Injuries and RehabTell us where it hurts! Do a quick search before asking about your shoulder injury to make sure your question hasn't already been answered (about 50 times), and read the sticky post first.
My advice for those with lower back injuries - specifically disc herniation
Hi, I thought I would share my experience to help others in a similar situation as I love going to the gym and exercise, but haev had a severe lower back injury for the last 5 years, and have tried numerous therapies.
..I'll tell you what happened first and then give my experience and advice below that:
firstly...what happened?:
1. When did the pain begin?
August 2003
2. What were you doing at the time? Or did the pain come on gradually over time?
Deadlifts with my own bodyweight, with awful form - bouncing the bar off the ground and my back was not flat. Felt a big kind of 'pop' and knew soemthign was wrong. Wasnt painful at first just felt 'wrong' and sore. pain rapidly increased until within an hour I could not walk. I got an ambulance to hospital, emergency physiotherapy and pain killers.
3. Where, anatomically, is the pain?
Lower back, right buttock hamstring and calf.
4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?
All of the above depending what Im doing! Constant dull pain 24/7. Sharp pain when I bend forward or backwards, pulling nerve sensation in legs and buttock, soemtimes very severe.
5. Is the pain constant, or intermittent, or only on certain motions?
Constant but worse originally with flexion (bending forward)...now also on leaning back as well.
6. What motions make your pain worse?
bending the trunk forwards or backwards, raising the right leg, flexign the right foot, sitting for long periods.
7. What, if anything, makes your pain better?
Lots of gentle movement like non impact cardio followed by a hot jacuzzi.
8. Does your pain radiate to any other part of your body?
right leg
9. What things could you do before, that you cannot do now because of your injury?
Initially i could not move at all. When it is bad I cannot put on shoes and socks, and in general i cannot really lift weights or run much anymore.
10. What is your main concern regarding the pain and its consequences?
OK, now for my advice
I am NOT a medical professional, only giving you my personal experience.
Diagnosis
Initially very vague as they were reluctant to do an MRi scan. It included ligamnet tearing, slipped disc and soft tissue inflammation.
Now that I have finally had my MRI scan the problem is clear:
treatment I received
Physio therapy - the emergency physio a few days after the accident increased my range of motion from nothing to eventually being able to hug my knees to my chest. later physio therapy (like a year later) involved the sphynx move and ice packs and had no effect
chiropractor - an initial manipulation seemed to release a nerve and within 24 hours my sciatica pain and range of motion were greatly improved. Subsequent sessions had little to no effect, apart from exercises I was given to strenghtne my core. i feel doing these everyday helped me.
Applied kinesiology - in retspect the benefit I felt was only psycosomatic
massage - definitely helps if you have a lot of muscle knots like I do, but wont help the underlying problem much.
MRI scan - this was the ultimate! It took 5 years for me to get one because they are expensive and the NHS doctors kept fobbing em off with pain killers etc. i highly recommend you to get an MRI if you have had a lower back injury
Cortizone epidural - I am having this in 2 days to reduce the disc herniation so I will update you with how it goes.
Advice After you get back pain
Rest, Ice, and anti-inflammatories (e.g. nurofen, ibuprofen, codeine, diclofenac). I didnt take any as i wanted to be 'drug free'. I wish I had - just take them and you'll be grateful later.
keep moving! Do not take bed rest! the first week after my injury I had to get up every hour in the night and walk around the room a bit - if you dont you will freeze up. Now (5 years on) I sit at my desk all day but still make sure i get up regularly and walk all my lunch break and before and after work.
If the problem persists and you think it could ber serious...pester your doctor for an MRI referral, or pay for one privately. Its the only definite way to get a clear diagnosis and prognosis and your health comes first.
What to avoid
Bed rest or complete inactivity
lifting weights
any impact such as running that will place a shock through your spine
sitting for long periods of time (lying or standing is better)
exercise
Go back to your normal routine when you feel ready, but please, if you feel discomfort, stop! i can't stress this enough and this is one of my biggest regrets.
