herniated disc

[rob garrison]

I am new to the forum but have a question that I am hoping someone can answer. I have been diagnosed with a herniation in L5 S1. My PT suggested the McKenzie type extension exercises but when I do these it seems to aggrevate the sciatica symptoms. When i told the Neurosurgeon that I had more pain when standing than when I sit he mentioned that was odd. What I am wondering is if my herniation is somehow different than most and if I should be doing flextion exercises instead of extention. Since my cotisone injection a week ago the pain is about a 3 and i am anxious to start some exercises that don't aggrevate the syptoms. Is my PT missing the boat in advising extention?

[Willie]

Rob, I am sure that UConnJulie will peek in here and give you some expert advice, but I thought I'd come in and say hello. I, too, have a herniation at L5-S1. I've had 3 epidural injections and lots of other therapy (chiro, acupuncture, and PT). 8 months later, I am finally feeling good. I never did the McKenzie exercises because they DID hurt, and I was advised not to do them. My pain also got worse when standing and resolved when sitting. I can do the Mckenzie extensions now, and have been advised by the PT to continue doing them as long as I feel better afterwards. Like I said, Julie has loads of good advice... all I can tell you, is keep checking back with your PT, or find another PT who is specifically geared towards athletes (this is not popular advice, I think, but it worked for me). Good luck!

[rob garrison]

Kate thanks for the reply. that is great to hear. I met with the PT today and he agreed that if extention (McKenzie ) is causing pain to stop and gave me some flextion exercised today. I had a much better day today because of it. I will look forward to hearing from the other "uconn" person you metioned. Rob

[UConnJulie]

Somewhere on this forum, I have posted about the trick to finding the right exercise. And the trick with backs. There are many different structures which can be injured, and just because you have a MRI confirmed herniation, doesn't mean that you don't also have a facet joint strain or something else. Or just that your anatomy is atypical. So rather than dogmatically assigning exercises based upon the diagnosis, it is important to note what the exercise does to the pain.

Let's say that "Joe" has lower back pain radiating into his right buttock. He rates it at a level "4" on a 0-10 scale where 0=no pain and 10=shoot me and put me out of my misery. He does exercise A. During the exercise, his pain drops to a "0". After the exercise, his pain is now a "6" and radiating into the back of his right knee.
THAT IS A BAD EXERCISE FOR JOE!!!

Now his therapist, because she is smart, having gone to UConn ... ... gives him exercise B. During exercise B his pain is the same (level 6 and down to his knee) or maybe even a little worse (level 7 in his back). But when he is done, his baseline pain is now down to a 3 and reduced to his back only (centralized symptoms).
THAT IS A GREAT EXERCISE FOR JOE.

"Joe, your homework is exercise B. Avoid all positions that mimic exercise A."

Does that answer your question from my standpoint?

[rob garrison]

Yes. Thank you so much. that makes sense and that is what the PT is now saying too. The difficulty is to find the right exercises. For example, biking doesn't seem to be too bad put the neurosurgeon ways that should be real bad. Streteching hurts yet the PT tells me to stretch if I can. I desparately need toexercise as my muscles are atrophying and I am going stur crazy but I don't want to injure it more. Sometimes I feel like I am babying it so as to avoid long term pain. Thanks for the info.

[Willie]

Originally Posted by rob garrison

Rob, I really can feel your pain. You can check out my log-- it details my journey from disc herniation to somewhat healthy and almost fully functional. I don't know how to link it, but you can search it using my screen name.

One thing I heard and read constantly was that I needed to continue exercising throughout the recovery process, as you DO need to strengthen your core. I biked a lot, but ultimately found that swimming laps was the most pain-free exercise for me. I should add that I lifted consistently throughout the last 9 months as well, but I did accommodate my injury.

I would defer to Julie for more / better advice, but I do empathize and am happy to tell you that I am pretty darn comfortable and very active these days, after thinking just two months ago that I would likely never be back to comfortable, let alone "normal."

Good luck.

[UConnJulie]

Stretching will/can hurt. You likely have some impaired neurodynamics both from the herniation itself, the underlying joint dysfunction, and some scarring. Ask your PT to show you some neural flossing exercises if she thinks you are ready for it. You also probably have a boatload of trigger points as they are very common (in general) after injury. Look into the Trigger Point Workbook by Clair Davies (Amazon and most local bookstores carry it).

[Willie]

Originally Posted by UConnJulie

Stretching will/can hurt. You likely have some impaired neurodynamics both from the herniation itself, the underlying joint dysfunction, and some scarring. Ask your PT to show you some neural flossing exercises if she thinks you are ready for it. You also probably have a boatload of trigger points as they are very common (in general) after injury. Look into the Trigger Point Workbook by Clair Davies (Amazon and most local bookstores carry it).

Don't know why I didn't mention this, too. Neural flossing was incredibly painful-- I'd be stretching at the gym and would have these (apparently) horrifying looks on my face. In hindsight, they were worth it, though!

[ark]

A Season of Recovery

I'm interested in reading your journal......

