A patient has an acute lumbar disc herniation and lumbar spondylolisthesis. Which of the following interventions is MOST appropriate?

• A. Passive Trunk Extension
• B. High-Velocity Manipulation
• C. Active Trunk Flexion Exercises
• D. Spinal Stabilization Exercises

Answer: (D)

In an acute lumbar disc herniation with spondylolisthesis, the priority is to protect the irritated neural tissue while restoring stability through controlled, progressive loading. Spinal stabilization exercises train the deep core muscles, especially the transverse abdominis and multifidus, to create dynamic support for the lumbar segments. This stabilizes motion at the affected level, reduces aberrant shear and flexion/extension that can worsen symptoms, and helps the spine tolerate daily activities without provoking pain. By focusing on neutral spine control and gradual loading, these exercises address both the instability from spondylolisthesis and the sensitivity of the disc without risking irritation from more aggressive approaches.

Passive trunk extension can aggravate posterior structures and disc pathology in this context. High-velocity manipulation is risky in acute disc herniation and unstable segments. Active trunk flexion movements may increase posterior load and nerve irritation. Stabilization exercises avoid these pitfalls and promote safer, controlled improvement.