Lumbar Disc Herniation: The Role of Exercise in Conservative Management

A disc herniation is characterized by the protrusion of the nucleus pulposus, most commonly occurring in the lumbar region. It affects approximately 1% to 3% of the global population, primarily individuals between 30 and 50 years of age. Its main clinical feature is pain, which may be localized or radiating.

Conservative treatment is considered the first-line approach for most patients with an initial diagnosis of lumbar disc herniation. Among available strategies, regular exercise stands out as a simple, accessible, and effective method for symptom relief and management.

A retrospective analysis of 409 patients with lumbar disc herniation showed that 320 were treated conservatively. Among these, 189 (59.06%) experienced hernia resorption, reinforcing the potential of this approach.

Core strengthening training is a fundamental component of rehabilitation. It aims to improve muscle strength and endurance, which are essential for:

• Regulation of intra-abdominal pressure

• Stabilization of the vertebral column

• Improved stability and mobility of the sacroiliac joints

• Control of pelvic movement and reduction of lumbar overload

When properly prescribed and performed, exercise promotes improved lumbar stability, reduction in both local and radiating pain, and a positive impact on quality of life.

Despite these encouraging outcomes, the effectiveness of exercise may vary depending on individual patient characteristics, associated conditions, and the timing of intervention.

Core stabilization programs based on Pilates, as investigated by Taşpınar et al. (2022), demonstrated a 62.3% reduction in pain. Additionally, the integration of neural mobilization and stabilization techniques has shown meaningful contributions to symptom relief.

However, there is still no clear consensus regarding the optimal exercise intensity, frequency, and type for patients with lumbar disc herniation. Therefore, high-quality clinical trials are needed to establish more definitive protocols.

Scientific References

Du, S., Cui, Z., Peng, S., Wu, J., Xu, J., Mo, W., & Ye, J. (2025). Clinical efficacy of exercise therapy for lumbar disc herniation: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Medicine, March 2025.

Thavarajasingam, S. G., Ramsay, D. S. C., Namireddy, S. R., et al. (2025). Exercise, manipulation and traction physiotherapy in the conservative management of lumbar disc herniation: A systematic review and meta-analysis. Brain and Spine, Volume 5.

Written by: Physiotherapist Marília Monteiro – CREFITO 129693-F