Physiotherapy advise - for L4-L5 disc protrusion / bulge with mild spinal stenosis (Physiotherapy)

Dr. Sheetal Kamble., BHMS


Medical Case Details:


I am looking for physiotherapy exercises for one of my patient who has been suffering from L4-L5 disc bulge, with mild pain in lower back, mild radiating pain in the left foot with mild tingling and numbness of left foot.

This is a young male, who has been lifting weights and doing work out for last 12 years. He has been doing some stretching exercises for back for last 10 years, has been taking hot and cold fomentation and mild massage of the back.

Can anybody recommend some specific exercises for this condition?

Thank you.



    Dr. Shwetanjali Gandhe

    Hi , the weight lifting history suggests he was doin a lot of spinal flexion , so I propose an anterior disc bulge , he should have a flexionbias , corresponding to more pain during bending than extending , if that's the scenario , ask him to do spine extension exercise & That should be followed by spinal core muscle strengthening protocol ! Hope that helps !

    ▲ 1
    26.Apr, 10:48am

    Dr. Shwetanjali Gandhe

    Sorry posterior disc bulge so u go opposite , ask him to do flexion exercises

    26.Apr, 10:50am

    Dr. Nadeem Rashid

    First of all u should provide him with proper physiotherapy treatment which will include SWD, ILT, US, TENS, Laser therapy etc.
    In addition to these start lumbar strengthening exercises & Mobilisation exercises. Stop heavy lifting exercises & any strainfull activity.
    Hope he recovers soon

    Dr Nadeem

    26.Apr, 10:56am

    Dr. Jwalant Patel
    Orthopaedician And Traumatologist

    You should start with conservative approach for this patient first.....start analgesics and tablet pregabalin and nortryptiline combination.....start lumber flexion and extension exercise......avoid heavy weight lifting and strenuous exercise.....plan further MRI of lumber spine....thank you!

    26.Apr, 11:32am

    Dr. Sreenivasa Rao


    Disc bulge with spinal stenosis will not allow you to treat in flexion or in extension position.
    Kindly check with what is the real source of pain...is it due to spinal stenosis or disc...as both can produce similar symptoms...
    i suggest..you do core stability and glute stability program in lying with normal lumbar curvature maintained...
    Don't load him in either flexion or extension.. as both can Increase pain...
    Maitland mobilisation for spinal stenosis with PA glide...grade 3

    This will definitely help in receiving his symptoms...

    26.Apr, 11:35am

    Dr. Ashwini Kadam

    As per the history and complaints of the patient it gives a picture of posterior disc protrusion compressing on the traversing nerve giving radiating pain.
    Since the patient has been working out I assume he must be having good core muscle and back muscle strength. So for this patient more than strengthening he needs to follow some ergonomic advices and few lifestyle changes. That would include lying in prone for 15-20min twice in a day ( early morning and before going to bed)
    Ceasing all gym activities which would load the spine and 3-4 days of bed rest is advisable.
    Once the acute condition comes in control, supervised physiotherapy sessions should be given which would include maintenance of strength and flexibility and nerve mobilisation techniques and spinal mobilsation (the latter to preferrably to be done by Physiotherapist only)

    Warm Regards,
    Dr. Ashwini Kadam (Physiotherapist)

    ▲ 1
    26.Apr, 04:57pm

    Dr. Tanushree Agarwal

    Hello Dr Kamble,
    A person working out in gym, has alwas a problem of stabiliser muscle strenth, i.e the deep core muscle. Also, they have an habit of keep the back arched all the time leading to overactive erector Spinae. This can lead to inihibition of transverse abdominis and internal oblique, the stabilisers.

    So we should focus on his deep core muscle requirment and posture correction along with gym ergonomics, if he is not following.

    27.Apr, 08:03am

    Dr. Sheetal Kamble
    Homeopathic Physician

    Thank you and appreciate all for the suggestions. I have referred this patient to a Physiotherapist. I will post his follow up in few weeks.
    Thank you again.

    30.Apr, 12:03am

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