On several occaisons i thought I felt something a bit wrong or a slight twinge in my back, but had the attitude of 'no pain no gain', or 'just a few more reps and im finsihed anyway'. Once I was doing calf raises with a smith machine and as soon as I laoded the weight my back felt funny. I knew I shoudlnt continue but I was embarrassed that all the other guys would notice I 'chickened out', so I did it anyway and ruined my back for several weeks of agony.
One week of preventative rest is better than 6 months of rehab if you push too far!
body-weight exercises that have worked well for me are:
-the plank - keep your bum down and build up to holding for at least one minute
-pressups - if you think about it these are just the plank in a dynamic motion. use variations like on your fingertips, knuckles, legs raised on a small block, wide hand placement etc.
-side plank - to strengthen your obliques - build up to at least 1 minute
-oblique exercise - lie on your back with knees bent and feet flat on the floor. Contract your abs to press your lower back flat down intot he floor and keep this held. breathe out and lower your right knee towards the floor, echale and bring it in control back to tough the left knee. Repeat 10 times on each leg, keeping the lower back flat on the floor.
-bird-dog - on all fours, extend the opposite arm and leg and hold 3 seconds. repeat 10 times twice a day.
-cat-dog - on all fours slowly arch and concave your back in a comfortable range using continuous movement. the more often the better e.g. 5 times a day
-sphinx - only if there is no discomfort when leaning backwards. Lie face down and prop yourself up on your elbows with your hips on the floor. Push your shoulders down to raise your upper body a few inches higher, stretching the traps. Hold for 3 seconds and repeat
-calf raises
when slightly more recovered these add more stress:
-handstand against a wall- aim to do handstand pressups - very challanging!
-pull ups
-1 legged squat (pistols)
AVOID
-running
-deadlift & good mornings (obviously!)
-ab roller - bad stress on lower back
-anything with a heavy weight - even picking up a dumbell could put you out
Any questions please ask as I wrote this ratehr hastily
I had my epidural 5 days ago. It is a bit unpleasant but not as bad as I thought - it just hurts for about 1 hour afterwards.
The next day I was disappointed as I half expected to be completely pain free and I wasn't. But over the last few days i have noticed easing of the symptoms like sitting for long periods is not as uncomfortable as it was, and my hamstring pain has gone when walking.
I still have discomfort and pain in my back when bending forwards, although my ROM has increased. I also get pain in my hamstring and back when I really arch my lower back.
It hasnt been the miracle cure I was hoping for but has definitely had some effect with minimal invasion so i would definitely recommend it if you have a slipped disc or nerve impingment.
My next referral is in 3 months time . It sucks that I might have to go this long when my back still isnt fixed to find out the next course of action.
In the meantime I have decided to really get strong, esp. my core. I have a dilema as to when/whether to return to weights and if I ever should do deadlifts again!
My advice? Don't deadlift ... don't work on "core" ... work on lower extremity flexibility, learn where pelvic neutral is (and start to learn to stay there throughout the day in various positions), learn about proper posture and safe body mechanics to avoid re-injury, and do the things that continue to reduce your symptoms.
If you return to aggressive exercise too soon, you will re-injure ... and it will affect you for the rest of your life.
__________________
Life's a Journey ... Enjoy the Ride!
I do feel very fragile and wouldnt go back to weights yet, but hope to within the next couple of months. Although I have already had this acute episode since October 18th which makes me wonder how much longer it will go on for.
The body weight core stuff I am doing feels good so I see no reason to stop it. I have also been advised by the back pain clinic to strengthen my core as those muscles will help to support my spine in a good position and prevent my weakened disc from slipping out again.
I am doing the plank and side plank every day and have increased from 30 seconds to 1min 10 seconds. I also do pushups, calf raises, pistols and pullups every other day, as well as 10mins of non imopact cardio and stretches.
I am seeing a physio therapist who has told me to keep doing what I am if it doesnt hurt, and to hug my knees to my chest, slide my hips to the left whilst standing straight, and do some traction with him. I'm slighlty disillusioned with this advice as I am already doing more intense things than that and I wanted a clear progression back to lifting weights. im not an oly or powerlifter, I just want to do some hypertrophy work.
At the moment I only have the sharp leg pain when I really arch my lower back. I get a bit of back pain/discomfort when sitting for long periods, and i feel a bit fragile in general and when picking up items. Other than that i feel ok and can go about my daily routines. Its just nagging that it has gone on for so long.
