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. 2013 Aug;8(4):482-516.

A phased rehabilitation protocol for athletes with lumbar intervertebral disc herniation

Leonard H Vangelder, Barbara J Hoogenboom, Daniel W Vaughn

A phased rehabilitation protocol for athletes with lumbar intervertebral disc herniation

Leonard H Vangelder et al. Int J Sports Phys Ther. 2013 Aug.

Abstract

Conservative non-surgical management of a herniated lumbar intervertebral disc (HLD) in athletes is a complex task due to the dramatic forces imparted on the spine during sport participation. The demands placed upon the athlete during rehabilitation and return to sport are unique not only from a sport specific perspective, but also regarding return to the sport strength and conditioning programs utilized for sport preparation. Many prescriptions fail to address postural and motor control faults specific to athletic development, which may prevent full return to sport after suffering a HLD or predispose the athlete to future exacerbations of a HLD. Strength exercises involving squatting, deadlifting, and Olympic power lifts are large components of the typical athlete's conditioning program, therefore some progressions are provided to address potential underlying problems in the athlete's technique that may have contributed to their HLD in the first place. The purpose of this clinical commentary is to propose a framework for rehabilitation that is built around the phases of healing of the disc. Phase I: Non-Rotational/Non-Flexion Phase (Acute Inflammatory Phase), Phase II: Counter rotation/Flexion Phase (Repair Phase), Phase III: Rotational Phase/Power development (Remodeling Phase), and Phase IV: Full return to sport. This clinical commentary provides a theoretical basis for these phases based on available literature as well as reviewing many popular current practice trends in the management of an HLD. The authors recognize the limits of any general exercise rehabilitation recommendation with regard to return to sport, as well as any general strength and conditioning program. It is vital that an individual assessment and prescription is made for every athlete which reviews and addresses movement in all planes of motion under all necessary extrinsic and intrinsic demands to that athlete.

Level of evidence: 5.

Keywords: Athletes; herniated lumbar disc; rehabilitation.