[rob garrison]

Kate Wow. I just read your journey. You are an inspiration. I am not in near the pain you were in but I am only 1 month and 1 injection into this. I hope the worst is not yet to come. Question: do you think your work outs helped your recovery or slowed it. I believe I can gut some things our if I thought it was the way to go. You seemed to almost exercise for your emotional sanity. I can hold off if need be although it really does suck. thoughts?

[NeilC]

I had a lumbar herniation a few years back. I was suffering a lot of pain which just got worse and worse. I was off work for a couple of months before I got around to having an operation due to sudden worsening of it.

I was taking multiple painkillers and still in so much pain I spent some days lying on the floor biting a leather belt. It made me depressed and weepy and just totally out of it.

Recovery was slow and had various treatments. Some good some bad. McKenzies were part of that. I found they sort of helped but are way off being a cure.

The turning point was when I was strong enough to do isometric core exercises: side-planks, iso-crunches and bird-dogs. My core was so weak and out of sorts that I couldn't even do a bird-dog at first. I was limited to just lifting one arm and even that would twist my core.

Anyway, I know how it feels and I'm glad it doesn't hurt like that anymore. For me the core exercises changed everything. I still won't do any loaded spine exercises like squats and I'm very careful with anything that stretches my spine in flexion or twists it.

[Willie]

Originally Posted by rob garrison

Thanks Rob. It's been a long road-- about 9 months now, and I feel better now than I have in recent memory. In fact, I just rowed this morning for the first time since early April. I'm sore-- and knew that I would be-- but so far, I have no disk symptoms.

As for exercise-- I was NEVER told not to exercise. I was told to limit and accommodate, but not to stop. I also went through 4 PT's-- yes, 4-- to find one who truly understood my goals. Some thought that I was shopping for someone to tell me what I wanted to hear, but ultimately, it was really important to me to find someone who believed that I could row again and was willing to to help me do so. At that point, I felt this person also had the credibility to tell me what my limits were. Anyway, in terms of exercise, I do not think it hindered my recovery in theory, but in practice, perhaps... Only because I have a habit of doing too much, too soon. I've definitely had to change my view of "hard work," for example, because I can't load my spine and I can't even lift (yet) more than a 40#db off the rack. Re: emotional sanity. Hell yes! I needed to move, period.

I did:
High reps, low weight
suspension trainer exercises
swam laps

Finally, I had a lot of luck with a chiropractor. It's not necessarily the popular route, but my chiro was willing to work with my PT (and vice versa). They shared quite a few phone calls and were both invested in working together. I really appreciated that and I'd advise that you ask your PT if he or she ever works with a chiro. Can't hurt.

Have you sought out any acupuncture?

[rob garrison]

Kate
I have not done the acupucture thing but have been seeing a chiro for a few years (mainly to keep things aligned but have had a few episodes per year of spasm- no sciatica before this however). Seeing the PT again in about an hour. Hoping for more excersises.
Thanks

[rob garrison]

Kate In yoiur last email you said you were told to accomodate. What does that mean. I went to PT yestereday. He said it was too early to do Nero flossing but he did some trigger points and did some light stretching. I then wen t home and tride to ride bikes with my kids and id a short (.25 mile) walk with them. I paid for it today. After the exercising I was sore and all day today was walking gingerly. Question: Have you been taking any medication through your journey? Any thoughts on the exercise? I.e is it good even though I hurt or did I take a step backward? One other question, how was your row? was it awesome to be back on the water?

[Willie]

Originally Posted by rob garrison

Hi Rob,
I'm sorry you're having such a hard time! By "accommodate," I meant, basically, "do things that don't hurt." Sounds like my injury is different from yours in that I got immediate feedback; if I did something to aggravate my injury, I knew it immediately, with numb legs, tingling feet, and a burning sensation in my thigh. At worst, stabbing pains down my leg. So, I think you shouldn''t take that kind of advice from me, as we're dealing with different circumstances, sounds like. I do know that for about a month after my "re-injury" I was strictly limited with what kinds of exercise I could do... basically, I could swim and do push ups and pull ups. They really wanted my back to stop spasming, etc., and reduce the inflammation, before they allowed me to do any core strengthening work.

I've had Prednisone and three epidural injections (Corticoid?). I had three months of Mobic, which is a prescription strength NSAID, I think. Then I took Celebrex for two weeks (until I read that it's under investigation for side effects / heart attacks... or something like that... I stopped reading after the first three articles I read had titles like "the top ten drugs you never want to take."), and now I take Advil, when needed, which is pretty rare.

The row was wonderful, but I was hyperaware of how I was feeling, and suspect that I will be tomorrow as well. I think too much!

[rob garrison]

[rob garrison]

Kate
Thanks for you quick replys. My wife thinks I am a wacky forum guy because I am even on this site. To me it is great to talk to others that are going through similar stuff.
In the big scheme of life this is just a hicup but it certainly real when you are used to working out daily for 15 years.
this too shall pass but I just want to do the right thing to increase the chace of healing as quickly as possible. You mentioned a re injury. Can you tell me about that . I read a couple of months of your journey but kept losing my internet connection so I'm sorry if that is detailed within. Was the re injury someting specific? And by the way was the original herniation anything specific. Mine was not.
It is odd to hear how different these can react. Mine is not horribly painful but constant. I have a limp because of the pain. No numbness or shooting pain, just contant nagging and dull. I picture the fragment just barely touching the nerve. One thing I know is that the body has a way of healing itself. We are all fortunate and blessed with that. tomorrow is another day.

