Lumbar disc herniation and stenosis are common causes of low back pain that often improve without surgery. Post-surgery rehabilitation focuses on education, low-impact exercises, and a gradual return to normal activities. Key goals include reducing pain and improving function to allow patients to return to work and daily life. Appropriate exercises target the lumbar spine, hips, and core muscles while avoiding positions that increase pain. Outcomes are best with a multidisciplinary approach including exercise prescription managed by a physiotherapist or exercise physiologist.

1. Lumbar disc herniation

2. Natural history
• Degeneration
• Up to 90% improve without surgery
• Discectomy gives excellent results in 80-90%
• Great for leg pain
• Success = decreased pain and ability to return to work,
daily activities (not pain free)
• Worse outcomes in work related/legal cases

3. Role of Passive Therapy Pre op
• Massage for spasm/tightness
• Stretches for adjacent joints
• Ice/Heat
• Positions of comfort/relief
• Painfree exercise, activity (cardio, normalise activity)
• Often “over therapied”
• Often differing advice from many sources : try offer
appropriate advice
• Avoid neural stretches!!

4. Post Discectomy Rehab
Cochrane review
• Neural mobilisation not effective for pain/functional
disability
• Post op rehab exercise program reduces pain v’s no
rehab
• High intensity rehab better results than low intensity
• No studies show early activity leads to re-operation
• Not harmful to return to activity post op
• Not necessary to stay passive

5. Post Discectomy Rehab
• Day Surgery:
• Education/exercise program (self managed with
upgrade)
• Activity guidelines (self managed)
• 2-3 weeks:
• Clinic vs phone
• Education: exercise/activity upgrade
• Work status
• 6 weeks:
• Exercise/activity/work review
• Exercise Physiologist review

6. Post discectomy exercise
• Hip/knee flexion

7. Post discectomy exercise
• Single leg supine bridge

8. Post discectomy exercise
• Modified Side Bridge

9. Post discectomy exercise
• Swissball Abdominal Brace

10. Activity Guide

11. Activity Guide

12. Activity Guide

13. Return to work guidelines
• Good work is good for you
• Recurrence
• Capacity and tolerance
• Medication side effects

14. Return to work guidelines
• Restricted/alternate duties
• Overhead, bending, carrying, lifting & prolonged
sitting
• Position descriptions
• Biopsychosocial

15. Discogenic back pain /
degenerative

16. Natural history of LBP
• Lifetime incidence up to 90%
• 8% of all Workcover QLD lodgments in 2014-15.
(Most common cause for common law claim)
• Statutory claim payments $75million
• Cause
• 30% of population without back pain have disc
degeneration

17. Natural history of LBP
• Treatment
• Conservative
• 50% improved within 1 week
• 90% in 12 weeks
• Steroid
• Surgery
• Recurrence
• Up to 80% in 2 years

18. Work as a cause of nonspecific back
pain and WorkCover certification
Work relevant or work related?

19. Discogenic back pain
• Most settle in 4 weeks
• 90% settle in 3 months
• 5% develop low back pain, chronic
• Multidiscipline approach is important
• Remain active
• Educate: shows improved outcomes; positions of ease,
posture, exercise, lifting and activity techniques

20. Therapy Role
• Education: consistent
• Exercise
• Postural correction
• Manual therapy

21. Exercise for Discogenic LBP
• Avoid forward slouch
• Exercise in comfortable range

22. Exercise for Discogenic LBP
• Prone on elbows

23. Exercise for Discogenic LBP
• Lumbar-hip Mobility

24. Exercise for Discogenic LBP
• 4 point kneel with arm raises

25. Exercise for Discogenic LBP
• Supine Swissball Hold with arms

26. Exercise for Discogenic LBP
• Hydrotherapy

27. Exercise for Discogenic LBP
• POOR Exercise Prescription

28. Lumbar stenosis

29. Background
• Incidence / prevalence >50yrs
• 5:1000
• Cause
• Primary
• Secondary
• Symptoms
• Fatigue caused by walking relieved by rest

30. Background
• Tests
• MRI
• Treatment
• Medication
• Steroid
• Surgery

31. Stenosis
• Extension-related pain
• Exercise in neutral spine and in flexion

32. Exercise for stenosis
• Supine crook lying rotation

33. Exercise for stenosis
• Supine Knee Tuck

34. Exercise for stenosis
• Supine Pelvic tilt

35. Exercise for stenosis
• Supine Pelvic tilt on Roller – variations

36. Exercise for Stenosis
• POOR exercise prescription

37. Rehab: elderly patient post Fusion
• 3-4 nights inpatient
• Mobilise day 0
• Consider co-morbidities (cardio, THR, TKR, OA)
• Education, simple exercises
• No Corset/Brace
• Review 3 weeks ( clinic / phone)
• Review 6 weeks + xray + Exercise Physiologist as
appropriate