With the majority of the population experiencing lower back pain, we must explore the options of the discus hernia rehabilitation after surgery.
I am sure we all know someone with lower back problems as this is one of the bigger health issues in the modern world. The doctors speak of 70% of the population experiencing the pain at least once in the life time! And the big question here is: can discus hernia be cured?
Usually this pain is a result of degenerative changes or of a spinal discus movement. However, a surgery must be done when you feel severe pain and the spine has been injured too much. And to be back on your feet quickly, the special discus hernia rehabilitation is a must.
Discus hernia – why does it hurt so bad?
Inactivity makes the condition worse
Being inactive weakens our whole body, especially the soft tissue that slowly start to decay and dissolute. Because of this the body carries more pressure which falls on the vertebrae.
In order to avoid this we must pay special attention to the correct execution of the core strengthening exercises as well as the exercises for the correct posture.
The pressure gets bigger when carrying heavier loads, with repeating movement patterns, bending, static postures … And also some of the autoimmune diseases that can cause certain spine degenerative changes.
When it comes to spine pain, the most common cause is underdevelopment of the specific muscles. This is the result of not strengthening the muscles that stabilise the spine. The overweight pandemic is another factor adding to these conditions.
The discus gets thinner through the years
The spinal discs itself does not hurt. There are no nerves or veins in it. A healthy spinal disc can take up to 70kg load on the level of the third lumbar vertebrae of a 70kg person. When we lay down, this load halves and when we jump or carry heavy loads, it doubles for our body weight.
As we age our spine collapses little by little. The disc is no longer enough hydrated and small veins begin to grow back into the disc. The tissue gets more granulated and alters the natural consistence of the discs. They become stiffer and more rigid.
What are the signs of the discus hernia?
The most evident symptoms of a discus hernia are a specific centrally located pain in the lumbar (lower back) section. Pain can also spread into one or both legs, depending in the location and extension of the injury. Pain is often described as sharp or burning. Issues that occur at a slower pace can be consequences of the spinal stenosis.
The location of hernia determines the roots that are affected. Usually the patients experience lower back pain that spreads to the leg either at a slow pace or as immediate sensation. The pain can get worse when you coughing, sneezing or moving into certain positions.
Physical therapy is very important
See your doctor first
Visiting your doctor is a must in order to get all the tests done. The discus hernia is best diagnosed with a MRI scan of the lumbar area (not X-ray!).
Only the MRI scans are specific and sensitive enough to show the pathologies of soft tissues like a herniated disc. It is a noninvasive procedure where the patient is not exposed to any kind of radiation.
Did you know? The diagnostic tests showed the discus hernia can be diagnosed to 20-30% of people that never feel any signs of the injury!
It is quite common that the physicians decide to send you to physical therapy first. They will use conservative therapy methods and they obviously work quite well as 35% of all the attendants do not decide for surgical treatment after their therapies end. Their health and lifestyle can be restored without big and invasive treatments.
But when the conservative methods are not sufficient and decompression of the neurological structures are needed, the doctors decide for a surgery. (Micro)discectomy or surgical partial removal of the disc is a procedure that has been successful and preferred for years!
The surgery is performed by a neurosurgeon and it is successful in 70% of the first procedures.
Rehabilitation after discus hernia surgery
The physical therapist’s goal after a discus hernia surgery is to retrieve the lumbar area function as soon as possible and of course, to relieve the pain. Only in this case the patient can return home independently.
Active rehabilitation immediately after discus hernia surgery
Active rehabilitation starts almost immediately after the surgery. You will need it for at least 6 weeks, some of you up to 12 weeks. The physical therapist will adjust the exercises to your abilities hence here you will find only the most often and general suggestions and guidelines.
The goals of rehabilitation after a discus hernia surgery are:
- Confidently and independently getting out of bed
- Confidently and independently walking, also up and down the stairs
- Achieving sufficient muscle power and mobility for an active life
Already at the hospital, the patient gets education of the correct execution of deep stabilising core muscles (the most important is the m. transversus abdominis) as using them correctly is the key to stabilize the spine in the neutral position.
