Herniated discs can be debilitating and lead to months or even years of pain & limitation if dealt with improperly. Populations around the globe are plagued by back pain and the toll it takes on both the individual, their family, community and economy is substantial. One of the most common causes of this lower back pain is a herniated disc, this could be in more minor forms such as a bulging disc or slipped disc, or even “disc strain” as perhaps a more helpful way to view the injury. Being such a common issue, with varying degrees of severity, it is no wonder the internet is awash with different exercises and recommendations. However, many of these are simply attempts to deal with the pain associated, and provide moment to moment relief instead of lasting results. Often these shortsighted approaches, be they exercises or stretches, are sacrificing long term healing and recovery for what can sometimes be as little as a moment’s relief. This leaves people instinctively knowing that the exercises don’t work and looking for alternatives.
If you’ve been struggling with a disc strain, whether it’s a herniated disc or ruptured disc, the more minor variations of a bulging disc or slipped disc, or you have been diagnosed with degenerative disc disease, then you’re in the right place. Today we’ll cover these exercises and stretches specifically to help you understand what they might be doing, and whether this could be considered helpful or harmful for the recovery of your herniated disc.
A brief overview of herniated discs and lower back pain
Before we get into the exercises and stretches it is helpful to cover some simple anatomy for you to better appreciate the role of the exercises, and how this relates to your back pain. It is additionally helpful to consider that often back pain may not be present, instead you might experience sciatica, without back pain, which can be confusing to say the least. The very first episode of The Back In Shape Podcast was all about understanding sciatica so if you’re experiencing sciatica and have been diagnosed with a disc injury, check that episode out after this one.
With that in mind it is helpful to think of a back injury instead of back pain, or sciatica. In this case it is the discs we are talking about.
The structure of a lumbar intervertebral disc
The discs form a cushion between the large front portion of the vertebrae, the vertebral body. They act as a separator leaving space between to vertebra so that the little nerves from the spinal cord can leave the spine and go wherever they need to, in the case of the lower lumbar spine, many of them join together to form the major nerves of the leg, such as the femoral nerve and the sciatica nerve.
The disc itself is very much like a ligament and functions as an extension of many of the other ligaments of the spine to work together to support the spinal structure. There is an outer section which consists of most of the mass of the disc. This is a series of 7 to 15 ligament layers arranged at 30 to 45 degree angles to one another running from the top vertebra to the bottom one. As these layers are combined they form a mesh which is tremendously strong. All together these layers of ligament form the Annulus Fibrosis. In the common analogy of a jam donut, these form the dough.
In the centre, the jam of the donut, is the nucleus, this is a fluid or gel like tissue. Why fluid? Because fluid is non compressive. So the strong ligament layers band together holding the nucleus in place, when compression occurs through the spine the fluid tries to move sideways and the small amounts of give in the annulus’ ligament structure give a little allowing for that shock absorption. When you move, bend and twist, these ligament layers all “give a little” to allow for full and normal ranges of spinal motion.
So long as all the ligament layers remain healthy and intact, stretching and compression is handled nicely throughout all the spinal discs. You have no way of choosing which vertebra to move, they just move fluidly as one long structure all working together to allow for fluid motion through the entire spine. Therefore all the discs share the load and stretch forces.
The structure of the herniated disc
When the disc becomes herniated, by definition those layers that formed such a strong mesh have been damaged or ruptured, to such a degree that some of the fluid has escaped through them. If we consider for a moment just how strong the discs are, to have such a clear failure at one particular level of the spine, we can see how that tension that worked together through the spine, now has a weak link. Here-in lies the difficulty. The ligaments need to remain “tight” or “taught” to hold their structure, whether it is resisting the compression trying to force the nucleus out through the layers in a neutral spinal position under gravity, or whether it is a forward bending motion stretching the fibres on the back portion of the spine as the vertebra tips forwards. Unfortunately both of these scenarios lead to forces targeting the weakest area, just like in Africa a pride of lions will target the weakest wildebeest for an easy meal, the forces travelling through your body will exploit the weak areas if you do not act to protect them consciously.
Complications of a herniated disc in the lower back
Herniated discs would be so much easier to heal if they happened in your knee or elbow, or even in the foot. Unfortunately they don’t, they occur in your lower back. The biggest challenge with the back is space. All injuries will result in a degree of inflammation, obviously. In our limbs we have stretchy tissues and “space” for swelling to occur without too much trouble. In the lower back however, we have finite space as mentioned earlier. Where those nerves come out for example, is a bony tube. One of the complications of lower back disc injuries is that the disc often bulges as it fails (herniates) making this space even smaller, which only exacerbates the “space issue” as the natural processes of inflammation try to take place. This leads you to try to do the only thing you can to increase the space, bend forwards and round your back. In so doing you make the issue worse as you focus even more strain through the injured tissues.
