Before strength training ensues, encourage
your client to practice breathing techniques
such as basal breathing in upright standing
or supine lying positions to minimise load on
the lumbar discs
Step 4: Mobility and stretches
Care should be taken when trying to stretch
out the low back to reduce tightness. The
discs seem to become aggravated with
end range rotation, such as a lumbar spine
rotation stretch, so holding these stretches
and pushing into the end range is not
recommended. Alternatively, a gentle side-
to-side knee rocking motion with feet on the
ground will achieve a similar result without
the load on the discs.
The worst stretch for acute disc injuries
is a seated hamstring stretch. Not only is
it pulling the client into sitting and spinal
flexion, it also increases traction on the
sciatic nerve which may aggravate some
clients. Again, replace this stretch with
your client in a supine position, knees bent,
and use a rope or towel around the foot to
perform a bent knee hamstring stretch.
The discs become aggravated with end range rotation, such as a lumbar spine
rotation stretch, so holding these stretches and pushing into the end range is
not recommended
Take care
These simple guidelines apply to most
clients that have experienced an acute disc
injury at some stage in the past. There are
other types of disc injuries – some that
herniate anteriorly, some that are chronic
and degenerative and many that have been
injured in conjunction with multiple other
structures. The information in this article
does not apply to all disc injuries, so take
care and refer when necessary.
In addition to screening new clients, you
should also screen those that resume their
training with you after some time away –
remembering to ask which daily activities
aggravate their pain and which activities help
to ease or reduce it. Don’t be afraid to modify
the exercises to keep your clients strong and
help prevent future disc injuries.
Merrin Martin, BAppSc (Physio), BSpSc (Ex.Sc)
is the founder of Active Anatomy Physiotherapy
& Health Professional Workshops in Sydney. An
experienced physiotherapist, exercise scientist,
health educator and clinical Pilates instructor,
Merrin is a highly respected expert in exercise
rehabilitation. activeanatomy.com
44 | NETWORK WINTER 2018
The worst stretch for acute disc injuries is a seated hamstring stretch, so
replace it with a bent knee hamstring stretch (pictured)
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REFERENCES
Schoenfeld, A.J. & Weiner, B.K. (2010) Treatment of lumbar disc herniation:
Evidence-based practice. International Journal of General Medicine. 3:209-214.
Published online Jul 21 2010.
John L. Zeller, MD, PhD; Alison E. Burke, MA; Richard M. Glass, MD (2006)
Herniated Lumbar Disks
JAMA. 2006; 296(20):2512.