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• Adequate strength and flexibility for return to sport
• Able to move through all planes of motion
Herniation occurs when the nucleus pulpous pushes through the annulus fibrosus ring
• Continue daily exercises, stretching and cardio
• Progress into gym equipment and ball stabilization exercises
Return to sport when checked by PT or MD
• Perform exercises 3 times a week, 2 sets of 15-20 reps
• Stretch daily for 2-3 reps of 30 seconds
• Cardio for 3-5 times a week for 20-30 minutes a day
• Sport specific activities and exercises
VanGelder, L. H., et al. (2013)
https://www.physio-pedia.com/Disc_Herniation
Lumbar disectomy for disc herniation in the lumbosacral region increased the length of a professional athletes career by 3.4 years. There was no significance difference noted for patients that undergo operative vs those who seek nonoperative treatment.
http://www.mckenzieinstitute.org/patients/what-is-the-mckenzie-method/
Hsu, W. K., Mccarthy, K. J., Savage, J. W., Roberts, D. W., Roc, G. C., Micev, A. J., . . . Schafer, M. F. (2011)
• Progression in activity levels, distance, and time
• Improve spinal flexibility
• Lower extremity strengthening
• Abdominal and pelvic stabilization exercises
Treatment depends on the symptoms experienced and evaluation and imaging results. The most common way of treating a disc is to begin with self healing and then going into surgery if symptoms continue.
The safest and most effective conservative treatment for patients with lumbar disc herniation (LDH) has not been established. Lumbar Spine Stabilization Exercise (LSSE) and general exercise (GE) can effectively reduce pain intensity in the lower back and legs, and improve functional capacity in patients. It was shown that long term, LSSE is more effective than GE in reducing pain intensity in the lower back, and in improving functional capacity. However, during the acute phase of lumbar disc herniation, physical therapy, such as low power laser therapy (LPL), is needed to relieve pain intensity. These results suggest that LSSE should be an essential component of the treatment plan for LDH patients, and that combination of LSSE with physical therapy, such as LPL, is an effective and performable program.
• Lower extremity stretching
• Spine stretches
• Core stabilization
• Hip exercises
• Bending and squatting
• Walking daily
• Isometric contractions against frontal and rotational movements
To reduce pain and symptoms and relax muscles that spasm as a result of herniation
- Ibuprofen
- Nerve Pain Medications
- Injections (if oral medication is not effective)
- Muscle Relaxers
• Maximize strength and flexibility
• Initiate functional activities
(Ye, Ren, Zhang, Wang, Liu, Fang, Sun, 2015)
• Perform exercises 3 times a week, 2 sets of 15-20 reps
• Stretch daily for 2-3 reps of 30 seconds
• Functional movements
VanGelder et al, (2013)
• Flexibility of spine and lower extremity
• Aerobic conditioning and cardio such as running, swimming, and the elliptical
• Strengthening of the lower extremity and hips
• Lunge and squat progression
• Able to use exercise machines
South Shore Hospital
• Lifting, bending and reaching exercises
• Perform exercises 3 times a week, 2 sets of 15-20 reps
• Stretch daily for 2-3 reps of 30 seconds
• Cardio for 3-5 times a week for 20-30 minutes a day
• Full integration of transverse movement
VanGelder et al, (2013)
- Named based on the vertebrae above and below it
- The most common are L4-5 and L5-S1
The spine performs
flexion, extension, rotation and lateral flexion
The sacrum provides strength and stability to the pelvis
Lumbar spine works to support compressive loads
www.youtube.com/watch?v=eW8zI_ib1-w
Return to sport in athletes who have undergone lumbar discectomy is 81% compared to the 76% returning after conservative treatment.
Studied professional athletes from the NFL, NBA, MLB, NHL.
Some studies report that lumbar disectormy results in a higher chance of return to play. However, the ability to return to prior level of play is significantly low at 36%.