That's fine, but if you are doing "core" work and strengthening your spine to be in a non-neutral position, you will set yourself up for reinjury down the road ... so which is more important to you? Get it right ... learn to keep your spine healthy and put off "hypertrophy" for a little while ... or jump right into it because it "doesn't hurt" and possibly deal with back problems for a long time to come?
My opinion.
__________________
Life's a Journey ... Enjoy the Ride!
That's fine, but if you are doing "core" work and strengthening your spine to be in a non-neutral position, you will set yourself up for reinjury down the road ... so which is more important to you? Get it right ... learn to keep your spine healthy and put off "hypertrophy" for a little while ... or jump right into it because it "doesn't hurt" and possibly deal with back problems for a long time to come?
My opinion.
Agree.
I had a mild disc herniation back in August. No amount of weightlifting (pain free or not) will help a damaged nerve. Now, I suspect you can keep active / workout to help limit muscle loss, but I only did mine under PT supervision.
Nerves need time to heal.
__________________
Since most of your life is already complicated, why make your training the same way? Jim Wendler
I am going to hold off hypertrophy for a little while...I just dont know how long...maybe 2 months.
Could you explain this please:
Quote:
if you are doing "core" work and strengthening your spine to be in a non-neutral position,
I don't really understand. I just thought that by doing the plank and side plank it will help my core muscles to stabilize. Are you saying there are wrong and right core exercises to do...or that I shoudlnt do any core work?
To learn neutral position, you really need to do it in a non-loaded position ... people with disk herniation should not in my opinion get into posterior pelvic tilt positions until they have been PAINFREE for a while.
"Core training" is a crap term that the popular fitness culture has bastardized to mean any type of abdominal work. Really what it is, is a method of learning very specific motor control of the trunk ... learning proprioceptively where you are in space, and then teaching your muscles how to hold you there against external forces like gravity and your extremities moving and pulling on the spine.
Doing planks and side planks are more strengthening moves IMO ... they build muscular endurance ... but they don't teach you how to hold neutral while walking or while reaching overhead to get a box off the top shelf in your closet or while bending over to pick up the newspaper off the stoop. If you want your back to be healthy for life, then this is where you need to start IMO.
__________________
Life's a Journey ... Enjoy the Ride!
Alex, your situation is eerily similar to mine. I was diagnosed with two herniated discs in 2002, and have been dealing with them on and off ever since. While doing some training last Spring, I injured it pretty badly (I felt a "pop" also) and spent the remainder of 2008 in P.T.
About three weeks ago, I was cleared to start going to the gym, and I've been going approx 4 times per week. I've been continuing the movements from P.T., such as bird dogs, step ups, lunges (front and lateral), planks, and doing some free weights. As per my doctor's orders, all of my weightlifing has been standing-- no exercises while sitting on a bench. Also, I'm keeping the weights light.
That said, two days ago, I did some goblet squats, with a 30 lb dumbbell, and my back is a bit sore today. So I'm obviously not ready for squats or deadlifts.
My understanding is that unilateral leg work is the best option for me right now-- split squats, etc. Am I correct? Or should I completely avoid any leg work? Are there other exercises that I should do or avoid?
To learn neutral position, you really need to do it in a non-loaded position ... people with disk herniation should not in my opinion get into posterior pelvic tilt positions until they have been PAINFREE for a while.
I have no pain at all when doing posterior tilt...only at the extreme of flexion (touching toes). But i do have pain with extension - arching my lower back.
Quote:
"Core training" is a crap term that the popular fitness culture has bastardized to mean any type of abdominal work.
I agree.
Quote:
Doing planks and side planks are more strengthening moves IMO ... they build muscular endurance ... but they don't teach you how to hold neutral while walking or while reaching overhead to get a box off the top shelf in your closet or while bending over to pick up the newspaper off the stoop. If you want your back to be healthy for life, then this is where you need to start IMO.
do you have any specific exercise suggestions?
after reading a lot more around the subject i think I am going to incorporate some new things:
-foam rolling
-glute activation (lunges)
-hip flexor stretching (they are tight, and my right one always 'feels' like it really needs stretching and feels good when i stretch it...i find it quite hard to stretch it to the degree i want though)
-Dr McGill's abdominal curl
I totally respect your advice but the plank feels good to me, which is why I dont want to stop doing it. however, I am willing to try adding things to help with the proprioception you mentioned.
