Back Pain Relief & Recovery: How an Exercise Physiologist Can Help

Back pain affects millions of people, limiting mobility and impacting quality of life. Whether you’re dealing with lower back pain, sciatica, or recovering from surgery, the right exercise program can make all the difference. As an Exercise Physiologist, Nick specialises in helping people overcome back pain through targeted exercises, movement correction, and rehabilitation techniques.

This guide explains common back conditions and how exercise therapy can help you manage pain, improve mobility, and regain strength.

Herniated Discs

The spine is made up of linked segments of bone called vertebrae. In between each vertebra is a ‘spongy’ disc that allows to your spine to bend in all different directions but also carry and bear load through a sophisticated hydraulic-like system.

The disc has two main parts:

Outer layer: called the annulus fibrosis, this is layers of collogen tissue, layered like an onion.
Inner layer: nucleus pulposus, a phlegm-like substance within the disc.

A herniated disc is a blanket term for all the different types of disc bulges, which are named and categorised in order of severity:

Disc bulge - occurs when there is a small tear in the annulus fibrosis (usually the outer 3rd), but the nucleus pulposus is still contained.
Disc prolapse - the tear in the annulus has now progressed to the edge of the annulus, but the the nucleus pulposus is still contained. This may cause both mechanical and chemical pressure on the nerve roots, causing sciatic pain.
Disc extrusion - the annulus has now been opened and the nucleus pulposus can exit through this opening. This very commonly has severe sciatic pain.
Disc sequestration - part of the nucleus pulposus breaks away and can move down the spinal canal.

The type of disc herniation is important to know as it gives a prognosis of the injury as well as if surgery is needed or not. This can be confirmed through a combination of physical tests and imaging (not either on their own!)

How do disc herniations occur?

The common belief and assumption is a disc injury occurs after a particular event, such as lifting something that was too heavy or even just sneezing, but in reality, the event is simply the straw that broke the camels back.

There is so much more happening before the episode of pain occurs. It is usually a combination of lifestyle and environmental factors, the way we move throughout the day (or lack of movement) tends to gradually load the disc in the same way repeatably. Over time, this stress increases and eventually leads to weakening of the annulus tissue, to which the herniation starts to occur. Other factors include your general health, as well as genetics plays a role too.

Do all disc herniations need surgery?

No, however a proper assessment is required to give us the best idea, as there are many factors to consider. Surgery tends to be overdone, but is still necessary when needed.
The biggest indication for surgery is unrelenting nerve pain, particularly if there is muscle weakness (such as foot drop or inability to raise your heel)

What exercises are best for a herniated disc?

There is no best exercise for a herniated disc, what you should be asking is what is the best exercise for me? Everyone is different, everyone's discs are shaped slightly differently and respond differently. This is why a detailed assessment is required to determine what is best for you.

Treatment Approach:

Nick’s approach to back pain is unique in that no one is the same. Everyone patient receives a detailed assessment and the intervention is tailor to their results and capabilities. Some people may be prescribed similar exercise, but like medications, the dose (sets, reps, frequency) is unique to the individual.

Sciatica

Sciatica is a common, yet very misunderstood condition that affects many people.

It is often characterised by the root of sciatic nerve at the spine being compressed, causing pain, tingling, or numbness along the sciatic nerve that can radiate from the lower back down into one or both legs.
However this pain is generally secondary to another injury, such as a disc injury (described above).

While it can be uncomfortable and sometimes disruptive, the good news is that it is very treatable.

Firstly to understand sciatica, we need to categorise it properly:

Radicular pain - nerve is irritated:
This is important, pain along the sciatic nerve doesn't always mean it's being compressed!
It may have been compressed previously, but it is quite common that there is increased tension due to the previous compression, scar tissue formation or even muscle tightness. Surgery is rarely needed to address this.
Radiculopathy - nerve is compressed:
When the nerve is being activity compressed, there is usually a loss of muscle strength which results in issues such as foot drop as well as loss of spinal reflexes and of course, great intensity of pain. Depending on the severity of this, surgical intervention maybe required.