Reiman, M. P., Sylvain, J., Loudon, J. K., & Goode, A. (2016).
https://www.researchgate.net/figure/Anatomy-of-the-spine-with-view-of-the-disk-From-Anatomy-of-the-lumbar_fig4_280626099
https://www.southshorehospital.org/Workfiles/Medical_Services/Orthopedics/Lumbar_Disc_Herniation.pdf
http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?27/24/28035
Hsu, W. K., Mccarthy, K. J., Savage, J. W., Roberts, D. W., Roc, G. C., Micev, A. J., . . . Schafer, M. F. (2011). The Professional Athlete Spine Initiative: outcomes after lumbar disc herniation in 342 elite professional athletes. The Spine Journal, 11(3), 180-186. doi:10.1016/j.spinee.2010.12.009
Joon-Shik, Lee, Yoon, Me-reiong, Yong-jun, Park, Shin, Meyoung, & In-Hyuk. (2016). Long-Term Course of Alternative and Integrative Therapy for Lumbar Disc Herniation and Risk Factors for Surgery: A Prospective Observational 5-Year Follow-Up Study. Spine, 41(16), 955-963. doi: 10.1097/BRS.0000000000001494
Reiman, M. P., Sylvain, J., Loudon, J. K., & Goode, A. (2016). Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: A systematic review with meta-analysis. British Journal of Sports Medicine, 50(4), 221. http://dx.doi.org.libproxy.library.wmich.edu/10.1136/bjsports-2015-094691 Retrieved from http://libproxy.library.wmich.edu/login?url=https://search-proquest-com.libproxy.library.wmich.edu/docview/1779912680?accountid=15099
South Shore Hospital. (n.d.). Retrieved March 3, 2018, from http://www.southshorehospital.org/Workfiles/Medical_Services/Orthopedics/Lumbar_Disc_Herniation.pdf
VanGelder, L. H., Hoogenboom, B. J., & Vaughn, D. W. (2013). A PHASED REHABILITATION PROTOCOL FOR ATHLETES WITH LUMBAR INTERVERTEBRAL DISC HERNIATION. International Journal of Sports Physical Therapy, 8(4), 482–516.
Ye,Chaoqun., Ren, Jimin., Zhang,Jianzheng., Wang, Chongwei., Liu, Zhi., Fang, Li., & Sun,Tiansheng.(2015). Comparison of lumbar spine stabilization exercise versus general exercise in young male patients with lumbar disc herniation after 1 year of follow-up. Int J Clinical Exp Med, 8(6), 9869-9875.
In this article it talked about the controversy between the difference in long-term outcomes of conservative and surgical treatment. Long-term results of lumbar disc herniation patients receiving nonsurgical complementary and alternative medicine treatment were more beneficial in this case than patients who had surgery and then went through extensive rehab. The results showed that to assess pain, functional disability, surgical status, and overall health patients sought out complementary and alternative medicine treatment over the risk factors for lumbar surgery.
extension of the disc margin beyond the margins of the adjacent vertebral endplates
can report false postitive results in lumbosacral region
the posterior longitudinal ligament remains intact but the nucleus pulposus impinges on the anulus fibrosus
(Joon-Shik, Yoon, Yong-jun, Shin, 2016)
the nuclear material emerges through the annular fibers but the posterior longitudinal ligament remains intact
the nuclear material emerges through the annular fibers and the posterior longitudinal ligament is disrupted. A portion of the nucleus pulposus has protruded into the epidural space
https://www.physio-pedia.com/Disc_Herniation
• Control pain and inflammation
• Reduce muscle spasms
• Proper body positioning and movements in pain-free ROM
• Stay active
• Stretching
• ROM
• Core muscle activation
• McKenzie Method Exercises
• Perform activities that minimize pain
• Find comfortable positions for sleep and sitting
• Posture education
VanGelder, L. H., Hoogenboom, B. J., & Vaughn, D. W. (2013)
http://www.mckenzieinstitute.org/patients/what-is-the-mckenzie-method/