stretching exercises can aggravate pain as can other exercises if they are done wrong.
Don’t twist, torque or strain
Exercises that strain or torque the spine are not recommended for people with low back pain. Exercises that impact joints can also add to pain not relieve it.

Here are 3 general stretching exercises that often help with back pain:

Partial sit-ups or crunches can help strengthen stomach and back muscles if done right. Try crossing arms in front of your chest instead of behind your neck. Pulling your neck off the floor with your arms strains the tissues surrounding the neck vertebrae. Instead you want the focus on stomach and back muscles to raise your torso off the floor. Just a few inches will do, no need to lift all the way up to a vertical position.

Hip Bridge work muscles similar to crunches. Lie flat on your back with hands to your sides, slide heels under the knees toward your buttocks. Then lift hips off the floor, to align with the torso and thighs and hold for several seconds.

Knee to chest stretches focus on the lower back muscles. Start by laying on your back with knees up and feet flat on the floor, then slowly raise one foot up to the height of the opposite knee and hold for several seconds, then repeat with the other leg.

AVOID these 3 exercises:

Full sit-ups can strengthen stomach and back muscles, but put a lot of pressure on the discs in your spine. Better to do partial sit-ups.

Standing Toe Touches like sit-ups, toe touches put a lot of strain on disks and ligaments in your spine.

Double Leg Lifts with weak core muscles these can put too much strain on muscles and ligaments surrounding the lumbar area of the spine.

Depending on your specific case different surgeons will recommend somewhat different approaches to post surgery recovery following microdiscectomy. At Dr. Michael Gomez, we take an integrated approach working with partners in specialized physical therapy and other specialists in low back pain to support you in your decision and to help you achieve the optimal pain relief for your low back pain, whatever treatment you decide. Request an appointment by contacting us by email, or calling 786-456-4152.