Core Exercises for Herniated Discs (for Prevention, Rehab, and Strengthening)

Best Core Exercises for a Herniated Disc:

When dealing with a herniated disc, the goal is to strengthen the core without aggravating the injury. You may have radiating pain into your legs and the exercises we select should not exacerbate those symptoms. From my experience working with patients, these tend to be effective core strengthening exercises for those with a herniated disc:

Bird-Dog:

• Start on all fours
• Extend one arm forward and the opposite leg backward.
• Hold for a few seconds, then switch sides.
• Start with 2-3 sets of 5-10 per side repetitions and progress based on symptoms

Dead bug:

• ‍‍Lie on your back with arms extended towards the ceiling and knees bent at 90 degrees.
• Lower one arm and the opposite leg towards the floor
• Then return to the starting position.
• Start with 2-3 sets of 5-10 reps per side and progress based on symptoms

Best Core Strengthening Exercises for a Bulging Disc

For those with a bulging disc, core exercises should focus on stability and support:

Bridge:

• ‍‍Lie on your back with knees bent and feet flat on the floor.
• Lift your hips towards the ceiling, squeezing your glutes and engaging your core.
• Hold, then slowly lower back down.

Plank:

• Start in a forearm plank position on the ground or on swiss ball for added challenge, ensuring your body is in a straight line from head to heels.
• Hold the position while engaging your core muscles. Avoid letting your hips sag or rise.
• Start with 10-30 seconds to test tolerance. Progress to 2-3 sets of 30-60 seconds.

‍

Mini-squat:

• Stand with your feet about shoulder width apart
• Perform a squatting motion as if you were sitting back into a chair until your knees are bent to about 30-45 degrees.
• You can increase the difficulty by performing a single arm bicep curl during your squat.
• Start with 2-3 sets of 8-12 reps

What is the difference between a herniated disc and a bulging disc?

As a physical therapist who treats a significant number of patients with back pain and spinal conditions, the topic of disc bulges and disc herniations often comes up. There are significant differences between these two terms, although nonmedical persons have been known to use them interchangeably.

Understanding the difference between the two terms can help temper expectations and guide rehabilitation.

A bulging disc occurs when a disc, which acts as a cushion between the vertebrae, starts to protrude outward, most commonly posteriorly or backwards, but maintains its overall structure. This bulge can press on nearby nerves, causing pain, tingling, or numbness in the limbs. Other times you can have a bulge with no symptoms at all. However, unlike a herniation, the inner part of the disc remains intact within its outer layer.

A herniated disc, on the other hand, is when the inner gel-like substance of the disc (nucleus pulposus) pushes out through a tear in the outer layer (annulus fibrosus). This rupture can exert more pressure on the nerves and surrounding tissues, often leading to more intense pain, and symptoms like muscle weakness or loss of reflexes.

Herniated discs can often be confused with muscle strains as well. For help diagnosing between those, read our article "Herniated Discs vs. Muscle Strains" here.

How to Reverse a Disc Bulge: Can We?

There is strong evidence that reveals that disc bulges and herniations do physiologically heal over time. So yes, disc bulges and herniations do get better over time and are not permanent changes in our anatomy.

Disc bulges and even severe disc herniations can and do change in a positive manner, both naturally with time and with the proper therapeutic environment (proper rest and recovery, rehabilitation program with a rehab professional, etc).

Spontaneous Regression of lumbar disc herniation [Chiu 2015]

There is a concept in disc herniation recovery called spontaneous regression meaning the size of the herniation can spontaneously recover with time.

What I find most fascinating, and encouraging, is that the worse the herniation the more likely there is to be spontaneous regression of that herniation.

That’s right, and counter to intuition, the worse the injury the more likely there is to be spontaneous regression of that disc injury. The theory is that the worse the herniation, the stronger and more immediate the inflammatory response. In this situation, the inflammatory response is what signals to the body where to begin healing.

Images and Pain:

What is also very important to know about disc bulges and herniations is that imaging (such as MRI) during the recovery process typically does not correlate with symptoms and I mean that in a positive way! MRIs can make your recover pathway more cloudy and prolong recovery. In general, I tell my patients to stay away from MRIs! 

For example, many times I will have a patient that has completed 2-3 months of rehab and will report significantly reduced pain and symptoms despite follow up imaging revealing that the bulge or herniation has only slightly improved in terms of its appearance.

The takeaway is your symptoms will often improve much more rapidly than your images.

Diagnostic images only show structures, not the complex properties of pain. Do not be distraught or disappointed if you feel better even though your images aren’t perfect.

Strengthening Your Core with Degenerative Disc Disease (DDD)

Degenerative Disc Disease (DDD) is a spinal condition of some controversy within the physical therapy and rehab professional community.  DDD is highly prevalent in many asymptomatic individuals and is correlated with age. Most don't know they have DDD until they have an X-ray or MRI.

DDD is typically seen as more of a age-related change in spine health, think of it as wrinkles on the inside. 

However, there still can be clinical implications for more severe cases. While DDD differs physiologically from herniated or bulging discs, core strengthening is still essential. The core exercises that are effective for treating disc bulges and herniation are also effective for treating DDD. Typically with DDD there will be less of a concern for radiating symptoms such as pain or numbness and tingling that extends into the legs which allows for more freedom of exercise selection.

Abdominal Exercises to Avoid with Herniated Disc or Disc Bulges:

Generally, for individuals experiencing pain from disc bulges or herniations is to minimize or avoid flexion-based exercises and movements: common examples include prolonged sitting especially in slumped postures, sit ups, crunches, things of that nature. Most individuals will tend to benefit from limiting flexion-based movements especially in the acute phase of injury but this rule is not absolute.

There are groups of individuals that actually get relief from flexion-based movements following a disc bulge or herniation. That is why I highly encourage someone to find a rehab professional such as a physical therapist who can develop a rehab program that will be appropriate for your specific situation.

Movement Restrictions:

Another piece of advice to take to heart is that while you may limit or avoid certain movements in the earlier stages of recovery, these are not for the rest of your life!

‍Down the road when you are feeling much better you can begin to reintegrate movements and activities that you would not have dared to do because of pain in the more acute stages of your injury.

The spine craves movement in all planes of motion and if you always limited yourself from flexing your spine, for example, then this can contribute to fear related avoidance of certain activities which can be detrimental to your wellness in the long-term!

Example Full Body Workout with a Herniated Disc

Maintaining overall strength is important even with a herniated disc. Obviously we want to strengthen our core and trunk but we cannot neglect the other functions and regions of our body. Here’s a full-body workout that is safe and effective:

1. Warm-Up: Start with 5-10 minutes of gentle cardio, such as walking. Walking is enough to get the blood flowing.
2. Bicep and Tricep Strengthening : Perform this exercise with a resistance bands or light weight. Yes, working you upper body works your core! 
3. Wall Sits: Lean against a wall and slide down until your knees are at a 90-degree angle. Hold this position to engage your legs and core without straining your back.
4. Dead Bug: Lie down on the ground and raise your legs 90 degrees and your arms towards the ceiling. Lower one leg and the opposite arm towards the ground. Raise back to starting position and switch sides. This exercise strengthens your core muscles.
5. Cool Down: End your workout with gentle stretching, focusing on hamstrings and nerve glides! 

Conclusion

Whether you’re dealing with a herniated disc, bulging disc, or degenerative disc disease, understanding the differences between these conditions and selecting the right exercises is key to managing pain and improving function. Remember to listen to your body, avoid exercises that cause discomfort, and consult with a healthcare provider or physical therapist if you're unsure about the best approach for your situation.

References