Rehabilitation of the lumbar spine

The Dikul's Method is an effective system of lumbar spine rehabilitation for herniated discs, protrusions and post-traumatic conditions. The unique method is based on the scientific principles of neuroplasticity and muscle adaptation, which have proven their effectiveness in clinical trials. In this article, we detail how dosed strength exercises work, why an individual approach gives the best results, and how Dikul's method helps even in complex cases where traditional rehabilitation is powerless. Learn how to restore spinal health without surgery and return to an active life!

Dikul's method of repairing herniated discs and protrusions of the lumbar spine¶

Concept of the Dikul Method for Lumbar Spine Hernia and Protrusion Repair¶

Valentin Dikul's method is a system of recovery of the musculoskeletal apparatus (MSA) after injuries, surgeries and chronic diseases (osteochondrosis, herniated discs, cerebral palsy, etc.).

Why choose Dikul's method for repairing herniated discs and protrusions of the lumbar spine?¶

Valentin Dikul's method shows good results in severe cases. The method has proven effective where traditional rehabilitation is powerless (for example, recovery from paralysis).

Scientific validity - based on the principles of neuroplasticity and muscle adaptation.

Neuroplasticity: - the ability of the nervous system to remodel and restore lost function.

How it works in the Diculus Method:

Research confirms that repetitive dosed loads (as in the Dikul Method) stimulate the formation of new neural connections in the spinal cord and brain (Taub et al., 2002; Kleim & Jones, 2008). Herniated discs often cause compression of nerve roots, resulting in muscle weakness and impaired perception of movement and limb position (i.e. the person has no control over their movements). The Dikul method restores neuromuscular transmission through systematic exercises by activating ‘sleeping’ motoneurons and forming a new corrected motor behaviour.

Example: In patients with chronic back pain, MRI records a decrease in the grey matter of the brain, but regular training, according to Dikul's method, reverses this process (this fact is published in Seminowicz et al., 2011).

Motoneurones

Motoneurons (motor neurons) are nerve cells that transmit signals from the central nervous system (CNS) to muscles, glands, and other effector organs, causing them to contract or secrete.

Example: Lumbar herniation may impair the conduction of signals from the lower motoneurons to the leg muscles. Dikul's method restores this connection through training, improving mobility.

Adaptation of muscles: - strengthening the deep stabilising muscles of the spine, which reduces the load on damaged discs.

Herniated discs and protrusions are often caused by muscle imbalances:

Deep stabiliser muscles (transverse abdominis, multifidus muscles) atrophy, increasing the load on the discs.
Superficial muscles (back extensors) compensatory overstretch, increasing pain.

How the Dikulia method solves the problem

Step-by-step strength training restores the muscular corset, reducing pressure on the disc (Hides et al., 1996 - hernia training study).
Strengthening multi-division muscles has been shown to reduce hernia recurrences by 30-40% (Yasuda et al., 2020).

Clear system - step-by-step programmes with objective progress criteria.

Dikulia's personal example - the author's personal story (recovery from spinal compression fracture) inspires not only our patients.

Anatomical Reference

key muscles for spinal health
Transverse Abdominal Muscle: The deepest muscle in the abdomen, located under the internal oblique muscles. It wraps around the waist like a ‘corset.’ Stabilises the lower back and pelvis and protects the spine during movement. Weakens with sedentary lifestyle, which increases stress on intervertebral discs.
Multiple muscles: A chain of short muscles along the entire spine, especially developed in the lumbar spine. They support the vertebrae, control small movements and prevent misalignment. Their atrophy is a frequent cause of chronic back pain and recurrent herniated discs.
Superficial Back Extensor Muscles.: Long muscles that run from the pelvis to the neck along the spine (you can see them in relief in trained people). They straighten the back and help with posture, but do not stabilise the vertebrae as much as the deep muscles. If the deep muscles are weak, they become overstretched, causing spasms and pain.