[Willie]

You're right-- these are days, and sometimes they are hard, but ultimately life is good.

The re-injury is speculation by my PT and chiro. I tripped, and the pain came on again (late March, if you're reading my log). The chiro took x-rays a week later, and I was all messed up. My right butt cheek was higher then, and forward of, my left (if I'm on my belly, it rested above my left and higher up my back). This, they decided, was then impinging upon the already-herniated-but-almost-fixed disk. I had to release all the muscles in my back that were twisted and spasming (cue the acupuncture), and then slowly rebuild my strength when everything was aligned. This is what I am doing now.

The original herniation-- I don't know, honestly. I did not do one thing that resulted in a "oh crap" moment. It got worse over time. I had a limp, numbness, tingling, burning, and shooting pains. It was all debilitating, at worst. I have a pretty high tolerance for pain, and I'd say it was a 10 for about two months, of the last 9.

I am healing, and I am confident that I've learned enough to keep this from happening again, or at least, to manage the injury if it recurs.

[rob garrison]

Kate I am happy to report that I think I am on the mend. I have had a good 3 days. My limp is alnost gone. I don't have constant painm and I am able to do some extension w/o pain. I went to the chiro wed and thurs and I think that heped just by gettign some movement in there. I swam yesterday and today and was able to take a wald on the beach today. I feel like I have a new lease on life.

[UConnJulie]

[Willie]

Wonderful!!!!!!!!!!!

[TAZMANUK]

Originally Posted by UConnJulie

Somewhere on this forum, I have posted about the trick to finding the right exercise. And the trick with backs. There are many different structures which can be injured, and just because you have a MRI confirmed herniation, doesn't mean that you don't also have a facet joint strain or something else. Or just that your anatomy is atypical. So rather than dogmatically assigning exercises based upon the diagnosis, it is important to note what the exercise does to the pain.

Let's say that "Joe" has lower back pain radiating into his right buttock. He rates it at a level "4" on a 0-10 scale where 0=no pain and 10=shoot me and put me out of my misery. He does exercise A. During the exercise, his pain drops to a "0". After the exercise, his pain is now a "6" and radiating into the back of his right knee.
THAT IS A BAD EXERCISE FOR JOE!!!

Now his therapist, because she is smart, having gone to UConn ... ... gives him exercise B. During exercise B his pain is the same (level 6 and down to his knee) or maybe even a little worse (level 7 in his back). But when he is done, his baseline pain is now down to a 3 and reduced to his back only (centralized symptoms).
THAT IS A GREAT EXERCISE FOR JOE.

"Joe, your homework is exercise B. Avoid all positions that mimic exercise A."

Does that answer your question from my standpoint?

This sounds like my problems, bascially i have suffered with back pain for 12 years, i have a facet joint problem which happened whilst i was lifting at work and been bad ever since

I have to have steriod injections into l4 and l5 facet joint every 12 months and visit the pain clinic every 3 months to injection into the s1 joint.

I have also found out that i have a extra vertabrate in my spine so i have the unluckly 13 so to speak which where all the problems are happening, also a mri scan showned a slight bulging disc but i cant remember what year they picked that up on.

Anyway i did a search reading as i have bought every gadget, been to PT which made my facet joint worse as he just pressed on it and he said it would release tenstion and get more momevment, it didnt.

They started me on mckenzie exercises however this in fact locks the facet joint together which can aggrivate them which i didnt know back then as i was given the exercises from PT.

Anyway i have new symptoms and now depressed over it all, when i sit i get burning down my right left i did used to get tingling for about 2 years but that has gone but still get the burning which is sadly to say ruining my life, i have also now started with cold sensation in my left thigh that comes and goes.

I just want to be better for myself and my kids as i am now getting more depressed and crumpy, i am not longer a happy person than i used to be

I just want to be given correct exercises that wont flare up my facet joint and try and get this bulging disc back or improve matters as i know i cant survive on these injections tat i have been having for 4 years

The procedure on facet joint injections are painful, plus your awake when having them - no pleasant to have, i just want to be able to improve this burning in my right leg, please help anyone!

[chek practitioner matt]

hello everyone i am a custom built pt in florida. i am also a chek practitioner who specializes in rehabilitation. i did not read the whole forum but i read the first few. The mackenzie stretch puts pressure on the disc and therfore may aggrivate the back. the best excersizes to do for a herniated disc is the horstance excersizes. horsestance excersizes are ideal for back patients. Also if you have symptoms of back pain the main muscles to focus on is the internal oblique, the transverse abdominis and the latisumus dorsi as these all stabilizes the spine. you must trigger the erector spinea musculature and to do that perfome back extensions. and instead of the mackenzie press up perform a prophylactic back extension either standing or laying prone. prone extensions are easier on the back than standing extensions for those with prior history of back injury. well i hope this has helped out a bit. my names matthew clockel matthewclockel@yahoo.com