Alex, your situation is eerily similar to mine. I was diagnosed with two herniated discs in 2002, and have been dealing with them on and off ever since. While doing some training last Spring, I injured it pretty badly (I felt a "pop" also) and spent the remainder of 2008 in P.T.
About three weeks ago, I was cleared to start going to the gym, and I've been going approx 4 times per week. I've been continuing the movements from P.T., such as bird dogs, step ups, lunges (front and lateral), planks, and doing some free weights. As per my doctor's orders, all of my weightlifing has been standing-- no exercises while sitting on a bench. Also, I'm keeping the weights light.
That said, two days ago, I did some goblet squats, with a 30 lb dumbbell, and my back is a bit sore today. So I'm obviously not ready for squats or deadlifts.
My understanding is that unilateral leg work is the best option for me right now-- split squats, etc. Am I correct? Or should I completely avoid any leg work? Are there other exercises that I should do or avoid?
its a nightmare isnt it?! Sometimes I panic when i look at the MRI scan...especially as I read if the nerve is pressed so much that you lose your reflexes it is considered a medical emergency. I have lost my right achilles reflex. physio and others have identidfied that but not really taken it seriously :s
Its hard to hold back from weights as I love doing them, but i havent picked up a weight in about 4 months now. In the past my back has felt 'funny' or 'sore' after doing weights and I now I can associate it with the MRI and realsie that my disc is actually herniating out at these times - thats a good motivator to stoop doing it!
For leg work...i am doing pistols (1 legged squats). They are very challenging but dont involve adding any weight - bodyweight only. Check out proper form (go all the way down until calf touches hamstring, always keep your heel on the ground).
Dont do these if you can't hug your knees to your chest as you need that much lumbar flexibility, or of course, if it hurts.
I've tried the pistol squats, but can't do a full one. Instead, I do an excercise that I did in P.T.-- I stand on a box, with one leg hanging, and lower myself with the one leg until the other is able to touch the floor. After working on this I can lower myself about 1 foot.
Does anyone know of a premade, whole body routine that would work well for someone returning from a herniated disc injury?
I had the same thing a few years ago. Felt a pop, that was it. I went home, felt sore the next day. 4 days later I went to the airport and at my 2nd connection I could barely walk. I'd hobble 50' and would squat down, which took the pain away. I did that 1/2 way across ATL. Spent my entire trip (visiting inlaws) sitting on a chair outside loaded up on drugs.
Returned, had the MRI...wow.
I still have some pain. Was pain free for a few months then was playing the other night with the SO and reinjured it.
I'm in the gym still but need to not do any sitting exercises, those are sure fire triggers.
I've tried the pistol squats, but can't do a full one. Instead, I do an excercise that I did in P.T.-- I stand on a box, with one leg hanging, and lower myself with the one leg until the other is able to touch the floor. After working on this I can lower myself about 1 foot.
Does anyone know of a premade, whole body routine that would work well for someone returning from a herniated disc injury?
for pistols try this: Hold a small dumbell in front of you with arms stretched out - this will make it easier by helping to counterbalance you. Then slowly lower yourself under control as far as you can, then bring yourself back to the top with both legs (and hand if necessary).
I mentioned my full body routine above but here it is for clarity:
on days (mon, wed, fri):
-5 mins elliptical machine
-joint rotations and dynamic stretches
-pullups - 3 sets to failure
-plank 1 minute
-side plank 1minute
-pistols - 1 set to failure
-handstand - 3 sets of attempted pushups
-press up variations - 3 sets of 12 (feet on bench, hands on bench, 1 hand on medicine ball etc)
-1 leg calf raises on step - 3 sets of 12
-Dr McGill's abdominal curl
Finish with stretches.
off days (tues,thurs):
-10-20 minutes elliptical machine
-plank
-sauna
obviously, work to your limits and check with a professional first. Some days the handstand seems to aggrevate me so I drop that - none of this should hurt.