Basic principles of the concept of the Dikul Method for lumbar spine restoration¶

Valentin Dikul's method requires a high level of self-discipline, but for many people it becomes their ‘last chance’ to regain mobility and restore lost function.

Principle of Active Rehabilitation in Lumbar Spine Rehabilitation¶

The method of Valenitin Dikul has undergone a lot of research and confirmation of its effectiveness all over the world. The sustained effect of the method confirms that dosed strength exercises in lumbar spine rehabilitation stimulate recovery better than passive methods. According to various studies (published in Kumar et al., 2011; Hayden et al., 2005), strength training:

Strengthen deep stabilising muscles (multifidus muscles, transverse abdominis), reducing compression on discs;
Activate neuroplasticity, restoring communication between the CNS and muscles;
Reduce pain syndrome by 30-50% by improving blood circulation and muscle balance.

Dikul's method, emphasising progressive strength exercises, provides structural restoration of the spine, as confirmed by MRI imaging in patients with herniated discs (see Yasuda et al., 2020 for more details).

Passive physiotherapy (massage, electrophoresis) provides temporary relief, but does not eliminate the cause - weakness of the muscular corset.

Physiological processes during strength exercises and their impact on spinal recovery¶

Key physiological changes occur when performing dosed strength exercises according to the Dikul method:

Activation of deep stabiliser muscles (multidivision, transverse abdominal muscles), which reduces compression on the intervertebral discs and evenly distributes the load on the spine. This creates conditions for decompression of nerve roots and reduction of inflammation.
There is an increase in blood circulation and lymph flow in the spine, which improves the nutrition of damaged tissues and accelerates the regeneration of the fibrous ring of the intervertebral disc.
There is a stimulation of collagen and proteoglycan synthesis in the intervertebral discs, which contributes to their moisture saturation and structural restoration.

Structural recovery is confirmed by MRI: herniation size is reduced, swelling around the nerve roots is reduced and the height of the intervertebral discs increases due to improved nutrition. Gradual increase of the load strengthens the musculoskeletal apparatus, preventing recurrences.

Fibrous ring of the intervertebral disc

The annulus fibrosus of the intervertebral disc is a tough, multi-layered ‘shell’ of fibrous tissue that surrounds the soft gel-like part of the intervertebral disc (the nucleus pulposus).

Simple words:
Imagine that an intervertebral disc is a doughnut: the fibrous ring is its elastic ‘rubbery’ outer part, and the pulp core is the liquid filling.

Its main role is to absorb shocks from walking, jumping, and exertion, preventing the vertebrae from rubbing against each other.

__What happens when there are problems? If the fibrous ring is torn (due to injury or age-related wear and tear), the ‘stuffing’ (the nucleus pulposus) can bulge - this is a herniated disc, which sometimes presses on nerves, causing pain.

Proteoglycans

Imagine a ‘sponge’ that holds water inside an intervertebral disc. This ‘sponge’ is made up of complex molecules that look like ‘hedgehogs’, where the ‘Rod’ is protein and the ‘Spikes’ are chains of carbohydrates. These are the Proteoglycans, which can hold a lot of moisture inside the intervertebral disc.

Proteoglycans attract and hold water, making the disc elastic (like a lubricant in the cushion between the vertebrae) and work as shock absorbers - softening shocks when walking and jumping. As we age or under stress, proteoglycans become less, the disc ‘dries out’, loses height and springiness, and osteochondrosis sets in.

Movement (especially dosed exercise, as in the Dikul method) improves disc nutrition and stimulates the production of proteoglycans.

Principle of neurophysiological approach for restoring connections between muscles and CNS in the treatment of the lumbar spine¶

Dikul's method is based on the principles of neuroplasticity - the ability of the nervous system to reorganise itself under the influence of repetitive loading. Thus, studies (Kleim & Jones, 2008; Taub et al., 2006) show that regular purposeful movements can activate ‘dormant’ neuronal connections between the brain and muscles, which is confirmed by fMRI data of our patients starting from the 3rd month of exercise.