Think about spraining your ankle, you fold over on the ankle and then for good measure, you repeat that sideways bend, with force, daily. Of course the notion that that is going to do any good whatsoever sounds preposterous, but as we will get to now, so many of the exercise and stretching recommendations involve this very movement. Which is probably one of the main reasons that people struggle to get better after having a herniated disc.
Hopefully by now you have a good understanding of what’s gone wrong if you have a herniated disc, now let us go through some of the common exercises for a herniated disc in the lower back, this should be insightful.
Common exercises, stretches & movements for herniated discs in the lower back
We’ll start out covering a list of the individual exercises, stretches and movements that are commonly recommended for lower back disc herniations, as well as critique so you can understand what they’re doing and if this is going to be good or bad for your herniated disc. Then we’ll finish up with our recommendations on the best ones to help you recover properly.
Common stretches for herniated discs
These stretches are working fundamentally on the proviso that your back is just tight and that tightness means you should stretch it to ease the tension. Two of the main reasons they feel nice is because stretching always feels nice and they are opening out that space we referred to earlier, which eases the pressure, but this comes at a cost.
Firstly we’ll cover the instruction and then get into the critique afterwards.
Knee hug stretch
The knee to chest stretch is a simple exercise for stretching the muscles in the lower back and buttocks. The typical instructions look something like this:
Lie on your back with your knees bent and feet flat on the floor. Slowly bring one knee towards your chest, using your hands to gently pull it closer if needed. Hold for 15-30 seconds, then release and repeat on the opposite side. Aim for 2-3 repetitions on each side, focusing on deepening the stretch with each repetition.
Child’s pose stretch
Child’s pose is a relaxing stretch that targets the muscles in the lower back and hips again. Start on your hands and knees, with your knees wider than hip-width apart. Slowly lower your hips towards your heels, reaching your arms forward and resting your forehead on the floor. Hold for 30 seconds to 1 minute, focusing on deep breathing and allowing your body to relax into the stretch. Repeat as needed to release tension and promote relaxation.
Note: we covered the child’s pose stretch in detail in a previous podcast episode.
Piriformis Stretch or “figure 4 stretch”
The piriformis stretch targets the piriformis muscle, which can become tight and contribute to lower back pain in individuals with a herniated disc. Start by lying on your back with your knees bent and feet flat on the floor. Cross one ankle over the opposite knee, creating a “figure 4” shape with your legs. Slowly lift the uncrossed leg off the floor and bring it towards your chest, using your hands to gently pull it closer if needed. Hold for 15-30 seconds, then release and repeat on the opposite side. Aim for 2-3 repetitions on each side, focusing on deepening the stretch with each repetition.
Note: if you want to better understand Piriformis Syndrome check out the dedicated episode of the Back In Shape Podcast on the topic.
Critique of the common stretches for lower back disc herniations
Firstly, you will notice that all of the above examples include the statement that the muscles need to be stretched and the back rounded. The simple truth is the average adult spends about 9.5 hours a day sitting, usually with a flat rounded lower back position, and this position has very well contributed to the herniated disc. Additionally, like the ankle example earlier, this forward bending is nearly always the movement associated with the “injury” when it occurred. The repetition of this movement serves to continue to stretch the injured tissues that are trying to knit back together. This is a classic example of trying to chase symptoms and alleviate the pressure build up from inflammation building in those small holes we talked about, giving rise to symptoms, at the expense of medium to long term prognosis.
Unfortunately, so many with herniated discs or even back pain in general flock to these exercises doing them months on end and going nowhere, only helping maintain a degree of dependence on such practices and weakening of the area in general.
Common Movements Recommended for herniated discs
Similar to the stretches, these movements are recommended to promote a degree of movement through the region, people often feel stiffness in the lower back when they have a disc herniation. Paradoxically, they feel vulnerable to excess movement. This mix of feeling stiff whilst being unstable at the injured site is quite a confusion issue for many. As a result the stiffness is prioritised which gives rise to the following movement recommendations.
Cat cow stretch (also called cat camel stretch)
The cat-camel stretch is a gentle exercise that helps improve flexibility and mobility in the spine. Start on your hands and knees, with your hands directly under your shoulders and your knees under your hips. Slowly arch your back, bringing your chin towards your chest and rounding your spine like a cat. Hold for a few seconds, then slowly lower your belly towards the floor, lifting your head and tailbone towards the ceiling. Repeat this movement, alternating between the cat and camel positions for 10-15 repetitions.
