As chiropractors, one of the most common conditions we see in office is low back pain. There are a lot of causes of low back pain, one of the more severe conditions being a lumbar disc injury. A few things that patients notice while experiencing a lumbar disc injury is back and/or leg pain associated with coughing, sneezing, or going to the bathroom. This actually mimics one of the orthopedic tests we use in office called the Valsalva maneuver. In this scenario, a patient’s history matches our clinical findings, helping us to confirm a diagnosis.
When we are confident in our lumbar disc diagnosis, one of our initial exercises we prescribe to patients is a nerve glide. The type of nerve glide given to the patient depends on where they are experiencing symptoms and what position is most comfortable. Typically we find that a seated sciatic nerve glide. To perform a seated sciatic nerve glide, begin seated in a firm chair with your hips and knees at 90 degrees and your head looking down at both feet on the floor. Next, fully straighten your affected leg at the knee until you feel a stretch in the back of your thigh. Do not move into a position that reproduces sharp or radiating pain. At the same time that you are moving your leg forward and up, extend your head to look at the ceiling as to nod “yes.” Then return to the start position.
Another exercise we prescribe initially with lumbar disc patients is a directional preference exercise. To find a directional preference, we will first test have the patient perform repeated end range movements in either extension (bending backwards), flexion (bending forwards), and/or lateral bending (bending side to side), while monitoring symptoms. The direction that improves symptoms will be prescribed as part of the home exercise program!
As patients progress and symptoms allow, we will begin adding in strength based exercises. One of our favorites for lumbar disc patients is the dead bug exercise! To perform a dead bug, lie flat on your back with your hips and knees bent to 90 degrees and your straightened arms reaching toward the ceiling, palms facing each other. “Tuck your tail” to flatten your lower back into the floor. Then, simultaneously slowly lower one arm and the opposite leg back down toward the floor. Return to the start position and repeat with your opposite limbs. Avoid arching your back, and keep your core braced throughout this movement!
When dealing with a lumbar disc injury, it is important to stay aware of your symptoms. If you begin feeling any leg weakness, numbness in your hips/pelvis, or the inability to control your bowel/bladder you need to seek emergency help. These symptoms are what are considered “red flags'' and need to be evaluated by a healthcare professional. If you feel an increase in your pain frequency or intensity, or if you feel your symptoms begin going down/further down your leg, let your healthcare provider know. These are symptoms that need to be monitored to be sure your disc injury is not getting worse. When treating a disc injury in-clinic, one of our first lines of treatment is our spinal decompression table. The spinal decompression table provides a gentle stretch to the lumbar spine, improving range of motion and reducing radiating symptoms. As you progress and as your symptoms allow, we begin adding in more traditional techniques including chiropractic adjustments if indicated and tolerated.
If you or someone you know needs help navigating a lumbar disc injury, we’re happy to help!