31/12/2025
From Bed Rest to Gym Training: A Conservative Spine Success Story
In September 2025, a 43-year-old male patient was referred to physiotherapy with severe low back pain and left-sided sciatica following exaggerated stretching during gym activity, combined with extensive cardio training, frequent running while dehydrated, and prolonged sitting related to his occupation.
MRI demonstrated a large posterior and left-sided L4–L5 disc extrusion measuring approximately 2 × 2 × 0.8 cm with cranial migration (~2 cm), causing significant compression of the left L4 nerve root. An additional left-sided L5–S1 disc bulge was noted, affecting the left S1 nerve root.
After assessment and administration of an epidural steroid injection, the orthopedic consultant decided to proceed with conservative management and referred the patient for structured physiotherapy rehabilitation.
At initial presentation, the patient had marked pain, motor weakness, restricted lumbar mobility, impaired gait, and limitations in daily activities.
Physiotherapy management focused on pain modulation, lumbar stabilization, neural mobilization, progressive lower-limb strengthening, postural correction, and graded functional and gym-based training.
Clinical outcomes:
After 1 month of physiotherapy: ~70% improvement
After 2 months: ~90% improvement
Pain medications discontinued following orthopedic follow-up
Functional progression from bed-level activity to gym-based functional training
This case highlights an important clinical insight:
Even large lumbar disc extrusions can respond very well to evidence-based conservative management when contributing factors are identified and addressed early through interdisciplinary care.
As clinicians, our role is to restore function, resilience, and safe movement, not to treat imaging findings alone.
Shared for professional education. Patient confidentiality maintained.
👉 If you are a clinician managing complex spine cases, or someone exploring non-surgical options for sciatica and disc pathology, feel free to connect.
