Acute Lumbar Disc Herniation

One Patients Story to Treatment and Recovery

““I like the AlterG because it gives my patients a way of non-painful, controlled weight-bearing early in the recovery period. Studies show that an earlier return to activity prevents atrophy of supporting muscles, decreases swelling, and improves outcomes.””

Dr. Lance Silverman, Orthopedic Surgeon, Silverman Ankle and Foot

Acute Lumbar Disc Herniation Protocol for Rehab Professionals

General Principles

This protocol for rehabilitation after Acute Lumbar Disc Herniation is designed to provide the rehabilitation professional with a general guideline for patient care with the AlterG Anti-Gravity Treadmill. As such, it should be stressed that this is only a protocol and should not be a substitute for professional clinical decision-making regarding a patient’s progression. And it should be further noted that progression should be individualized based upon each patient’s specific needs, pain level, physician’s guidelines, physical examination, progress, and presence of any complications. The guidelines provided here are based upon our published experience with appropriate adjustments for a wide range of patients based on clinical expertise.

Download Protocol for printing.

Up to daily for high-level athletes, or 3-4 times per week for others.

Increase in pain during or after use of the AlterG Progressing neurological signs and symptoms

PHASE I (Immediate): Week 1 – Week 4


  • Protect injured tissue from excessive loading
  • Decrease painAvoid progressive nerve root damage


  • Bed rest
  • Pain and muscle relaxant medications
  • Anti-inflammatory medications
  • Passive extension exercises (McKenzie)
  • Hip and lower extremity flexibility exercises
  • Early protected activity

(See Progresion Table Below):

  • Walking on the AlterG Anti-Gravity Treadmill may begin as soon as the patient can safely get into and out of the unit
  • Gait training should begin at ~50% BW, 3° – 5° incline to further reduce impact forces, and a comfortable walking speed approximately 2 -4 mph
  • The initial session should be limited to 10 minutes, and only if symptoms do not increase during the session.
  • If symptoms are no worse after the session and the following day, then speed, duration and %BW can be gradually increased while monitoring for increases in symptoms during, immediately after, and the following day after each session

PHASE II (Early Recovery Phase) Weeks 2-4


  • Decrease residual pain
  • Maintain aerobic fitness
  • Stimulate healing connective tissue with controlled stress
  • Initiate efforts to recover any strength loss from nerve root injury


  • Progress as appropriate with passive extension exercises (McKenzie)
  • Initiate trunk stabilization exercise program
  • Initiate lower extremity strengthening for muscles with weakness due to nerve root injury

(See Progresion Table Below):

  • Gradually progress the speed, duration, and %BW. Reduce grade on the AlterG Anti-Gravity Treadmill as tolerated
  • Continue to monitor for worsening of symptoms, and modify %BW on AlterG Anti-Gravity Treadmill if necessary

PHASE III (Recovery Phase) Weeks 4+


  • Continue to stimulate healing connective tissue with controlled stress
  • Strengthen trunk musculature
  • Encourage body mechanics awareness
  • Enhance aerobic fitness
  • Recover strength loss from nerve root injury


  • Progress with trunk stabilization exercise program, especially into functional positions
  • Progress with lower extremity strengthening for muscles with residual weakness from nerve root injury

(See Progresion Table Below):

  • Gradually progress the speed, duration and %BW on the AlterG Anti-Gravity Treadmill as tolerated
  • Continue to monitor for worsening of symptoms, and modify %BW on AlterG Anti-Gravity Treadmill if necessary
To view the progression table form the study, please click HERE

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