Also, repetitive movements during exercises form new motor habits, compensating for damaged areas (this fact is described in detail by Wolf et al., 2006). That is, some muscle fibres sometimes take on the function of a holding corset, while the other part is ‘trained’ to perform motor functions.

Regular training on special simulators improves proprioception (sensation of body movements and posture) by stimulating muscle receptors (very convincingly described in Ribeiro et al., 2021) and actually reprogrammes the brain to use healthy and fully functional tissues (muscles, ligaments) to replace lost functions.

Clinical studies of patients with lumbar problems demonstrate that this approach is 2-3 times more effective than passive therapy in restoring motor function and reducing pain syndrome.

Physiological processes in the nervous system during lumbar spine rehabilitation¶

Repeated dosed loads in the Dikul method trigger key processes of nervous system and tissue restructuring:

Neuroplastic changes: New neural connections (synapses) are formed in the CNS between the motor cortex and the spinal cord, which is confirmed by neuroimaging studies (fMRI). ‘Dormant’ motor units are activated, improving neuromuscular transmission.
Tissue adaptation: Back muscles are strengthened through growth and strengthening of muscle fibres and improved tissue blood flow, and proteoglycan and collagen synthesis is increased in the intervertebral discs, as confirmed by MRI.

Structural recovery occurs in stages: first the muscle corset is normalised, reducing the load on the discs, then their moisture saturation and disc thickness are restored. This reduces nerve compression and allows the spine to return to its anatomically correct position.

The principle of personalisation in the formation of lumbar spine rehabilitation programmes¶

The Dikul's method pays special attention to this principle, as all programmes are adapted to the severity of pathology and physical capabilities of each patient, and kinesiotherapists control the dynamics of changes within the framework of an individual programme.

Thus, numerous studies prove that individual rehabilitation programmes are much more effective than standard ones. For convincing we will cite the data of Hayden et al. (2005), who conducted research on large groups of people with low back pain, who were engaged in personalised schemes. The results of the 3 month sessions were:

30-50% better results in mobility recovery (compared to general exercise);
2 times less recurrences due to taking into account the peculiarities of the pathology.

The Dikulya Method is used in the restoration of the lumbar spine:¶

Stage-by-stage loads corresponding to the stage of the disease (from gentle to forceful);
Adjustment of the programme according to MRI dynamics and functional tests, which are performed in our centre by each kinesiotherapist at all sessions.

Example: For L5-S1 hernias, first relieve the spasm, then strengthen the deep muscles, and only afterwards add axial loads. This prevents complications and speeds up recovery.

Principle of psychological motivation in lumbar spine mobility restoration programme¶

In order for a person to get results and stay on track, it is very important that they have the belief in positive results and discipline - these are the key factors in a recovery programme.

One can have a terrific technique with unique results, but the lack of faith and a person's desire to recover will undo all the efforts of that person and those helping them along the way.

Numerous studies confirm the critical role of psychological factors in musculoskeletal rehabilitation. According to Main et al. (2015), patients with a positive attitude and high motivation demonstrate 40% better recovery results (in terms of mobility and pain scores) and are 3 times more likely to comply with their exercise regime.

The Dikul's method emphasises cognitive-behavioural aspects (creating an attitude of recovery), a system of rewarding progress (at each stage, results are visualised through objective MRI and kinesiology tests) and discipline (regularity as the basis of neuroplasticity).

Example: A study by Nicholas et al. (2011) found that motivated patients with chronic back pain:

Cortisol levels are reduced by 25%

Muscle activation scores improved by 35%.

These data explain why the Dikul method pays as much attention to psychological training as to physical exercise.