Note: we covered the cat-cow stretch in its own episode of the Back In Shape Podcast which you can check out for a deep dive.
Pelvic tilts or pelvic tucks
Pelvic tilts are given as an exercise for strengthening the core muscles and improving the stability of the lower back. To perform a pelvic tilt, lie on your back with your knees bent and feet flat on the floor. Slowly tilt your pelvis forward, flattening your lower back against the floor. Hold for a few seconds, then release. Repeat 10-15 times, focusing on engaging your abdominal muscles and maintaining proper form throughout the exercise.
Note: The misguided nature of pelvic tucks is something we covered at length in the dedicated podcast so if you’ve been recommended these it is certainly worth watching or reading.
Knee rocks can help alleviate lower back tension. Lie on your back with knees bent and feet flat. With arms spread out for balance, gently drop both knees to one side, stretching the lower back and hip. Return to the centre and drop to the opposite side. Keep shoulders grounded. Rock knees side to side for 10-15 repetitions, focusing on spinal rotation and lower back relaxation.
The Cobra pose is a simple stretch for the spine sometimes recommended for herniated discs. Begin by lying face-down on a comfortable surface with your legs extended and the tops of your feet touching the ground. Position your hands directly beneath your shoulders, palms pressed down. As you inhale, press through your palms, engaging your back muscles to lift your head, neck, and chest off the floor. Ensure your elbows remain slightly bent and close to your body. Your hips should remain grounded, creating a gentle arch in your lower back. Feel the deep stretch in your abdomen and the lengthening of your spine. As you exhale, slowly lower your upper body back to the starting position. Aim to perform this movement with precision and control, repeating it several times, and always focusing on your breath and maintaining a fluid motion throughout.
Critique of the common movements for disc herniations
Again there is a focus, certainly in the first two movements, the cat cow and the pelvic tucks on this degree of flexion through the lower back, similar criticism could be levelled at these as we did for the previous section on stretches like child’s pose. The knee rocks are perhaps considered to be less problematic as the critique would not apply, however, there are still issues with this exercise fundamentally. Simple movements are doing little to”help recovery and rehabilitation. Additionally, the main issue with a disc herniation, and really for all injuries for that matter, in the spine or elsewhere, is one of instability, therefore simply trying to “wiggle it” doesn’t offer much value at all. In fact, with a degree of instability present in the low back, it is more probable that you aggravate the little facet joints. This would result in the classic sharp and shooting pain you might experience as you twist. Granted the knee rock is gentle but we would put them down in the category, at best, of being a waste of time, more likely an unnecessary risk of aggravation.
The cobra is one of the exercises that is perhaps considered to be more in line with the principles necessary to recover from back pain in that it is doing the opposite of nearly all the exercises mentioned so far – it does not round the low back more! However, the nature of this kind of extension can often be problematic as it makes the little holes smaller than in a neutral spine which can be immediately painful, and like the knee rocks, instability at the lower lumbar spine, particularly L5, S1, can result in aggravation by way of the facet joints becoming jammed together, often resulting in the same immediate sharp pain.
Common strengthening exercises for disc herniations
Strengthening is a vital component of recovering from back pain and much more in line with the principles we teach in the Back In Shape Program, it is strengthening that addresses two main areas. Firstly the immediate issues with instability, using the muscles to provide an external “suit of armour” for the injured sections. Secondarily, addressing the weaknesses that preceded the issue in the first place is a non-negotiable if you are ever to recover from your herniated disc.
The bridge exercise targets the muscles in the lower back, hips, and buttocks. Lie on your back with your knees bent and feet flat on the floor. Slowly lift your hips off the floor, engaging your glutes and core muscles. Hold for a few seconds, then lower your hips back down to the starting position. Repeat 10-15 times, focusing on maintaining proper form and avoiding any excessive arching or straining of the lower back.
The superman exercise helps to strengthen the muscles in the lower back and improve overall spine stability. Start by lying on your stomach with your arms extended overhead and your legs straight. Slowly lift your arms, chest, and legs off the floor, keeping your gaze towards the floor to avoid straining the neck. Hold for a few seconds, then lower back down to the starting position. Repeat 10-15 times, focusing on engaging the muscles of the lower back and avoiding any excessive arching or straining.
