Physical therapy plays a critical role in the treatment of lumbar disc herniation (LDH) for countless individuals, often producing excellent results without the need for surgical intervention. In fact, research1 has shown that referral from a primary care physician to physical therapy for recent-onset sciatica improves disability and outcomes.
How can physical therapy benefit patients struggling with LDH and relieve sciatica symptoms? This article provides an overview of the benefits of physical therapy for a lumbar herniated disc, as well as what you can expect from the process.
Treating a Lumbar Disc Herniation with Physical Therapy
Physical therapy can provide symptom relief, prevent flare-ups and recurrences, improve function and mobility of the lumbar spine, and alleviate the underlying cause of sciatica, which is most commonly LDH. Specifically, the goals of physical therapy for a lumbar herniated disc are to:
- Relieve leg and lower back pain
- Reduce muscle spasms
- Improve lower body mobility
- Restore pain-free movement
- Improve posture and motion
- Strengthen core muscles
- Improve strength and endurance
- Prevent future pain flare-ups
Strengthening your core and the muscles that support your back is not only a must for athletes—it can also improve your posture, aid in everyday tasks like household chores, and potentially protect you from pain and injury. Your “core” refers to the midsection of the body (essentially the torso), and it involves all the muscles along the front, back, and sides. Examples of daily activities that require core strength include:
- Reaching for something from the top shelf
- Bending down to tie your shoes
- Bathing and getting dressed
- Picking something up from the floor
- Cleaning the house (e.g., vacuuming)
- Walking around and standing still
- Working outside (e.g., gardening)
- Controlling bladder/bowel functions
Many people don’t realize the role core strength plays in spinal health. Your core muscles help support and stabilize your spine. On the other hand, weak core muscles can result in persistent lower back pain, poor posture, and muscle injuries that make it difficult to exercise and engage in daily activities. Prolonged sitting and inactivity both weaken the muscles of the midsection.
Sitting at a desk all day at work in sedentary roles can be counteracted by practical solutions such as getting up every 20 minutes to move around, stretching at lunch, using a standing desk, and/or engaging in core strengthening exercises. Core strengthening exercises train muscles in the lower back, hips, abdomen, and pelvis to work in harmony and improve balance and stability. Low-impact exercise can also help you maintain a stable weight, which can reduce the loads and pressure on your spine.
What to Expect from Physical Therapy for Your Sciatica
During your first appointment, your physical therapist will conduct an evaluation. The evaluation will consist of an interview and physical examination. This will help determine the best course of treatment to help reduce pain and improve functional movements. During the interview, your therapist will gather the history of symptoms, symptom behavior, and functional limitations, while also considering lifestyle habits and medical history. During the physical examination, your physical therapist will assess your lower back/hip range of motion, strength, posture, reflexes, gait, and other functional movements in order to determine the impairments present. The impairments identified will allow the physical therapist to determine the contributing factors to your pain. The information gathered in the evaluation will allow your therapist to more accurately develop a treatment plan. The plan will detail the timing, frequency, duration, and types of treatment needed to improve pain and attain the movement goals. The treatment may consist of one or a combination of the following:
Joint Mobilization and Graded Passive Mobilization (GPM)
Joint mobilization and Graded Passive Moblization involves applying pressure and/or force to a joint in order to mobilize it, reduce pain, and restore movement. Past research2 has revealed that physical health improvements are more likely when patients with Sciatica are treated using joint mobilizations.
Nerve mobilizations focus on treating a symptomatic nerve (in this case, the Sciatic nerve) by placing it in and out of tension in order to facilitate healthy movement and reduce painful Sciatica symptoms.
Strengthening exercises rely on body weight and resistance techniques to strengthen muscles in the core, lower back, hips, and legs. These exercises typically involve contracting muscles using resistance bands and weight training. Common muscles targeted to help relieve pain and restore function in patients with low back pain and LDH are Transversus Abdominis, Multifidus, Gluteals, and other core muscles3.
Examples of other common physical therapy exercises that can relieve sciatica pain resulting from LDH:
Extension and Flexion Exercises
These types of exercises help relieve Sciatica symptoms by incorporating backward (extension) and forward (flexion) bending tailored to the individual. Sciatica patients often feel relief with specific directional movement of the lumbar spine.
Mechanical Diagnosis and Therapy
Widely known as the “McKenzie Method,” this technique involves a series of directional movements similar to extension and flexion exercises, which helps to identify and treat the source of pain in the lumbar spine. Physical therapists who practice this method typically have special training in mechanical diagnosis and therapy.
Functional retraining focuses on reintroducing basic movements that can become difficult due to sciatica symptoms, such as lifting, bending, carrying, and squatting. The goal is to utilize proper techniques and movement patterns to reduce pain.
Muscle Energy Technique
This form of manual therapy involves performing gentle muscle contractions in conjunction with a physical therapist moving painful joints through a specific range of motion. The goal is to reduce pain and restore normal function.
Soft Tissue Mobilization
During soft tissue mobilization exercises, a physical therapist uses their hands to mobilize painful soft tissues in the legs, lower back, and hips to decrease muscle tension and/or muscle spasms.
Other techniques are also used, including dry needling, gait training, and assisted range of motion. Your physical therapist may include passive treatments as well, such as deep tissue massage, hot and cold therapy, electric stimulation via a TENS unit, traction, and ultrasound therapy. Physical therapy may or may not be combined with relieving injections (given by a Pain Management Physician) to more quickly reduce pain/inflammation and restore movement.
Independent Therapy at Home
Additionally, your physical therapist may also give you homework, or exercises to perform at home between supervised physical therapy sessions. If a particular physical therapy technique or exercise causes you pain or discomfort, always let your physical therapist know so they can adapt their approach as necessary.
As you approach the conclusion (discharge) of your physical therapy treatment you should expect a progressive relief of pain and improvement in the impairments identified at the evaluation. The reduction in pain and improvement of impairments should translate into the progressive attainment of the functional movement goals established. At discharge you will be issued an exercise program to continue at home and further education on how to prevent the pain from flaring up in the future.
Exploring Physical Therapy to Relieve Sciatica Symptoms
Physical therapy and other conservative treatments—like exercise and stretching programs, pain management, and relaxation techniques—can all be incredibly effective for patients recovering from a LDH and seeking relief from disabling sciatica symptoms. Consult with a doctor to learn whether physical therapy for a lumbar herniated disc is a good next step for you.
While this blog is meant to provide you with information you need to make an informed decision about your treatment options, it is not intended to replace professional medical care or provide medical advice. If your physician recommends a discectomy surgery, Barricaid is an implant intended to close holes in your disc and prevent reherniation.
If you have any questions about the Barricaid device, please call or see your doctor, who is the only one qualified to diagnose and treat your spinal condition. As with any surgical procedure, you should select a doctor who is experienced in performing the specific surgery that you are considering.
1 Julie M. Fritz et al, “Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica,” Annals of Internal Medicine (2020): doi: 10.7326/M20-4187.
2 Dianne V. Jewell and Daniel L. Riddle, “Interventions That Increase or Decrease the Likelihood of a Meaningful Improvement in Physical Health in Patients With Sciatica,” Physical Therapy 85, no. 11 (2005): 1139–1150, doi: 10.1093/ptj/85.11.1139.
3 Fritz JM, Sharpe J, Green T, Magel J, Thackeray A, Kawchuk G. “Optimization of Spinal Manipulative Therapy Protocols: A Factorial Randomized Trial Within a Multiphase Optimization Framework” The Journal of Pain 11.008 (2020)