Modified Gym Program for Flexion-Sensitive Low Back Pain(Disc Herniation pattern)

Yes, we can usually still train

It sounds counter-intuitive, but patients with disc herniations tend to tolerate loading quite well - it’s the angle of the spine that generally predicts if they will have symptoms or not. This is great, because once establishing the provocative postures/movements, we can (and should) continue to participate in physical activity without provoking increased symptoms.


Important Notes:

  • Purpose is to avoid positions that include flexion, can easily go into flexion without perfect technique, or create tension down the sciatic nerve.

  • You must still be careful of lifting posture while retrieving/returning weights from the rack

  • None of the movements should create sensation (even non-painful sensation) in the low back. The exception being something like supermans which is intended to use those muscles.

  • 2 sets of 12 rep-max (a weight you can do 12 times with clean technique) for one exercise from each category is a good place to start


Cardio:

  • Yes: Walking/Jogging (no incline), Elliptical, Swimming (front crawl/freestyle and back crawl only)

    • Careful not to lean forward while on the cardio machines, no flip turns in pool (both would put the low back in flexion)

  • No: Rowing, Cycling, Stair-Climber, Jacob’s Ladder, Skierg

Upper-body

  • Back: Seated (not long-seated) rows, standing cable Row, TRX hanging row, pull-ups, standing straight-arm-lat-pulldowns

  • Chest: Push-ups, standing cable chest press (or fly’s), bench press (barbell prefered over dumbbell)

  • Delts: Virtually any standing delt exercises (front raise, laterals, shoulder press, military press)

  • Arms: Virtually any standing isolation work (except kickbacks): cable, dumbell, EZ curl, barbell (curls, pressdowns, overhead extensions, etc.)

Lower-body

  • Back Chain: Pelvic raises/bridges

  • Quads: Split-Squats (ie lunges but without walking)

Other Core

  • Obliques: Side planks, obliques side crunch over back extension machine (careful to not lean forward - moving the back into flexion), horizontal oblique cable twist, standing oblique cable crunch

  • Low Back: Supermans

Abs

  • First workout - Skip abs all together and prove tolerance of the other elements of the program

  • Second workout - Trial planks only


Standard Disclaimer:

These resources are intended for Physio Steve Procter's patients, and only as prescribed. To avoid serious complications, it is important to be evaluated, diagnosed, and educated on exercises specific to your particular condition before attempting them independently.

About the Author:

 Physio Steve, MScPT, BScKin, CEP, HFFC-Fellow

Physio Steve, MScPT, BScKin, CEP, HFFC-Fellow

Physio Steve Procter is a physiotherapist and personal trainer practicing in downtown Montreal.

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