The plank exercise
The plank exercise is a full-body exercise that targets the core muscles, including the muscles that support the spine. Start in a push-up position, with your hands directly under your shoulders and your toes on the floor. Engage your core muscles and lift your body off the floor, maintaining a straight line from your head to your heels. Hold for 30 seconds to 1 minute, focusing on maintaining proper form and avoiding any sinking or excessive arching. As you get stronger, you can increase the duration of the hold.
Bird dog exercise
The bird dog exercise is an excellent way to strengthen the core muscles and improve balance and stability. Start on your hands and knees, with your hands directly under your shoulders and your knees under your hips. Slowly extend your right arm forward and your left leg backward, keeping your spine neutral and avoiding any arching or twisting. Hold for a few seconds, then return to the starting position. Repeat on the opposite side. Aim for 10-15 repetitions on each side, focusing on maintaining proper form and engaging the core muscles throughout the exercise
Critique of the strengthening exercises for herniated discs
Although the principles of strengthening exercises are starting to move in the right direction there are some issues that could be improved upon in these particular examples. Given that instability is an issue one of the major issues with both the bridge and the superman is the incorporation of spinal extension into the movement which can have the same undesired consequences as the cobra stretch. As for the bridge specifically, it is commonly taught in conjunction with a pelvic tuck to avoid this, however, this pelvic tuck is an issue for reasons mentioned earlier, additionally, it is not applicable to being upright in the real world. Doing a pelvic tuck to engage your core is a bad habit as it moves the spine into a flexed position rather than focusing on neutral. We would instead recommend the marching bridge, or a simple bridge that is done focusing on the neutral spine. A marching bridge being more helpful for working on stability in a safe plane (off weight bearing) whilst also working to build the same muscular group, with less risk of over extension.
When it comes to the plank, this, much like the leg raise exercise this has a habit of focusing stress on the L5, S1 segment and to a lesser degree L4, L5 and so we would generally prefer to use a kneeling side plank as an option here, which seems to offer a little less risk of aggravation and helps build the ability to stabilise with the muscles on the side of your trunk.
Finally we get into the bird dog, this is one we would consider to be a good beginner exercise, similar to the modified dead bug which we like a lot too, it is working in many ways to help you stabilise. The shortfall here however, is that these exercises are all commonly prescribed floor exercises. And often the strain one is under is most prevalent when upright and active.
Very few people, even those with particularly bad disc herniations, will be bed bound. You’re upright doing things, often in spite of the pain. This truth means that most rehabilitation work does not go far enough to help guide people on the safe introduction of upright strengthening exercise for herniated discs. Often with the individuals focusing on such floor based exercises for way too long and leaving themselves vulnerable during daily tasks. We will get into this in more detail with some specific recommendations to help you after this final section on the “common ones”
Common low impact exercise recommendations for herniated discs
Movement is important, it helps keep your circulatory system fit and also helps avoid build up of inflammation in that lower back, this is one of the reasons that back pain often bothers people at night or first thing in the morning, a lack of movement during sleeping hours. However, some of these common recommendations have serious pitfalls that make them useless or even counterproductive when it comes to recovering from a herniated disc.
Walking for low impact exercise and critique
Walking is a low-impact exercise that can be done almost anywhere and at any time. It helps improve cardiovascular fitness, strengthen the leg muscles, and promote overall spine health. Start with a slow, comfortable pace and gradually increase the duration and intensity of your walks as your fitness level improves. Aim for at least 30 minutes of walking most days of the week, and listen to your body to avoid any excessive strain or discomfort.
The above advice is common but flawed. Many with a herniated disc struggle to walk for duration, you should take care to avoid walking in hilly areas and stick to the flat. Additionally, shorter durations of 5 to 15 minutes would be sufficient. Sometimes even a few minutes walking will be painful, in which case additional strategies need to be employed. However, as you recover this will become easier. The temptation to walk for longer durations is common, this unfortunately does not contribute to your recovery and serves to take time away from more fruitful enterprises. This is something we discuss in detail in the podcast episode on how walking can help your back pain recovery.
Swimming for low impact exercise and critique
Swimming is a commonly recommended exercise for individuals with a herniated disc as it provides a full-body workout without putting excessive stress on the joints and spine. The buoyancy of water reduces the impact on the body while providing resistance for muscle strengthening. Whether you choose to swim laps, take a water aerobics class, or simply walk in the pool, swimming can help improve cardiovascular fitness, build strength, and promote overall well-being.
