Physical therapy exercises for herniated disc pdf file size chart printable

Physical therapy exercises for herniated disc pdf file size chart printable

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[PubMed] [Google Scholar]Page 2Subjects' general characteristicsItemExperimental group I(n=15)Experimental group II(n=15)Age (years)32 ? 7.935.5 ? 10.9Height (cm)168 ? 9.1 164.3 ? 10.3Weight (kg) 60.93 ? 13.667.38 ? 15.1SMM (kg)24.8 ? 7.122.68 ? 7.0BFM (kg)16.5 ? 4.0 21.19 ? 8.0BMI (kg/m2)21.7 ? 2.2 25.29 ? 3.7 Think of the cushioning discs between your vertebrae as your car's brake pads--they actually have more in common with shock absorbers, but stay with us. When your brake pads are wearing down and making that awful grinding noise, you just change them out if you're handy or have a mechanic do it if you're not. It's not so easy with your back. Although disc replacement materials have become more advanced and the procedure less invasive and costly, it's still surgery, and you want to avoid it if possible. So initially you'll want to take a different track if your intervertebral discs become damaged or herniated, and that means exercise and stretching. Your vertebrae ? the small bones that make up your spine ? have cushioning discs between each one. Think of the discs as small, squishy balloons filled with an elastic, gel-like substance. You have 23 of these cushions, referred to as discs or intervertebral discs. Intervertebral discs are held in place by cartilage on the end of each vertebra. Intervertebral discs function as the body and spine's shock absorbers (see, what did we tell you?), transferring weight and stress from vertebra to vertebra. But these discs can wear down over time or become injured and their gel centers can leak out and press on the nerve roots that emerge from the spine. This type of injury is a herniated disc.Sara Mikulsky, a doctor of physical therapy, explains, "When we have a herniated disc, the disc can lose its height because it has lost some of the fluid and water inside. This loss in height not only affects the bony structures (because they are now closer together) but it also affects the ligaments that connect each bony segment. These ligaments then are slackened and therefore do not offer the same stability as before.Because ligaments cannot be strengthened with exercise, it becomes even more important to strengthen the muscles around the spine to make up for this lack of stability." According to Lali Sekhon, MD, a neurosurgeon, this loss of disc height is generally gradual and occurs over years and sometimes decades.Herniated discs most often occur in the cervical (neck) and lumbar (low back) areas of the spine; however, though rare, the thoracic (mid-spine) can also suffer herniated discs. Depending on the severity of the injury, the displaced disc may place pressure on nerves, which results in pain and other discomfort. Herniated discs also lose much of their cushioning effect, causing the vertebrae to rub against each other.Herniated discs are extremely common. Most often, conservative, non-invasive treatment methods should be tried first. They are very effective to relieve painful symptoms while the body heals. While you can't replace your shock absorption system, stretches and exercises designed for herniated discs can work alongside other conservative treatment methods to relieve the pain and discomfort of a herniated disc. If you are suffering from a herniated disc, consulting your treating clinician before beginning any new stretching or exercises is imperative. You may risk additional injury without approval and proper instruction. Exercises and stretches should be avoided during the acute stage of a herniated disc."Sometimes intervention with a steroid injection or oral steroids is required before exercise," says Dr. Mikulsky. "However, once the steroids are administered, exercise is critical in preventing the nerve root from being impacted again." Once the proper clinical considerations have been addressed, gentle exercises and stretches can help ease the pain and other symptoms of a herniated disc. When you strengthen your back and hamstring muscles, pressure on the spinal column is eased, which helps to prevent pain. Exercise also helps prevent further injury and pain, and promotes healing by:Increased blood flow to the spine to help heal the injuryBuilding strength in the support muscles for the spineDecreased stress on the spine, which relieves painImproving abnormal postures related to painDon't avoid exercises after a herniated disc diagnosis. The sooner you start stretching and exercising, the better prognosis (outcome), with your physician's approval. For safety, start out designing a daily small exercise routine from the below choices and slowly build up to more intense exercises as tolerated by your body. As a general rule, avoid the "BLTs" (bending, lifting and twisting).Though you don't need any supplies to do these exercises, certain items may make the stretches and exercises easier and more comfortable. Suggested supplies: a yoga mat (particularly if