Exercises after a herniated disc of the lumbar spine


After a Herniated disc in the lumbar spine It is important to relieve the strained structures and avoid bad posture and stress. This is possible through specific exercises for strengthening and mobilization, gymnastics or equipment-supported training at home as well as in physiotherapy treatment.
It is important to make a detailed diagnosis at the beginning in order to find out exactly which structures cause problems for the patient, or which postures or activities led to the herniated disc.


Gymnastic exercises are ideal for herniated discs because they are easy to perform and no separate devices are required. You can train with your own body weight and at the same time improve your awareness of certain postures that may damage the lumbar spine. First of all, it is imperative to train good body awareness.
You can practice this in front of a mirror. The physiotherapeutic exercises in the case of a slipped disc in the lumbar spine are relatively easy to implement, but must be carried out precisely and correctly in order to avoid renewed damaging incorrect stress.

1. Train body awareness

The Body awareness can be practiced well in an upright position. The patient stands in front of a mirror and closes his eyes. Next, he turns his attention to his feet, which are about hip-width apart, and shifts the weight from the forefoot to the heel and from right to left. The aim is to load both feet equally. The right and left foot press the ground equally hard.
Now we direct them attention on your knees, these should never be fully pushed in when standing upright, but rather slightly bent. Here, too, it is easier to find the right position by testing, by first pushing your knees backwards very firmly and then deliberately kneeling slightly. A comfortable middle position should be found. Observed in between of the Patient his posture in the mirror.
Now we are approaching the lumbar spine. The patient now focuses on his pelvis. It often helps to initially place your hands on the protruding pelvic bones. Now the pelvic tilt is practiced. Movement of the pelvis goes hand in hand with movement of the lumbar spine; after a herniated disc, mobility is often restricted by pain or relieving postures and must be regained.
However, a lack of mobility can also lead to constant incorrect loading of individual parts of the spine and thus be one of the causes of the herniated disc. Our lumbar spine can perform several movements. Ventral and dorsal pelvic tilting can be practiced particularly well via the pelvis.
That means tilting the pelvis forward (ventral), with an increased hollow back in the lumbar spine and the curling of the pelvis backwards (dorsal), in which the lumbar spine curves and bends. During this movement, the patient feels how the pelvic bones first move downwards forwards and then upwards backwards. It is important that the chest does not move with it (Self-control mirror) and the movements come from the lumbar spine.
If the exercise is difficult while standing, you can also do it while sitting. Here the ischial tuberosities serve as a control point, which move forward and backward over the surface of the chair when the pelvis is rolled (hollow back - ischial tuberosities point backwards, rounded back in the lumbar spine - ischial tuberosities point forward).
These movements are fundamental for conscious and correct training and should be well practiced and internalized. Then, depending on the findings, a specific exercise program for the herniated disc in the lumbar spine can be worked out. A frequent component is the so-called basic tension or core activity.

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A herniated disc is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

Therefore, treating a herniated disc requires a lot of experience.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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2. Exercises to strengthen the basic tension

The basic tension is practiced particularly well in the supine position.

This exercise strengthens the muscles lying behind, i.e. the buttocks, the rear thighs and the back muscles.
The patient lies supine on the mat and assumes a neutral spinal column position (try again, first make a more hollow back, then press the lower back into the surface - the middle position is the correct starting position for this exercise). The patient stands up on their feet and pulls their toes up so that only their heels are in contact. You can fit about two fists between your knees. The hands lie next to the body with the palms up, the head rests on the floor as an extension of the spine, the gaze goes to the knees (so that the cervical spine is not overstretched).
This is the starting position for these and many other alternative exercises. Now the patient builds his own with the exhalation Basic tension up, that means he tries to tense his muscles so that the whole body is firm and, if one would turn him to the side at the knees, the whole body would follow.
We systematically build up this tension by pressing the heels firmly into the mat, tensing the buttocks, pulling the navel in a star shape towards the spine, pressing the shoulder blades and arms firmly into the mat and making a slight double chin with our head. The tension is held for 2-5 breaths and gradually reduced again.
From this position, if the basic tension can be safely taken, many exercises for coordinated strengthening of the lumbar spine can be done, e.g. Lifting the buttocks out of the basic tension (bridging), lifting one leg, lifting the arms, possibly with a stick, without releasing the tension.
The individual exercises should be tailored to the patient and first discussed and practiced with their physiotherapist or trainer in order to avoid a potentially incorrect and damaging implementation.

3. Exercises to strengthen the abdominal muscles

Since in the case of a herniated disc in the lumbar spine, one that is often not strong enough Abdominal muscles plays a role, it is also important to train it specifically. For this purpose, holding exercises from the starting position of the basic tension in the supine position are ideal. For example, with exhalation you can press your slightly bent arms against your thighs, while your legs do not want to give in to the pressure.
There is tension in the straight abdominal muscles. By increasing the pressure on one side, you can specifically train the lateral abdominal muscles. Variations of crunches and situps should urgently need to be practiced with a therapistMany unfavorable mistakes can be made here.

