Ask the Doctor: Gentle exercise can help with recovery from back pain
12 hrs ago
Dear Doctor: I have just been diagnosed with a herniated disc and pressure on the sciatic nerve in my lower spine. Currently, I participate in yoga, weights and machines at the gym, and I walk for most of my errands. Am I helping or hurting my recovery with these activities?
Dear Reader: First, let’s take a look at your spine. The bones of the spine are called vertebrae; in between those are intervertebral discs. The discs help hold the vertebrae together, but also act like shock absorbers when you jump, run, walk or lift.
The outside portion of a disc is essentially a ring of strong, cartilage-like material. Within this ring is a gel-like material called the nucleus pulposus, which also helps absorb shock. When a disc herniates, the gel-like nucleus pulposus bulges through the cartilage-like layer of the disc. The problem with disc herniation is that the bulge pushes upon the nerves coming out of the spine. In the lumbar spine, this can lead to nerve pain that radiates down the leg. This is termed radiculopathy, which is what you seem to be describing.
The pain of lumbar radiculopathy can be debilitating, leading to time off work, inability to exercise and poor sleep. The encouraging fact is that the majority of people with lumbar radiculopathy recover fully.
As for exercise, the amount should depend on the activity and whether the activity increases the pain.
A 1999 study in the New England Journal of Medicine looked at 183 patients with symptoms of lumbar radiculopathy, separating the groups into those with bed rest and those who maintained their daily activities. The authors found that there was no difference in symptoms between the groups at either two or 12 weeks.
Similarly, a 2002 Journal of Neurosurgery study of 250 patients with symptoms of radiculopathy failed to find any difference at one, two or six months between those who underwent bed rest versus those who maintained their daily activities. Nor did a 2004 combined review of 11 studies find any benefit to bed rest in those with lumbar radiculopathy. In fact, among people with lower back pain, maintaining activity showed greater benefit than bed rest.
As for yoga, I would consider a class that focuses on breathing and gentle stretching rather than intense stretching. If done properly, yoga can help improve posture, decrease muscle tightness and reduce pain. However, the more aggressive flow-type of yoga can have negative effects if positions are performed improperly. Take similar care with weights. Avoid any such exercises that place strain on the back — especially dead-lifting — and be sure to decrease the number of pounds you’re lifting.
Walking is somewhat different. It shouldn’t worsen your symptoms — and may in fact be helpful. That said, while you recover from your disc herniation, I would recommend avoiding stairs because going up or down them may be jarring to your back.
My advice? Be prudent about the types of exercise and activities you do with a herniated disc, because activities that place stress upon the lower back may make the herniation worse. As your symptoms get better, you can start back-strengthening exercises that will reduce your risk of future low back pain.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
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