Manual physiotherapy treatment of the upper back

Herniated Disc Treatment in Cologne Worringen

Professional physiotherapy for herniated disc at Hackhauser Weg 61

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A herniated disc is not always over after a short time. Some people have surgery, in others the herniation sits in the cervical spine and radiates into the arm, and still others have symptoms after three months. This page describes how follow-up treatment and rebuilding work and what to watch for. Treatment at Praxis Pirnay in Cologne-Worringen is on a prescription from your doctor (Heilmittelverordnung).

Herniated disc: after surgery and with a longer course

An intervertebral disc consists of a tough outer ring and a gel-like interior. If the outer ring tears, material can escape and press on the nerves that leave the spinal canal at that point. In the neck these nerves run to the shoulder, arm and hand, in the lower back into the leg. The symptoms therefore differ depending on the level of the herniation.

Surgery is performed mainly when paralysis or problems with the bladder and bowel occur, or when severe pain does not ease under conservative treatment. During the operation, the tissue pressing on the nerve is removed. The disc is not like new afterward, and the muscles have often weakened from avoiding strain. Follow-up treatment follows the clinic’s instructions.

A longer course is spoken of when symptoms last beyond about three months. Then the issue is less about relief than about learning to trust your own movement again: if you avoid every bend out of worry, you lose strength and mobility. This can be worked on with measured, regularly increased loading. How far the symptoms recede varies from person to person.

What leads to a herniation and what slows recovery

Aging of the disc

Over the course of life the outer ring becomes more prone to tears and the core drier. Herniations in the cervical spine as well as in the lumbar spine arise on this basis.

Narrowing at the nerve exit in the neck

In the cervical spine it is mostly the lower, particularly mobile levels that are affected. Bony spurs at the edges can narrow the nerve exit further.

Another herniation after surgery

Even after an operation, tissue can escape again at the same disc or at a neighboring one. Specialists call this a recurrence.

Protecting the back and tension

Keeping the back still for a long time costs muscle strength. Constant stress, poor sleep and fear of damage can further intensify pain and prolong its course.

Symptoms in the neck, arm and after surgery

Herniation in the lumbar spine

• Lower back pain that radiates into one leg
• A numb, fuzzy feeling in the lower leg or foot
• Unsteadiness when walking on heels or toes

Herniation in the cervical spine

• Neck pain that pulls into the shoulder blade and arm
• Tingling or numbness in individual fingers
• Loss of strength when gripping or extending the arm
• Worse when turning the head or looking up

Common after surgery

• Wound pain and pulling in the surgical area
• Remaining numbness in the leg or arm
• Tiring quickly when sitting and standing
• Uncertainty about which movements are allowed

With a longer course

• Changing pain without a clear trigger
• Stiffness in the morning and after periods of rest
• Declining strength and endurance in the trunk
• Avoiding bending, lifting or sports

When you must not wait

Paralysis, numbness around the anus and genitals, and problems with the bladder or bowel are an emergency, even after an operation. Call the emergency number 112 in that case. Discuss the other signs the same day with the clinic or a doctor’s office.

New or increasing weakness in the arm, hand, leg or foot – emergency
Numb feeling in the area you sit on, between the legs or on the inner thighs – emergency
Urine or stool leak involuntarily, or the bladder cannot be emptied – emergency
Unsteady walking or clumsy hands with a herniation in the neck
The surgical wound becomes red, swollen or weepy, or you develop a fever
Suddenly severe pain again in the arm or leg after a good recovery

Follow-up treatment and rebuilding in Cologne-Worringen

After an operation we work according to your clinic’s follow-up treatment plan: it sets out what is allowed from when. Otherwise the prescription and the assessment determine what we choose.

Physiotherapy exercises (Krankengymnastik)

You practice getting up, turning and sitting down in a way that protects your back, and you extend your walking distance. Once you are cleared, tension exercises for the abdomen and back are added, later strengthening movements. With a herniation in the neck we train the deep neck muscles and the shoulder girdle.

Manual therapy

In the cervical spine, careful traction in the lengthwise direction can take pressure off the nerve exit. We also mobilize the thoracic spine and shoulder so that the neck has to compensate less. We do not treat freshly operated segments directly.