4. The forearm support

Another good exercise is that Forearm supportwhich, like the basic tension in the supine position, now strengthens the front muscle chain (i.e. abdominal muscles, front thighs, chest muscles). The patient lies prone and raises the upper body.
The elbows are under the shoulders, the forearms are parallel to each other. The knees stay on the ground at the beginning and can later be raised to reinforce the exercise. The spine forms a straight line with the thighs, the view points towards the floor, the cervical spine is long and stretched.
From this position too, many exercise variants can be built up, which should be worked out in an individual training plan.For example, "pillars" (ie an arm or a leg) can be lifted off the floor while the patient tries to keep the trunk in balance and not allow any movement there.

5. More exercise options

Other favorable positions are the quadruped position, the seat, the squat and many more. Once the basic tension has been mastered, exercises can be tailored to the patient in all possible positions.
Furthermore, the gymnastic exercise program after a herniated disc of the lumbar spine naturally also includes training for any muscle weaknesses or pareses that could have resulted from the incident.
If the foot is weak, pulling in the foot can be practiced; if the thigh muscles are weak, for example, squats can train the weakened muscles. Later on, the gymnastics can be supplemented with small devices such as dumbbells or a Theraband.
The improvement of sensitivity, if this was limited, can also be achieved in gymnastics. The patient trains with his own body weight and has a lot of contact with the floor or performs exercises that demand a high level of self-awareness.

Exercises after an operation

During an operation, it is always important to follow the surgeon's instructions regarding load, movement and resilience as a priority!

Rotational movements are often restricted or prohibited initially after spinal surgery. That is, they should be avoided in therapy until released. The Basic tension exercises are ideal for exercising your back gently after an operation. Targeted tensioning and loosening not only improves coordination and strength in the affected area, but also the supply of blood, which transports nutrients and oxygen, and the removal of metabolic products is improved. That promotes healing.
After an operation, the back muscles, which go from vertebra to vertebra and stabilize our spine, are often inhibited. The basic tension allows these muscles to be gently addressed again. In addition, a muscularly stabilized position of the lumbar spine protects against incorrect stress in everyday life.
After an operation, transfers from certain postures should always be carried out with good basic tension. This protects the injured structures from shear forces. This means that the patient should consciously tense his core muscles, especially when getting up from lying down to sitting or from sitting to standing.
If a lot of training is not yet allowed in the back, you can take particularly good care of the peripherally damaged structures after an operation. So it is not the damage to the back that is trained, but the consequential damage in e.g. the legs. For this purpose, gymnastic exercises for the leg muscles can be used, a Gait school in bars, on supports or free, or even a Sensitivity training. If the consequences of the operation allow, the Leg press very good for specifically strengthening the thigh muscles.

In addition to improving strength, as soon as mobility is released again, mobility should also be practiced again within the permitted framework. The back can be adjusted by simple movements to the side (sideways tilt), tilting the pelvis (see above) forwards and backwards, or careful rotation, e.g. on a stool mobilized become.

The stabilizing muscles can later be activated through coordination training. It is also a good idea to initiate exercises using the arms and legs. If the arms are quickly moved back and forth next to the body in an upright, healthy stance (see above) as when sprinting, the upper body tries to move with the swing of the arms. If you consciously hold against this movement, you tense the entire deep core muscles and practice stability.

Exercises for the home

After a herniated disc, it is particularly important to learn to deal with your body consciously. A homework program is essential and should be worked out urgently in physiotherapy. The above-mentioned gymnastic exercises are good exercises at home, as no equipment is required for this.
Bridging (lifting the buttocks out of the basic tension in the supine position) can be done easily on the floor, sofa or bed. If abdominal muscle exercises are mastered well and safely, they can also be done excellently at home.
In addition, back-friendly handling is best trained in the home environment. Lifting a laundry box, first empty and later perhaps weighted down, offers good prerequisites for learning back-friendly lifting and can also be used to strengthen the leg muscles (Squats). A stretching and mobilization program should also be carried out.
This includes, depending on the symptoms and the cause of the herniated disc, e.g. the torsional stretch position or the package fit. For the torsional stretch position, turn your knees from the supine position to one side towards the floor, the opposite arm and head are turned to the other side. With the package seat, the buttocks are placed on the knees on the heels, the forehead is placed on the floor, while the arms are drawn back next to the body.
Basically, there is a wide range of exercises to do at home after a herniated lumbar disc. A suitable tailored program should be worked out with a therapist.

Exercises in physiotherapy

More difficult exercises can also be tackled with a physical therapist.

In physical therapy, the exercises (described above) should be explained and practiced until the patient can safely and correctly perform them. The patient's body awareness should be trained and improved if necessary.
The independent practice is absolutely necessary for the success of the therapy. In addition to exercises, soft tissue and mobilization techniques are also used in therapy. Here, targeted damaged or changed structures (e.g. tense muscles and fascia, blocked vertebrae) are exercised, which the patient cannot do alone at home.


Together with a good exercise program, supplemented by joint exercises during therapy, and the important training on your own, a coherent, individual treatment plan for the patient with a herniated disc of the lumbar spine can be coordinated.