you only have hard floors), resistance band (a towel will do in a pinch), yoga blocks, stable upright chair (not a recliner), timer (your phone should have one).If any of the following exercises or stretches cause pain, stop immediately and consult your physician or treating clinician.According to Dr. Mikulsky, "More often than not, a herniated disc in the cervical spine is caused by a forward head posture and increased lordotic curvature [`swayback' or excessive inward curvature] of the spine. This extension of the spine places stress on the posterior aspect of the disc structures." Isometric hold exerciseSit up straight and relax your shoulders. Place your hand on your forehead.Press your head into your hand without moving your head.Hold for 5 to 15 seconds. Repeat 15 times.Neck extension with head lift exerciseLie on your stomach on a raised, stable, flat surface.Place your arms by your sides.Hang your head off the edge.Raise your head up slowly to its neutral position and hold for 5 to 10 seconds.Repeat 15 to 20 times as tolerated.The following two exercises are "a must" according to Dr. Mikulsky, Chin tuck / neck retraction exerciseLie on your back on a flat surface. Place your arms at your side.Tuck your chin in and down toward your chest until you feel a tug.Hold for 5 to 10 seconds. Repeat 15 to 20 times.Shoulder retraction exercise (scapular retractions)Sit or (preferably) stand with your back against a wall.Let your arms hang down naturally at your sides.Bend your elbows until your arms are at a 90-degree angle at the elbow (your upper arms should remain against the wall).Move your shoulders down and back. Push the back of your upper arms against the wall while squeezing your shoulder blades together. Hold for 15 to 30 seconds.Dr. Mikulsky also recommends posture training, "In this training, the person would sit straight up, bring the head and chin back, shoulders back and then elongate or lift the head up (as if a string is pulling the spine up)."After your herniated disc symptoms have resolved completely, Dr. Mikulsky recommends the following exercises, "I would recommend these after the symptoms have cleared in order to regain any loss in range of motion. But doing these stretches while the disc is herniated could lead to more stress on the structures and could increase pain."Sit up straightRelax your shouldersHold each stretch for 30 seconds then restRepeat 3 to 5 times per dayNeck rotation stretch: Gently turn your head to one side without turning it past your shoulder (you shouldn't turn it so far that you can see behind you). After holding for 30 seconds, turn your head slowly to the other side and hold again.Lateral bend stretch: Tilt your head to the left like you're trying to touch your shoulder with your ear (you don't need to touch your ear ? just tilt until you feel a pull). Hold, then tilt to the right shoulder.Scalene stretch: Sitting in a chair, grab the seat with your left hand, move your left shoulder blade downward, bend your right ear toward your right shoulder until you feel a tug, then tile it slightly backward.Gentle knee-to-chest stretchThis is a great stretch to start out with and also use on days when your body won't tolerate more strenuous stretches. The knee-to-chest stretch works muscles on each side of the back to help relieve pain:Lie on your back, knees bent, both heels planted on the floor.Place your hands behind one knee and gently pull it toward your chest until you feel a tug.Hold the stretch for at least 10 seconds, switch, and repeat several times.Cat-cow stretch A favorite for back pain relief, the cat-cow stretch opens the spaces between your vertebrae, relieving pressure on the herniated disc and improving the mobility of your spine:Lower to your hands and knees to the floor so your body is in a "tabletop" position with a flat back. Inhale deeply and sink your stomach down toward the floor while looking up at where the wall meets the ceiling.As you then exhale slowly, round your spine into an arch, like an angry cat, and let your head hang low and loose. You should be able to see your back feet.Perform as set of 10 two to three times.The "cat" phase of the cat-cow stretch.Back flexion stretchThis stretch extends both your back muscles and spine to relieve low back pain, one of the most common medical complaints. Lie on your backPull your knees toward your chest and wrap your arms around the knees.Lift your head straight up off the floor until there is a tug across the mid and low back.Hold for 10 seconds and repeat 5 to 10 times.Spinal decompression stretchTake pressure off your spine and discs by stretching the space between your vertebrae.You'll need something stable to hang from (e.g. a bar designed for pull ups at the top of a doorframe, playground monkey bars or other bar, etc.).Grasp the bar with an overhand grip. If your feet touch the ground, lift them at the knees until they no long touch.Hang for 30 seconds and repeat 3 times.Piriformis muscle stretchStretching this small muscle in the buttocks helps relieve low back pain. This stretch is also helpful if you