Classical massage

After a long period of protective posture, the muscles of the neck, shoulders or lower back are often hard and sensitive to pressure. Massage can loosen them. We leave out the scar until it has healed sufficiently.

Home visit

If you cannot yet get to the practice after the operation, we come to you at home or at the nursing home. Requirement: the home visit is noted on the prescription.

Step by step back to physical load

1
Review documents, carry out the assessment
At the first appointment we go through the operation report, the follow-up plan and the images. Then we examine posture, mobility, scar, strength and sensation.
2
Getting safely through the day
First it is about what you need every day: getting out of bed, sitting, getting dressed, walking short distances – as far as the clinic allows.
3
Rebuilding the muscles
Once you are cleared, we step up the exercises: first holding, then moving, finally with weight. The benchmark is how your body reacts the next day.
4
Work, hobby, conclusion
We prepare for what awaits you, such as standing for long periods, carrying or working overhead. Finally we check what has been achieved, and you take an exercise program home with you.

Steps you can take yourself after surgery and with a long course

After an operation, your clinic’s instructions always take priority. What is written here are general suggestions for the time between appointments.

Get up via your side

In bed, with your knees bent, turn onto your side as one unit, push your lower legs over the edge and push yourself up with your arms. This keeps your back straight.

Walk a little further each day

Walking is usually part of the program early on after a disc operation. Start with a few minutes and extend the walk gradually, as long as leg or arm pain does not increase.

Relieve the neck at the screen

Set the monitor so that the top edge is roughly at eye level, and do not clamp the phone between your ear and shoulder.

Schedule your exercises firmly

With a long course, regularity counts more than intensity. Link the exercises to a fixed habit and increase only when the current amount feels easy.

Directions, documents and languages at Hackhauser Weg

You will find Praxis Pirnay at Hackhauser Weg 61, 50769 Cologne-Worringen, in the northernmost district of Cologne and close to the Rhine. If you drive, take the A57 to the exit Köln-Worringen and park directly in front of the practice – helpful if longer walking is still difficult. The bus stop “Worringen Hackhauser Weg” is a few minutes’ walk away.

For follow-up treatment we need, besides your health insurance card and prescription, above all the discharge letter and, if available, the clinic’s follow-up treatment plan as well as MRI and X-ray reports. Wear something loose; with a herniation in the neck, a top that leaves the shoulders free. The first appointment takes longer because of the assessment; otherwise, depending on the prescription, it is usually 20 to 60 minutes.

We give appointments by phone or via the form on the website. Please tell us when the clinic says treatment should begin. Therapy is available in German, English or Spanish.

Opening hours: Mon–Tue 7:00–18:00, Wed 7:00–18:20, Thu 8:00–19:30, Fri 8:00–14:00

Questions about surgery, recurrence and a long course

When does physiotherapy begin after a disc operation?

The operating clinic sets the timing. Often you are up on your feet under guidance on the day of the operation or the day after. When outpatient treatment starts and how much load you may put on your back is stated in the discharge letter or the follow-up treatment plan. We follow that.

What should I avoid in the first period after the operation?

What matters is what your clinic specifies. Usual at first are restrictions on heavy lifting, deep bending, twisting movements under load and, in some cases, prolonged sitting. How long they apply differs depending on the procedure and the hospital.

Can a disc that has been operated on herniate again?

Yes, that is possible. Only the escaped tissue is removed; the rest of the disc remains and can give way again later. Strong trunk muscles and a considered increase in load make sense but do not rule out a recurrence. If severe pain in the leg or arm returns, see a doctor again.

Is physiotherapy still worthwhile if the symptoms have lasted a long time?

Yes, it can be worthwhile even then. With a long course, the focus is on active exercises, a planned increase in load and breaking down protective postures. How far the pain eases as a result cannot be said in advance. The cause should have been clarified by a doctor.

Does health insurance cover follow-up treatment?

Yes, with a prescription from your doctor we bill statutory as well as private insurers. After an operation, it is often issued by the clinic at discharge or by the practice that continues your care. People with statutory health insurance pay the usual statutory co-payment unless they are exempt. With private plans, it is advisable to ask your insurer.

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