Treatment Approach:

It's important to distinguish the types of sciatica as it greatly influences how they are treated.

Radicular pain - nerve is irritated:
If pain is present then the tension on the nerve needs to be reduced, this is when nerve flossing is actually bad to do as flossing just tensions the nerve more. Changes in position and posture are key here to reduce the tension on the nerve. If there is no pain, just tightness, then this is where flossing can be effective to improve the mobility of the nerve, which will reduce the tension along the nerve tract.
Radiculopathy - nerve is compressed:
Finding positions of respite and postures to reduce the nerve compression is key, also due to the intense inflammorty response (especially in the acute stage), medications and procedures such as nerve root injections or surgery to relieve the compression on the nerve root.

facet joint pain

The facet joints are the joints of your spine that connect each vertebrae together. They allow the spine to bend (flexion) forwards and backwards (extension) and sideways (lateral flexion).

They do restrict rotation (twisting) and the joints at each of the different levels of the spine are shaped and angled differently (this is why you can turn your neck much more than your lower back).

Like many joints on the body, these can become irritated and inflamed with activities that repeatedly load these joints, or sore with flare ups of joint changes such as osteoarthritis (depending on the severity can result in pain and restriction of movement).

Facet joints are generally felt as local back pain, usually a little away from the center of the spine. It is rare for facet joints to cause referred pain down the leg.

The facet joints can be damaged or irritated by a sudden excessive movement or by activities that repetitively load them. For example, things that

place the spine into repeated extension (leaning backwards) or repeated side-to-side movements.

In the younger population, the facet joints can be damaged or irritated by a sudden excessive movement or by activities that repetitively load them, such as tennis serves and cricket fast bowlers (which then can progress into stress fractures).

The older population (which is generally from oesteoarthritis), can be from repeated movements (such as twisting when gardening)

Treatment Approach:

The key to addressing facet joint problems is avoiding movements and positions that continuously load them, so learning new ways to move and perform out daily tasks can be very powerful for helping manage these issues.

There also needs to be an improvement in the strength of the torso muscles to help reduce the overall load being experenined by these joints.

Post-Surgical Recovery

Recovering from spinal surgery is a journey that requires time, patience, and the right support. Whether you've undergone a discectomy, laminectomy, spinal fusion, or another procedure, understanding what to expect and how to aid your recovery, can make a big difference in your long-term outcome.

Every spine surgery is different, but the recovery is surprisingly similar, with some adjustments based on the procedure done.

After surgery, your body needs time to heal the surgical site, rebuild strength, and reestablish healthy movement patterns (this is a big focus as any surgery, no little how small changes how your spine moves and functions).

Some common post-surgical experiences include:

Soreness and swelling at the incision site
Temporary movement limitations
Fatigue or reduced endurance
Changes in nerve sensations as healing progresses
If you have any concerns it is best to speak to your surgeon, GP or Allied Health Professional.

Treatment Approach:

The healing process must be respected, most structures of the lower back have a reduced blood supply and naturally take longer to heal.
The overall outcome depends on a number of factors, such as the procedure that was done (for example a fusion requires much more recovery than a microdiscectomy), but other factors such as your health before surgery, the skill of the surgeon and your diligence will all impact your recovery process.

Our approach is first focused on learning how to move and do your daily movements and activities in the most spine sparing way possible (this is also important for long term spine health).

When appropriate, strengthening exercises are given to help develop the torso muscles to provide better support and stability for the healing spine.

Through a very gradual and meticulous process, exercises are progressed and adjusted to be specific to your goals.

If you're struggling with back pain, a detailed assessment, coupled with the right exercise plan can help you regain strength, mobility, and comfort.

Book an assessment with Nick to start a personalised rehabilitation program designed to help you move pain-free!