To learn neutral position, you really need to do it in a non-loaded position ... people with disk herniation should not in my opinion get into posterior pelvic tilt positions until they have been PAINFREE for a while.
"Core training" is a crap term that the popular fitness culture has bastardized to mean any type of abdominal work. Really what it is, is a method of learning very specific motor control of the trunk ... learning proprioceptively where you are in space, and then teaching your muscles how to hold you there against external forces like gravity and your extremities moving and pulling on the spine.
Doing planks and side planks are more strengthening moves IMO ... they build muscular endurance ... but they don't teach you how to hold neutral while walking or while reaching overhead to get a box off the top shelf in your closet or while bending over to pick up the newspaper off the stoop. If you want your back to be healthy for life, then this is where you need to start IMO.
I've had the exact same problem. I herniated both L4-L5 and L5-S1. I had my first epidural a year ago, this week. In a year's time, I have been cleared to go back to rowing (with no limitations!) and I lift "heavy". The only thing I don't do is squat or deadlift; in fact, now I'm doing overhead squats so as to not load my spine.
I quoted this post from Julie because I wanted to "ditto" it. Thankfully, I had a PT, chiro, and acupuncturist who were all willing to speak to each other (this, I gather, is rare). One of the things that they all felt very strongly about was that I should not be "working my core" until the muscles in my back were released so that they could stop guarding. Basically, I had been so jacked up for so long, that none of the muscles or joints in my back were working properly. In fact, when the chiro laid my down on my belly, my right butt cheek was three inches further up my back than my left, and another two inches higher (hope that makes sense). I didn't truly start feeling better until the acupuncturist and chiro had worked together to get all my muscles firing properly. And, ultimately, I had three epidural injections.
So, keep your chin up. It took all of those things to happen before I started feeling better. I still have some (very vague) residual pain, likely due to the scar tissue (right, Julie?). But, I am back in action and honestly, haven't felt this good in a really, really long time.
My whole journey is documented in my log. I don't actually know how to link my log, but you can search for it using my username, Willie.
I'm walking 60 miles for a breast cancer cure, September 11-13, 2009! Please support my walk and help me raise funds for cancer research by donating to the Susan G. Komen Breast Cancer 3-Day: http://www.the3day.org/site/TR/Walk/...nal&fr_id=1300
I've had the exact same problem. I herniated both L4-L5 and L5-S1. I had my first epidural a year ago, this week. In a year's time, I have been cleared to go back to rowing (with no limitations!) and I lift "heavy". The only thing I don't do is squat or deadlift; in fact, now I'm doing overhead squats so as to not load my spine.
I quoted this post from Julie because I wanted to "ditto" it. Thankfully, I had a PT, chiro, and acupuncturist who were all willing to speak to each other (this, I gather, is rare). One of the things that they all felt very strongly about was that I should not be "working my core" until the muscles in my back were released so that they could stop guarding. Basically, I had been so jacked up for so long, that none of the muscles or joints in my back were working properly. In fact, when the chiro laid my down on my belly, my right butt cheek was three inches further up my back than my left, and another two inches higher (hope that makes sense). I didn't truly start feeling better until the acupuncturist and chiro had worked together to get all my muscles firing properly. And, ultimately, I had three epidural injections.
So, keep your chin up. It took all of those things to happen before I started feeling better. I still have some (very vague) residual pain, likely due to the scar tissue (right, Julie?). But, I am back in action and honestly, haven't felt this good in a really, really long time.
My whole journey is documented in my log. I don't actually know how to link my log, but you can search for it using my username, Willie.
Good luck!
Hi kate,
glad to hear you're feeling better.
My jnext consultant appointment is still 3 months away so I have no idea of my prognosis or course of action.
in the meantime, I really want to keep exercising, and the exercises I ahve outlined above feel 'safe' to me whilst helping me progress towards a goal.
If you know specific techniques that you would recommend instead please list them. Or, if you recommend I see a professional what qualifications/background should they have? Some of the PTs I see at my gym dont inspire confidence as they spew pseudo science. One of them even claimed to be able to 'fix' another guy with a back problem and was puching him into positions that made the injured guy wince with pain.
Geoffrey Maitland was an Austrailian physio who pioneered a specific evaluation and treatment system in which I am trained and of which I think very highly.