have sciatica.Lie on your back on the floor or yoga mat. Bend your knees and firmly plant both your heels planted on the floor.Pick up one leg and rest your ankle on the other leg's bent knee. This should like an upside-down triangle.Reach one arm through the triangle and use both hands to grasp the bent leg.Pull the leg toward your chest until you feel a tug in the buttock of the crossed leg and hold.Repeat on the other leg.Seated hamstring stretch This stretch does double duty by strengthening the muscles that support your lower spine as well as providing a pain-relieving stretch, but should only be performed once all symptoms have resolved. Dr. Mikulsky cautions, "If someone has any radiating pain, this [stretch] should not be completed. Doing a hamstring stretch with prolonged holds can irritate the nerve and nerve root. I may recommend this stretch after the disc heals but definitely not if symptoms are present."Sit in a chair with one foot on the floor with the knee bent at 90 degrees and the other extended out straight with the heel still planted on the floor.Straighten your back and lean forward over the stretched out leg until you feel a stretch along the back of your upper thigh.Hold this stretch for 15?30 seconds then switch legs.Repeat several times as tolerated.Option: If desired, you can deepen this stretch by lying on the ground and lifting one leg into the air. Wrap a resistance band (or long towel) around the raised foot and hold the towel/band, pulling your leg toward your body.Prone extension stretch This stretch helps reposition the disc back toward its proper place, which helps the healing process. Note: this stretch may be not be tolerated by every person. This is normal. Start very slowly. If you experience any pain, stop immediately.Lie face down on the floor or yoga mat.Place your forearms on the floor next to your body. Your elbows should be bent at a 45- degree angle.Slowly prop yourself up on your elbows into a "Sphinx" position, being sure to keep your hips connected to the floor.Keep pressing yourself upward until your elbows are bent at a 90-degree angle.Hold the upward position for 10-15 seconds, then return to your starting position.Repeat the stretch 10 times and gradually increase the time you hold the upward position until you can maintain it for 30 seconds.Pelvic tilt or abdominal bracing"This exercise helps to improve the deep core stabilizers, which will take pressure off the disc space and help return the spine to a neutral position," says Dr. Mikulsky. "When doing this exercise, the focus is on contracting the transversus abdominus (TA). This muscle is the "weight belt" of the body and works to stabilize the spine to prevent flexion and extension forces on the spine." Lay on your back with knees bent and feet flat. Contract and pull in the deep and lower ab muscles without holding the breath. As this motion occurs, the lower back will flatten down to the floor, placing the spine in a neutral position. Hold for 10-15 seconds and repeated multiple times. Thomas stretch"Many times, the iliopsoas (hip flexor) muscle has adaptively shortened due to prolonged sitting," says Dr. Mikulsky. Because of its anterior attachment to the lumbar spine, when shortened it can place stress on the spine and pull it forward. We may see an increased lordosis in the lumbar spine when this occurs. The Thomas stretch is a gentle and safe way to stretch the hip flexor without stressing the spine." Lay on a flat surface. Pull one leg up to the chest.Pull the abs in and hold the other leg off the surfaceA stretch should be felt in the front of the thigh. No pressure or pain should be felt in the back.You can cause or worsen a herniated disc if performing strenuous exercises and sports. Any heavy lifting or sudden pressure on your back can cause a herniated disc, as well as strenuous repetitive activities. If you are currently recovering from a herniated disc, you should avoid all strenuous activities until cleared by your physician. While recovering, avoid any exercise that causes or intensifies your pain. If you have sciatica, avoid hamstring exercises. Because they can jar the spine, avoid high-impact activities, such as running or certain sports. Swimming or water exercises are a great option because there is no impact and the discomfort of gravity is removed while in the water. Dr. Milkulsky strongly suggests stretching, exercising, neutral posturing and working on flexibility to avoid future disc injuries. "Once a disc is herniated it permanently loses its disc height. Therefore, continuing to do exercise to maintain strength of the deep core stabilizers is important," she says. "Doing some form of these exercises as maintained is important to prevent more herniations. Additionally, learning to keep the spine in neutral positions during activities such as lifting, carrying, and sitting can also help reduce the chance of another herniation. Also, maintaining flexibility of the hamstring and iliopsoas will also help prevent further herniations."

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