Firstly, swimming obviously reduces the strain on the injured discs however it comes with some flaws. Firstly, short term, although the benefit of being in this low gravity environment is obvious, the contortion and ordeal of changing into your tight swimming costume in a confined cubicle, getting undressed and dressed again, as well as the risk of slipping makes any minor benefit from the activity itself extremely limited. Secondly, long term, it does not serve to increase the strength of the area, as there is negative load, relative to walking, and so is not going to help strengthening and remodelling of the discs in the way other exercises would do. Finally it will take time away from those more preferable exercises as you are swimming when you could be doing better exercises for your herniated discs recovery.
Cycling for low impact exercises and critique
Cycling, whether on a stationary bike or outdoors, is a low-impact exercise that helps improve cardiovascular fitness, strengthen the leg muscles, and supposedly promotes overall spine health. Start with a comfortable pace and gradually increase the duration and intensity of your cycling sessions as your fitness level improves. If you choose to cycle outdoors, be mindful of your posture and avoid any excessive strain on the lower back
Cycling is not good for back pain, we spoke extensively in a very recent podcast on cycling, but this is one of the most misguided recommendations, a list will work best here:
- You already spend too much time sitting, the average adult spends 9.5 hours a day as mentioned earlier
- You cannot cycle in a good spinal position, you’re always going to have to lean forwards which focuses forward bending at the low back
- There are other better options such as walking or when in latter stages of recovery, running can be incorporated effectively.
- Cycling in latter stages of recovery tends to be a drawn out affair, i.e. hours in the saddle in a bad position.
- It takes away from time that could be spent doing effective strengthening exercises.
The best exercises you can do for herniated discs
Although many of the exercises, stretches and movements we’ve covered so far are commonly recommended for herniated discs, they all have major issues, with one or two exceptions. These issues simply demonstrate a lack of understanding of back pain and disc injuries on the part of the prescribing healthcare professionals, unfortunately. With back pain, like being stung by stinging nettles, the pain motivates us to do things that might feel nice in the short term, but do not contribute to long term healing. With this in mind here are some of the movements and exercises we recommend as part of the Back In Shape Program.
The best stretch for lower back disc herniations
The towel exercise is by far the best back pain stretch that you can do for short term intervention when you’ve injured your lower back but also for long term back health to offset the pandemic of sitting in modern life. It gently supports the natural lordosis, unloads the discs and the vertebral segments as a whole, unlike the cobra which can be problematic. It also takes pressure off the muscles on the back. We discuss this at length in the episode of the podcast on the towel stretch, linked above.
The best core exercise to start to stabilise your back
Our core engagement exercise focusing on the corset muscles whilst maintaining a neutral spine is a great exercise that can be done lying on your back to teach you where and how to activate the core, without having to do silly movements that are counterproductive, such as the pelvic tilt. When you learn how to engage the core without moving the spine you are learning a skill that is applicable to being upright too so more advanced exercises will be safe for you!
Building core strength and stability off weight bearing
Once you can engage your core effectively, challenging this stability with the modified dead bug offers you a mechanism to build stability in a safe environment. As your legs move, your core must work to hold the spine steady and resist the pulls and pushes. This is just like real life, your spine is pulled in one direction or other and must maintain composure. Again this is all about stability, holding the spine steady around the injured section, using your muscles to help learn to protect this injury as it heals.
The best upright exercises for a herniated disc
As we transition to upright there are two vital exercises that should be done. These are the squat and the hip hinge. These two movements are used every day whether hour herniated disc is causing you pain or if it is not! Too many people with back injuries cannot tolerate these movements because they are bad at them. This inadequacy is a major barrier to recovery of the injury. You must start to learn these exercises and incorporate them sooner rather than later. But do so safely! When done correctly, you take the principles you developed in the earlier exercises of spine stability to maintain this in movements of daily life, such as getting out of a chair or washing your face.
Follow a proven strategy for helping recover from herniated lower back discs.
Unfortunately the road to recovery of herniated discs is a little longer for a variety of reasons, often a major reason for this is that so much time is wasted in the early days when the herniation wasn’t as bad. This is made worse by incorrect exercises like those we’ve covered today. And then there is the issue of relapse when you think you’re out of the woods and feeling better because you didn’t continue proper strengthening work to restore stability and integrity to the recovering disc. Like any other tissue much of the restoration of normal health takes place while there is no overt pain, just like if you’ve broken an arm or leg. Unfortunately your back is not put in cast, and so when the pain isn’t there the disc isn’t herniated – or at least we often behave that way.
If you’ve been struggling with your herniated disc and do want to get things resolved once and for all then check out the Back In Shape Program, it has everything you need to recover from lower back disc herniations. The education, the exercises and stretches in a clear Phase-by-Phase plan, plus you’ve got the support of our team along the way. Click the image below to learn more!