Orthopedist's suggested exercises for herniated lumbar discs - Legit or silly?

[laughter95]

Question 1:These are the orthopedist's prescribed exercises, are they all bogus?

The first three exercises are to be done for reps of 30, 2 sets daily. He explained that the first exercise is to strengthen my core and glutes (he also wanted me to flex the abs/back in addition to the glutes). This made me question his credibility because this seems similar to those quad sets that you have criticized in the past.
The second and fourth exercise is to stretch the sciatic nerve as I have some radiculopathy in the butt and left leg.
The third seems to simply be a stretch for my lower back. (But this would force your spine into flexion... which may have been the original cause of my disc herniation.)

Question 2: How do you gauge when you can start rehabbing disc herniations with traction, low-weight/high-rep or low weight 3x5 deadlifts, and maybe reverse hypers? I'm not in much/any pain right now, and rarely have sciatica. I have some decreased range of motion due to a tight lower back. There is some pain in the lower back when sitting for too long.

Background:
This is a follow up post to http://startingstrength.com/resource...ing-discs.html

The MRI said this:
1. At L4-5 there is a central disc protrusion which indents the aspect of the thecal sac, but does not compress the nerve roots.
2. At L5-S1 there is a left paracentral disc protrusion without mass effect upon the nerve roots.

28 y/o male, 160 lbs. Did 2.5 months of the novice LP and then had acute symptoms on 3/8/16 at the bottom a 225 lb squat. My last training session was on 3/17/16 when I squatted 235lbs. I got the MRI that confirmed herniated discs on 3/18/16 and the doc told me to stop training. Current meds: Soma 350mg taken nightly for a tight lower back. I received the first of three therapeutic epidural block shots on 3/23/16 and will be receiving the next two on 4/11/16 and 4/25/16. Afterward he's prescribing 9 sessions of rehab at 2x/week. I'm planning to go to the first PT session to see if she shows me something interesting/effective as she used to treat the Washington Nationals baseball team.

The orthopedist hasn't told me to swear off squats and deadlifts forever, only for the duration of the treatment protocol (3 months).

If someone else finds my post, these posts were helpful:
http://startingstrength.com/resource...-recovery.html
http://startingstrength.com/resource...-strength.html

[Will Morris]

Why do you suppose he said to lay off for specifically three months?

[laughter95]

Why do you suppose he said to lay off for specifically three months?

I think his rationale is to allow time for the annulus to heal.

Three therapeutic block shots spaced approx 2 weeks apart (45 days) after diagnosis of herniated discs via MRI and physical exam. Follow up two weeks after last epidural block shot takes us to 60 days, then 9 PT sessions 2x week results in 3 mo after herniated disc diagnosis.

I just did those exercises he prescribed and am considering to get a second opinion because those exercises did not seem useful...

[sbrl_19]

I have a lower back history and the knees to chest movement (and a few others, including the same thing one leg at a time) have always helped make my back feel better when it acts up. Just one guy's experience, For what that's worth. I consider them stretching though and not exercise or training. I put them in the same ballpark as other back and hamstring and hip stretches.

2 bulges and a herniation between L3 and S1.

[Will Morris]

So, that seems like an awful lot of treatment for a herniated disc, especially when considering about 70% of people over the age of 30 have them. But, of course, I'm not the one billing your insurance for all that nonsense. The reason he said to lay off for three months is because that is the natural life cycle for an uncomplicated herniated disc. The injury will heal itself within three months, but he just made his Porsche payment with your treatment.

Also, use a little biomechanical analysis here, how can a knees to chest exercise make a herniated disc better?

[laughter95]

So, that seems like an awful lot of treatment for a herniated disc, especially when considering about 70% of people over the age of 30 have them. But, of course, I'm not the one billing your insurance for all that nonsense. The reason he said to lay off for three months is because that is the natural life cycle for an uncomplicated herniated disc. The injury will heal itself within three months, but he just made his Porsche payment with your treatment.

The 3 mo guideline was helpful, thank you.
Regarding his Porsche... I will pay him one additional visit as a result of getting 3 epidurals as opposed to one. I don't actually perceive him trying to make money off me...

Also, use a little biomechanical analysis here, how can a knees to chest exercise make a herniated disc better?

But considering these disappointing exercises he prescribed me, including one that forces the lumbar into flexion, and the fact that I'm lucky if I get as much as 10 minutes of face time with him, I'm going to see my old orthopedist for a second opinion. I would have gone to him in the first place but on that acute pain day he was in surgery and this guy was available to see me.

[sbrl_19]

Also, use a little biomechanical analysis here, how can a knees to chest exercise make a herniated disc better?

I always figured it's because it creates space between the vertebrae and relieves pressure on the nerve with which the herniated disc is interacting. Is that incorrect?

Wrong or not, it feels good for me. In a decade of dealing with this, that's probably the one back stretch that is always good for some relief.

[Will Morris]

I always figured it's because it creates space between the vertebrae and relieves pressure on the nerve with which the herniated disc is interacting. Is that incorrect?

Wrong or not, it feels good for me. In a decade of dealing with this, that's probably the one back stretch that is always good for some relief.

For a symptomatic herniated disc, lumbar flexion (especially lumbar flexion achieved with the knees to chest exercise) actually creates a posterior compressive force that forces the nucleus posteriorly....thereby, exacerbating the herniated disc.

That said, knees to chest feels great for lumbar facet arthrosis and degenerative disc disease without herniation. Disc herniations come and go, but arthritis does not. The fact that you get symptom relief from knees to chest tells me that a herniated disc is not your chief complaint, but, rather, you have a big ol' case of arthritis in your back.

[sbrl_19]

For a symptomatic herniated disc, lumbar flexion (especially lumbar flexion achieved with the knees to chest exercise) actually creates a posterior compressive force that forces the nucleus posteriorly....thereby, exacerbating the herniated disc.

That said, knees to chest feels great for lumbar facet arthrosis and degenerative disc disease without herniation. Disc herniations come and go, but arthritis does not. The fact that you get symptom relief from knees to chest tells me that a herniated disc is not your chief complaint, but, rather, you have a big ol' case of arthritis in your back.

Thanks, doc.

None of my providers have ever mentioned that. I'll ask about it if I am ever treated again for it or maybe at my next physical.

Sorry OP for jumping in on your thread, but maybe some of this discussion will be helpful to you.

[laughter95]

Thanks, doc.

None of my providers have ever mentioned that. I'll ask about it if I am ever treated again for it or maybe at my next physical.

Sorry OP for jumping in on your thread, but maybe some of this discussion will be helpful to you.

No problem, discussion is very helpful