You know the drill, when you lay down on the floor and have to push your belly button in the floor and try not to pee.
It is also very important to strengthen the gluteal muscles (yes, your butt), front and back thigh muscles and other core muscles. We should also not forget the so called vein pump; we activate this set of muscles with flexing and abducing our feet.
There is 10-15% chance the discus hernia might repeat within 6 weeks from the surgery. It is really important to educate the patient how to bend properly, avoid sudden movements and lift loads.
The most important set of moves you need to learn as quickly as possible is how to get out of bed. Do not worry, friendly hospital staff will show this to you as soon as doctor approves it. Take this as a note and check the pictures below.
At the hospital you will also start increasing the distance you walk every day as well as learn how to use the stairs; both activities are key to love actively when you return home.
You will stay at the hospital up to 3 days after your discus hernia surgery. When discharged, you will leave with the precise instructions how to act and move until your first post-op exam.
You will find some of the instructions in the remainder of this article.
What are other important information when it comes to discus hernia rehabilitation after surgery?
The below instructions are suggested to be implemented in your everyday life for 4-6 weeks after the surgery.
Choose a chair with quite hard sitting area and suitable arm support as well as lower back support. All comfortable armchairs are not recommended because the spine is often in the most comfortable position. This is not the desired position of the spine.
Try to sit as short time as possible in both phases – the acute and later on. If sitting less is not possible at your working place, consider buying a lifting desk.
It is crucial you avoid any kind of lifting things when at home. When you really have to pick some smaller items from the floor bend your knees, torso to remain straightened. Do not lift or carry items heavier items than grocery shopping bags or a laundry basket and do not move any heavy furniture around your living area!
The maximum weight still allowed after the surgery is 3 kg (approximately 6,6 lbs). Lifting heavy objects overhead is not recommended. Even after one year after the operation, you should not lift loads heavier than 10 kg.
Walking is extremely healthy yet one must not exaggerate. Start with independent moving around the house and add a few steps every day till you can sovereignly take a short walk. Please listen to your body and rather walk less than your limit would be. Pain might occur but you can manage it with taking some painkillers.
Walking upstairs is not advised. You can walk, but try to avoid them to the best of your ability.
Driving a car
The reflex response may be significantly slower due to certain medications. It is not recommended to drive the car during the acute stage after disc herniation surgery. Any sudden reactions will not benefit you.
What can further aggravate the condition are the slight compression vibrations while driving, which compress the disc in the wrong position.
Try to avoid sexual activity 2-3 week after the discus hernia surgery.
Stabilization is foundation
Capability of activating the deep abdominal muscle (m. transversus abdominis) is the foundation of stabilization. But when moving we must activate all other abdominal muscles in order to stabilize our body properly. Activating only deep stabilizing muscles is not sufficient to rehabilitate the discus hernia.
The human body works as a whole. This is also the principle of our core muscles. The core muscles are many muscle groups like the deep and outer abdominal muscles that stabilize the spine and pelvis with a help of the gluteus muscles.
Famous transversus abdominis, but …
All of these muscles form a unit of the body’s core when it comes to core stabilization. The deep muscle of the transversus abdominis is no more active in stabilizing the spine than the rest of the abdominal muscles.
In addition, its complete isolation is possible only at the expense of less activation of other abdominal muscles, which is undesirable from the point of view of good movement patterns.
The body core, which successfully performs its function, inhibits the movement of the lumbar spine in the direction of rotation, bending forward, or bending to the side. However, this is only possible if a person masters these movement patterns with appropriate exercises.
Among all available and prescribed therapies to rehabilitate after the discus hernia surgery is definitely the kinesio therapy.
With the therapeutic exercises we want to improve, restore, develop and secure joint mobility, bone strength, muscle efficiency, body balance, movement coordination, general body endurance, speed, psychological mood/feeling and functional moving patterns.