Herniated disc help, please!

[Willie]

I will answer the cut and paste questions, and am posting this in an effort to get some guidance about how to lift according to NROLW with this issue. I have a log on the training forum, if it would help to look at my workouts. It's called "season of recovery."

1. When did the pain begin? August, more or less.

2. What were you doing at the time? Or did the pain come on gradually over time? I row competitively, so that, I suppose. The pain is intermittent, but over time it has gotten more frequent and significantly more intense.

3. Where, anatomically, is the pain?
Low back, superficially. Right leg, specifically. The herniated disc is pinching my sciatic nerve.

4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting? All of the above It's sharp, shooting, in the leg, with frequent numbness in my heel. In my back, it's a dull ache.

5. Is the pain constant, or intermittent, or only on certain motions?
Intermittent, and follows most exercise, but also occurs while standing, walking, and sleeping (oddly enough).

6. What motions make your pain worse?
I honestly don't know. I've not really been able to identify any specific patterns of behavior or exercise that make it worse.

7. What, if anything, makes your pain better?
Sitting up, with legs extended, small pillow under my right knee.

8. Does your pain radiate to any other part of your body? Nope.

9. What things could you do before, that you cannot do now because of your injury? Row on the rowing machine (I haven't been in a boat since Thanksgiving, but will be on the water in three weeks), which presents a different load to the lower pack than on-the-water rowing does. I could back squat 165 (1rm), and these days I don't load my spine at all.

10. What is your main concern regarding the pain and its consequences? I'd like to be able to be comfortable, be healthy, and be able to continue getting stronger as a rower and a lifter (I know these don't necessarily complement each other, but that's what I do...).

11. Have you ever injured that part of your body before? If so, how? This is my S1. I have degenerating disc issues between L3 and L4 and L5. After a year of PT, those seem to be resolved, but these days my back hurts enough that I am not entirely sure of the source.

12. Is your pain getting worse over time? And if so, how much worse over what time period? Well, I've now had two rounds of oral steroids, which brought some relief, but that was in November and it got worse in late December. I had an epidural last week, and am hoping for another one in six weeks. It is better since the epidural, noticeably, but it's still keeping me awake at night, I'm still afraid to load my spine, and my workouts are still limited because of the pain and the fear of making it worse. I begin PT on Monday.

Thank you so much for reading all of this; I know it's long. Any suggestions regarding treatment or lifting or just how to sit and sleep comfortably are greatly appreciated.

Kate

[UConnJulie]

It's good that you are starting PT on Monday ... please report back with what he/she says and does.

A good resource is Robin McKenzie's "Treat Your Own Back" (you might be able to get a copy at the library ... otherwise I think Amazon carries it).

One of the main things with disk injuries, is that you need to let them heal, without doing the provoking movements. Typically in disk injuries this is spinal flexion ... so if you were my patient I would tell you to lay off the ergo, and the rowing for a period of time to let the injury fully heal. No loaded flexion exercises, so no crunches, no KB swings, etc.

Think of it like a cut on your knuckle. Everytime you bend your finger, the cut cracks open again and takes weeks to heal. But if you tape a popscicle stick to it to keep it from bending, the cut heals in a few days.

I would also incorporate backward bending exercises like the press up (you'll find a progression in the book I referenced above). Avoid prolonged sitting. Use proper body mechanics at all times.

As for modifying NROL4W ... I would avoid weighted squats for now and do bodyweight. If you need to make them harder, do single leg, off a box or pistol-style. Deadlifts are also risky ... very risky ... for your situation. But it is a natural movement that is used in everyday life to lift anything off the floor. You'd be better off in doing it in single leg fashion and using bodyweight only. If you need links to pics/videos for form, I can probably scare some up (or Lisa~ can if she sees this!! )

You say you have never taken more than 2 days off rowing (in your log) since college ... that might be part of the problem. You might need a good few MONTHS rest to keep this from becoming a chronic, long-standing problem. And if your goal is truly to avoid surgery, which is possible, then you can't have it both ways. You will need to make some sacrifices for a while (maybe a year) to get it to fully heal and have your entire back be strong and healthy. JMO.

[Willie]

Julie,
Thank you so much. I should have been more specific-- I've taken lots of time off from rowing, specifically, but not training (when I wasn't rowing, I was lifting / running, and now that it's nasty and rainy here in Seattle, I'm mainly on land since Thanksgiving). There was a period of 5 years when I was coaching but not actually rowing, at least, not regularly. I've always joked that I'll rest when I'm pregnant (in a couple years)... so you're saying I should plan a little better than that? So... if I need surgery and then a few months... would another epidural help me manage a little while longer, like, say, til June (or August if we're really fast, which we should be), and THEN I could get surgery?

So... no erg. Not a problem. Already broke that news to my coach (who happens to be my brother), and he's good with it. Interestingly, the ONE workout that I really did on the erg this winter, which is a common / standard measurement for me, was faster than it's been in my entire life. So as yet, I don't feel like I'm losing any fitness... that was a week ago. As I mentioned earlier, the erg places a hugely different load on the back than rowing does. And I won't row at all until Feb 9th at the earliest. If it's recommended to wait... sigh... I can, but our first race is in early April.

I am excited to start the PT next Monday, and will definitely post an update.

As for NROLW-- I can to body weight squats and all sorts of other single-leg exercises in the meantime, no problem. Slow-- no momentum from the "back" leg-- step ups are hard enough with the 2 x 15 anyway. I haven't done any kettlebell work for a week, either.

The analogy of the cut on a knuckle was a great one. Can you tell me more about spinal flexion (this is a question for my PT, too, I assume?)? I was interested to read "no crunches." Can you recommend any ab / core exercises that I CAN do? Seems like plank is the only one

What about things like wall-ball (throwing a 12lb medicine ball up to the wall, squatting down as it's caught, ala Crossfit style)?

Julie, thank you so much. I still feel like there is hope.

Kate

[UConnJulie]

I would hold off on any med ball throwing until your PT evaluates your ability to maintain neutral with activity in person.

As for core stuff to do ... there is plenty ... planks and plank versions are probably the best. Add in something like elbow touches, push ups, and chin ups and you are working the abs pretty fully. But again, it depends upon what position your spine is in when you are doing these things. Your PT will be able to direct this better after he/she evaluates you in person.

Robin McKenzie's book explains it best, but here is a decent article on maintaining neutral.

[Willie]

Thanks Julie.
This morning was difficult enough with no weight on the 1-leg squats. I held 30lbs during the lunges... it felt light and was easy.

I will check out that book and article later.

Kate

[bryanc]

Do you have imaging to confirm a herniated disc?

[Willie]

I do-- an MRI from November.