Bad lower back pain

[Willie]

Originally Posted by UConnJulie

A PT who has evaluated you in person knows a heck of a lot more about your situation than I. I would nearly always defer to someone who has evaluated you in person. McKenzie does not work for everyone, but it is a good jumping off point when the suspected injury is disk.

That's what I figured

My dad / coach has always told me to do those exercises, too... I just don't always know what is "good" pain and "bad" pain.

[UConnJulie]

The way I see it ...

Rate your pain before the exercise on a 0-10 scale.
During the exercise the pain might go up, and that's okay really.
What matters most when looking at symptom-reducing exercises (like McKenzie) is what does your pain feel like when you're done.

So let's say that "Mary" has lower back pain. She rates it at a level of 6 which is pretty strong pain. She does some prone-on-elbows. Her pain goes up to an 8 while she is resting in that position. But when she's done, her pain is now a 3. To me that is a good exercise for her. (Especially if it also centralizes the pain, ie takes leg pain away and puts it in the back.)

However, let's say "John" also has pain at a level of 6. He does press ups and during the press up his pain is a 2. But when he's done, his back pain is an 8 and he now has leg pain. That is clearly NOT the exercise for him.

The hard thing about the back is that many different structures can cause similar pain. And more than one structure can be injured. For example, someone might have lifted with improper form, and pulled a muscle, strained a facet joint, and caused a small disk bulge. It takes good evaluative skills to determine which one is causing the most pain. And treatment for one area can aggravate another. It's a delicate balance.

And very hard to do over the internet.

[Willie]

Originally Posted by UConnJulie

The hard thing about the back is that many different structures can cause similar pain. And more than one structure can be injured. For example, someone might have lifted with improper form, and pulled a muscle, strained a facet joint, and caused a small disk bulge. It takes good evaluative skills to determine which one is causing the most pain. And treatment for one area can aggravate another. It's a delicate balance.

And very hard to do over the internet.

Thanks Julie!
This is really what I-- and my doctors-- believe is going on with me. I had originally injured the disc, and had rehabbed it to a manageable place in early March. In late March I tripped, and shifted my pelvis / sacrum all over the place, which was bad enough in itself, but then also impinged the nerve again. Sigh. It's taken awhile to get it all straightened out... slowly but surely.

[NeilC]

Wouldn't a herniated disk be causing referred pain down the sciatic nerve or similar? Mine certainly did. The McKenzie extensions work pretty well for centralising referred pain but AFAUIK don't do anything to strengthen up the core or ensure the correct muscle activation.

I second the recommendation to look into McGill's book. This has been a revelation to me. I was in more or less constant back pain for about 18 years until I followed the advice in that book. The prime points that helped were:

- Overall concepts of lumbar stiffness
- Activation exercises to train the body to keep the spine stiff whilst using the correct muscles to bend/squat etc.
- The isometric strengthening exercises - side-bridge, bird-dog, isometric curl-up

Surprisingly, to me at least, I can do some of these exercises even when in an acute episode and they really help - especially the activation ones.
The book is a good read anyway and covers some interesting ground on how to go about training in general.

[karky]

I think you can have a herniated disc without the disc impinging the nerve, but I'm not sure. I guess if it is possible that would be a not so serious herniation.

I think I had some referred pain here the other day lying in bed waiting to fall asleep. There was a burning pain in my hip flexor, like a poking pain (let me explain) It started low, then gradually built up then went down again until it was gone. It happened at pretty unregular intervals and there was quite some time in between each "poke".

[NeilC]

Yeah I've had a similar burning pain - felt like a hot coal inserted into my hip bone.

Since I had my disk shaved, the scans show it's all clear - yet I still very occasionally get referred pain/numbness (sometimes as far as the foot). So I assume one can get referred pain without the impingement.

I've also known people diagnosed with disk herniation who have then recovered before their operation came though (NHS can take many months). So I take the view that focussing on the disk (and I was quite obsessed for years) isn't always the thing to do and that working on the underlying weaknesses that caused the problem is better. In my case this appears to be muscular weakness and improper use of the back and it's related muscles. At least training on this basis has been successful. I was quite big and strong during this time yet still had critical core weaknesses.

[UConnJulie]

Herniation does not necessarily mean that you will have radicular symptoms. The problem with backs is that it is all highly variable. I have treated people with herniations who only had lower back pain, who only had leg pain, who had no pain only weakenss and paresthesias. I have also treated people with the above symptoms, with no evidence of herniation on MRI.

It is highly variable.

So, when I am offerring advice over the internet to a person whom I have not had the pleasure of examining in person, my best course of action is to make a guess, and offer some exercises to try. If they don't help, then there are other exercises to try.

And that's the best I can do for free.

[Willie]

Originally Posted by NeilC

I've also known people diagnosed with disk herniation who have then recovered before their operation came though (NHS can take many months). So I take the view that focussing on the disk (and I was quite obsessed for years) isn't always the thing to do and that working on the underlying weaknesses that caused the problem is better. In my case this appears to be muscular weakness and improper use of the back and it's related muscles. At least training on this basis has been successful. I was quite big and strong during this time yet still had critical core weaknesses.

I think I wrote about the specifics of my injury above, but this ^^^ pretty much sums it up. The acupuncturist, chiro, and PT all believe that muscular imbalances and structural issues combined to worsen the symptoms of my already-herniated disk.