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

Shwetanjali Gandhe
Physiotherapist

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 !

Shwetanjali Gandhe
Physiotherapist

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

Nadeem Rashid
Physiotherapist

Hello
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

Regards
Dr Nadeem

Dr. Patel Jwalant Yogeshbhai
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!

Sreenivasa Rao
Physiotherapist

Hi..

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...

Ashwini Kadam
Physiotherapist

Hi,
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)

Tanushree Agarwal
Physiotherapist

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.

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.