__________________
Life's a Journey ... Enjoy the Ride!
Im still in pain, especially in my leg when i first wake up in the mornings. This is the 14th week of this acute episode.
My consultant now wants to refer me for surgery. The surgeon may want to try a 2nd epidural, or go straight for the surgery, but I'll find out on 24th Feb.
Hi,
Just looking around and I found this post
I had a herniated disc in my lower back ,L5, about 4 years ago and I ended up having surgery. It was pretty bad--the pain and loss of muscle (use) in my calf. I couldn't stand on tiptoe and walked with a limp a lot of the time.
The injury started slow and then one day when I was feeling fine, just walking down the street, the sciatic started up agian and it just got worse and worse.
Part of the disc was literally hanging off my vertebra in the MRI, like a pancake flopped over a plate!
To make a long story short I had the surgery and it went fine. I was walking around with in a few hrs after waking and went home the next morning.
Note that I did the same thing to my neck a few years prior and had surgery then as well so I wasn't as nervous the second time around. I have since leraned to take it easy even when I don't feel tired or worn out!
Be careful with exercising. I was not and, even though you may feel great one day, the disc could still be "compromised", but just not touching the nerve so you may not feel so bad. It doesn't take much to make a wrong move so go slow.
And yes, ice was my best friend, that and painkillers.
Best of luck, I'm sorry this may seem so rambling, I'm rushing out the door. Any questions, just ask! I'm not a health care pro though, so I can only speak from my experience....
ZZ
Im still in pain, especially in my leg when i first wake up in the mornings. This is the 14th week of this acute episode.
My consultant now wants to refer me for surgery. The surgeon may want to try a 2nd epidural, or go straight for the surgery, but I'll find out on 24th Feb.
It took me THREE epidurals over the course of 6 months to finally feel good. I would think they'd want you to have as many as you can get before they refer you to surgery.
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sounds sensible. My only fear is that even if the epidural makes the disc shrink back inside it will pop out again in the future, whereas surgery seems to be more of a permanent solution.
I have read mixed 'reviews' of the discectomy, from it being a great decision to it causing overnight paralysis, so its nerve wracking to say the least.
Just wanted to say that I have had a discectomy and it was a very positive experience.
I also have had a fusion (upper back/neck) and that also was a positive experience.
I am by no means a medical expert or even close...but before both procedures I did like most people and 'read up' as much as I could and also felt the nerve wracking feeling..heard many MANY more people advise against it (surgery) and just wanted to say that sometimes (not all) it is the right decision and not a 'last resort. Just my two cents based on my personal history. (my second surgery - the fusion - I tried some PT first as I felt the 'pressure' not to get surgery and that just delayed it and put me thru pain for longer that I needed to be)
I just wanted to say I could not be happier with the outcome and I continue to workout and enjoy life without the pain I had before both...
just saw this and realized my photo was from right after my fusion...needless to say the neckbrace has long since been 'retired' (and by retired I mean smashed and burned)...
sounds sensible. My only fear is that even if the epidural makes the disc shrink back inside it will pop out again in the future, whereas surgery seems to be more of a permanent solution.
I have read mixed 'reviews' of the discectomy, from it being a great decision to it causing overnight paralysis, so its nerve wracking to say the least.
Of course. BUT. I just went for a "check up" with my PT, almost exactly a year after my first epidural (back story: I heard a horrible noise come from my back and it freaked me out). She was AMAZED at how much stronger my back is now. Of course, there's always a threat of it popping again, but the PT said that with all of the scar tissue and the back strengthening work I've done, there's no greater risk than there ever was. Meaning, it could easily pop again if I'd gotten the discectomy.
(Turns out, the noise I heard was probably either scar tissue breaking up, or some sort of joint manipulation)
I'm walking 60 miles for a breast cancer cure, September 11-13, 2009! Please support my walk and help me raise funds for cancer research by donating to the Susan G. Komen Breast Cancer 3-Day: http://www.the3day.org/site/TR/Walk/...nal&fr_id=1300
My advice for those with lower back injuries - specifically disc herniation
. It sucks that I might have to go this long when my back still isnt fixed to find out the next course of action.
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