Dikul's method differs from other kinesiological methods in lumbar spine rehabilitation¶

Progressive strength loads in lumbar spine rehabilitation¶

The Dikul Method is fundamentally different from other kinesiological approaches in its philosophy of active recovery through progressive strength training.

While most techniques (such as the Bubnovsky system) emphasise gentle mobilisation and joint exercises, Dikul deliberately uses forceful exercises with dosed weights as the main rehabilitation tool.

This is due to the belief that only through a gradual increase in load can real recovery of the muscle corset and neuromuscular connections be achieved.

And unlike many other approaches, Dikul's method provides for work with simulators and weights even in complicated cases - after severe spinal injuries, in the presence of herniated discs and protrusions, when traditional rehabilitation usually prohibits such loads.

Comprehensive multi-level approach to lumbar spine rehabilitation.¶

The most important distinguishing feature is the complex multilevel approach, which combines not only physical therapy, but also elements of mechanotherapy, special breathing techniques, and a special attitude to pain.

In contrast to methods that completely eliminate pain syndrome, Dikul's system treats pain as an important marker that must be dealt with competently, not just avoided.

This comprehensive approach allows us to influence the problem from several sides simultaneously - not only by strengthening muscles, but also by restoring neural connections, improving tissue nutrition, and forming correct movement habits.

A scientifically based, individualised approach to load dosing in spinal rehabilitation¶

Another key difference is the scientifically based individual approach to dosage of loads.

While many kinesiological methods offer relatively standard sets of exercises, in the Dikul's method the programme is always strictly personalised, taking into account not only the current state of the spine, but also the peculiarities of the neuromuscular response of a particular patient.

This allows the method to be safely applied even in cases where other rehabilitation systems are ineffective.

Particular importance is attached to psychological preparation and motivation of the patient, as rehabilitation using this system requires regular sessions over a long period of time.

It is this comprehensive, scientifically based, yet highly personalised approach that ensures the unique effectiveness of the Dikul Method in complex cases of musculoskeletal disorders.

Dikulya Method Lumbar Spine Rehabilitation in our centre¶

At our centre, Dikul's lumbar spine rehabilitation starts with a thorough diagnosis, including functional tests and MRI data analysis.
Our specialists develop an individual programme that takes into account the degree of spinal injury, the patient's physical fitness and comorbidities.
- The programme always starts with gentle exercises on special simulators that allow to relieve axial load from the spine, while providing the necessary work of deep stabilising muscles.
- Gradually, under the constant supervision of a kinesiotherapist, the load is increased by adding exercises with weights aimed at strengthening the muscle corset and restoring neuromuscular connections.
- Our specialists pay special attention to the correct technique of exercises and breathing, which allows you to maximise the effectiveness of the necessary muscle groups without the risk of injury.
During the rehabilitation process, we regularly adjust the programme based on the dynamics of recovery - muscle strength, spinal mobility and MRI monitoring data.
In parallel with physical activity, patients undergo psychological training to help them maintain motivation and discipline throughout the course of treatment. They meet with doctors, exchange experiences, and attend various training programmes at our lumbar spine rehabilitation centre.

This comprehensive approach allows us to achieve impressive results even in complex cases of intervertebral herniations, protrusions and lumbar trauma.

It's time to bring health back to your back!¶

It's time to say no to pain! Make an appointment for a consultation!

If you are concerned about low back pain, restricted mobility or the consequences of injuries - don't wait for the problem to get worse! In our centre we help to restore the lumbar spine even in complicated cases - herniated discs, protrusions, post-traumatic conditions and chronic pain.

Dikul's method is a proven effectiveness, individual approach and real results confirmed by research and thousands of patients. Our specialists will choose a personalised programme for you, taking into account the specifics of your condition, and will accompany you at every stage of recovery.

Don't delay treatment! The sooner you start working on strengthening your spine, the sooner you will return to an active life without pain.

Make an appointment for a consultation now

Take the first step to a healthy back!

Your health is our concern!