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Figures

Figure 1.
Figure 1.
The Panjabi Spinal Stabilizing System Model
Figure 2.
Figure 2.
The Four-Phase Lumbar Herniated Disc Rehabilitation Protocol
Figure 3a.
Figure 3a.
Prone Press Up - Bottom
Figure 3b.
Figure 3b.
Prone Press Up - Top
Figure 4a.
Figure 4a.
Hip Hinging in Standing - Start/Stop
Figure 4b.
Figure 4b.
Hip Hinging in Standing - Hip Flexion/Middle
Figure 5a.
Figure 5a.
Bilateral Bridge - Top Position
Figure 5b.
Figure 5b.
Unilateral Bridge - Top Position
Figure 6a.
Figure 6a.
Weighted Bridge / Hip Thrust - Start
Figure 6b.
Figure 6b.
Weighted Bridge / Hip Thrust - End
Figure 7a.
Figure 7a.
Quadruped - Lordosis
Figure 7b.
Figure 7b.
Quadruped - Neutral Spine
Figure 8a.
Figure 8a.
Traditional Plank
Figure 8b.
Figure 8b.
Ball Plank
Figure 8c.
Figure 8c.
Suspended Plank
Figure 8d.
Figure 8d.
2-Point Ball Plank
Figure 8e.
Figure 8e.
Side Plank - Advanced
Figure 9a.
Figure 9a.
Kneeling Pushup - Start
Figure 9b.
Figure 9b.
Kneeling Pushup - End
Figure 9c.
Figure 9c.
Full Pushup - Start
Figure 9d.
Figure 9d.
Full Pushup - End
Figure 9e.
Figure 9e.
Suspended Pushup - Start
Figure 9f.
Figure 9f.
Suspended Pushup - End
Figure 10a.
Figure 10a.
Stationary Lunge - Top
Figure 10b.
Figure 10b.
Stationary Lunge - Bottom
Figure 10c.
Figure 10c.
Bilateral Weighted Lunge - Top
Figure 10d.
Figure 10d.
Bilateral Weighted Lunge - Bottom
Figure 10e.
Figure 10e.
Barbell Lunge/Split Squat - Top
Figure 10f.
Figure 10f.
Barbell Lunge/Split Squat - Bottom
Figure 11a.
Figure 11a.
Lateral Squat Stepping - Resisted Abduction - Start
Figure 11b.
Figure 11b.
Lateral Squat Stepping - Resisted Abduction - Step
Figure 12a.
Figure 12a.
Lat Pull Down - Top
Figure 12b.
Figure 12b.
Lat Pull Down - Bottom
Figure 13a.
Figure 13a.
Suspension Inverted Row - Angled Incline - Bottom
Figure 13b.
Figure 13b.
Suspension Inverted Row - Angled Incline - Top
Figure 13c.
Figure 13c.
Suspension Inverted Row - Parallel Incline - Bottom
Figure 13d.
Figure 13d.
Suspension Inverted Row - Parallel Incline - Top
Figure 14a.
Figure 14a.
Pull-up - Hang Position
Figure 14b.
Figure 14b.
Pull-up - Top Position
Figure 15a.
Figure 15a.
Suspension Assisted Squat - Top
Figure 15b.
Figure 15b.
Suspension Assisted Squat - Bottom
Figure 16a.
Figure 16a.
Bodyweight Squat - Top
Figure 16b.
Figure 16b.
Bodyweight Squat - Bottom
Figure 17a.
Figure 17a.
Anterior Loaded Squat - Top
Figure 17b.
Figure 17b.
Anterior Loaded Squat - Bottom
Figure 18a.
Figure 18a.
Turkish Getup - Bottom
Figure 18b.
Figure 18b.
Turkish Getup - Hip and Trunk Drive
Figure 18c.
Figure 18c.
Turkish Getup - Lunge Position
Figure 18d.
Figure 18d.
Turkish Getup - Top
Figure 19a.
Figure 19a.
Unilateral Side Lift - Bottom
Figure 19b.
Figure 19b.
Unilateral Side Lift - Top
Figure 20a.
Figure 20a.
Stability Ball Curl-up - Start
Figure 20b.
Figure 20b.
Stability Ball Curl-up - Finish
Figure 21a.
Figure 21a.
Kettlebell Deadlift - Bottom
Figure 21b.
Figure 21b.
Kettlebell Deadlift - Top
Figure 22a.
Figure 22a.
Trap Bar/Hex Bar Elevated Deadlift - Bottom
Figure 22b.
Figure 22b.
Trap Bar/Hex Bar Elevated Deadlift - Top
Figure 22c.
Figure 22c.
Trap Bar/Hex Bar Deadlift - Bottom
Figure 22d.
Figure 22d.
Trap Bar/Hex Bar Deadlift - Top
Figure 23a.
Figure 23a.
Single Leg Deadlift - Top
Figure 23b.
Figure 23b.
Single Leg Deadlift - Grab
Figure 23c.
Figure 23c.
Single Leg Deadlift - Lift
Figure 24a.
Figure 24a.
Single Leg Squat - Top
Figure 24b.
Figure 24b.
Single Leg Squat - Bottom
Figure 25.
Figure 25.
Bottoms Up Kettlebell Carry
Figure 26a.
Figure 26a.
Lunge with a Twist - Same Side Rotation - Top
Figure 26b.
Figure 26b.
Lunge with a Twist - Same Side Rotation - Bottom
Figure 27a.
Figure 27a.
Stability Ball Twist - A
Figure 27b.
Figure 27b.
Stability Ball Twist - B
Figure 27c.
Figure 27c.
Stability Ball Twist - Weighted - A
Figure 27d.
Figure 27d.
Stability Ball Twist - Weighted - B
Figure 28a.
Figure 28a.
Band Chop - Top
Figure 28b.
Figure 28b.
Band Chop - Bottom
Figure 28c.
Figure 28c.
Band Lift - Bottom
Figure 28d.
Figure 28d.
Band Lift - Top
Figure 29a.
Figure 29a.
Two Handed Kettlebell Swing - Bottom
Figure 29b.
Figure 29b.
Two Handed Kettlebell Swing - Top
Figure 29c.
Figure 29c.
Single Handed Kettlebell Swing - Bottom
Figure 29d.
Figure 29d.
Single Handed Kettlebell Swing - Top
Figure 30a.
Figure 30a.
Kettlebell Snatch - Pre-swing
Figure 30b.
Figure 30b.
Kettlebell Snatch - Pull
Figure 30c.
Figure 30c.
Kettlebell Snatch - Press
Figure 31a.
Figure 31a.
Hang Clean - Mid Thigh - Bottom
Figure 31b.
Figure 31b.
Hang Clean - Mid Thigh - Pull
Figure 31c.
Figure 31c.
Hang Clean - Mid Thigh - Catch
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