Disc Problems

[bkred]

There's a couple of topics that people have started regarding back problems. I've discussed my back problems a bit in the past and want to add some advice based on my experience for the folks that are having difficulty. One caveat before I begin. Everyone is different and my experience may not be the same as others. Also I appoligize for my spelling in advance.

Ten years ago I ruptured the disc in my back between the L4 and L5 vertabra. I woke up one morning with pain shooting down my left leg. I thought at first I had pulled a muscle but by Noon I know something was bad wrong. My doctor took Xrays and said I had "degerative disc disease". That scared the crap out of me. I had visions of a wheel chair in my future. I went to a Neurosurgeon who told me our discs begin degenerating in our 20's and not to be concerned about degenerative disc disease. He also told me discs don't show up on xrays and sent me for an MRI.

Turned out the disc was ruptured and a piece was floating around and had gotten against my sciatic nerve. Thus the bolts of pain down my leg. Forget about working out, I couldn't walk. I had surgery soon afterwards and started rehab. At first rehab consisted only of walking. Later I was sent to a physical therapist who gave me some exercises to do. Mainly hamstring stretches, "birddogs" etc. Gradually I got back to jogging, lifting some weights, scuba diving, etc. While I can do most everything I could before rupturing the disc, I learned pretty quickly that certain things are going to ding my back. I have to be careful about anything that leaves me unbalanced. A weight in one hand with nothing in the other for example. It doesn't take much weight. Even a grocery sack will get me. Also anything I do that involves holding my arms above my head for a period of time is iffy. Painting for example.

As for exercise, since my surgery I've jogged off and on. I hope to get back into it this year, but jogging is something folks with back problems have to be real careful with. Jogging puts give the low back a big jolt. Also jogging can give you real strong hamstrings. The physical therapist told me a lot of back problems are caused by tight hamstrings so if you jog, stretch the hammies and strengthen the quads.

Weight lifting. I'm currently working out with one of JP's trainers and have not had a lot of trouble with my back. Everything else hurts but not my back. We've learned to stay away from quick jerking motions. For example, the lying leg curl seems to hit my low back, the sitting leg curl machine doesn't seem to bother me as much. I also have to be careful with leg extensions, and squats. Ab exercises are good so long as my legs are supported and raised. We've also been careful with rowing type motions.

Other exercises. I was using the eliptical pretty hard about a year ago. I started having some difficulty with my back/hip. I think there is a kind of twisting motion with the hips when using the eliptical machine that gets me. Surprising I don't seen to have the same issue with the stairmaster, maybe because it wears me out quicker than the eliptical. I generally do okay with cycling both with my outside bike, and the stationaries, both upright and recumbent. I try not to stay bent over for long periods of time while cycling.

In short, when exercising, I suggest you find out what you can do without too much pain and stretch. I saw a massage therapist for about 8 months who did something called active isometric stretching with me which seemed to help. The main thing is to keep active. If I'm not careful, I'll sit all day at my job, and my back will act up.

Drugs. I've taken Vioxx, Celebrex and Naprelan, all of which have been in the news lately. I'm as confused as everyone else on this topic. I see a Rheumatologist every 6 months. My next appointment in February and I think I'm going to try going cold turkey on the drugs until I see the doctor then. I may be a ball of pain by next week and change my mind on that. I've mainly taken the Naprelan, two 500 mg time-release pills whenever I have a back flareup. I don't usually need the pills everyday, but I have gone for a month taking them everyday. I've also gone a month or so without taking anything. Naprelan is a stronger version of the stuff in Alleve.

That's all I can think of to say. If anyone has any questions I'll try to answer them. If anyone has any experiences to share or suggestions for addressing back pain, I'd like to hear them. For those of you who are experiencing back pain, I feel for you. It is a miserable experience that I would not wish on anyone.

[Bill Hartman]

Your explanation indicates that you still have a couple stand-out issues. Your hip flexors sound overactive (prone leg curls strongly activate the hip flexors...thus the pain) and your trunk strength and strength endurance is inadequate.

To be fully rehabbed (you may not be even if it was 10 years ago) you should be able to hold a prone plank with a neutral spine for 2 minutes, a side plank for 65% of the time of your best static back extension which would ideally be at least 2 mintues. Rarely do folks develop that kind of trunk strength-endurance (they give up) but if you do you'll be surprised as to how many problems improve or even resolve. Strength-endurance is more important than absolute strength.

Have your trainer check your hip flexors and IT band for excessive tightness (use a Thomas Test and Ober test). Tight hip flexors and weak abs will also promote an anterior tilt of the pelvis. This makes the hamstrings seem tight and shuts down you glute max which you need for hip extension. It sounds like you're substituting a lot of back extension for hip extension which will only aggrevate your back pain. Stretching the hammies just makes it all worse. The hamstrings are frequently stretched too much. These two problems are most likely why you can't move quickly or tolerate prolonged walking or jogging (I'm surprised you didn't indicate that you've strained your hamstrings while trying to jog)

Find someone that does aggressive soft-tissue work and have them work on your psoas and spinal erectors ASAP.

Exercises to make friends with:
Side bridge
Planks (start by leaning on the wall if you can't do one prone)
Supine bridging
Swiss ball hip extension with feet on ball
Split squat (start with ISOs and eventually Bulgarian split squat)
Reverse Hypers (start with one legged swiss ball variation first and progress to both legs and then bench and then loaded)
Push-ups (great for trunk stabilization)
Standing cable lat exercises
Standing cable push exercises
Cable chop/lift without trunk rotation

Exercises for your temporary shit list:
any form of trunk flexion abs
The eliptical trainer
exercise bike (it's comfortable because the hip flexors are functioning in a shortened range...nice for comfort but it promotes shortening of the muscle)

If you work at balancing things out, I think you'll be a much happier camper.

I know you were posting to help others, but I hope you'll take this into consideration for yourself. [img]smile.gif[/img]

Bill

[poopy pants]

my wife has DDD and is contemplating artificial dsik replacement

it's a tough road

[Matt Toupalik]

bkred-Thanks for starting this thread.Your post was very insightful and gave me a few things to contemplate.We have a lot of the same symptoms.

Bill-Great information in your post.When you refer to the static back extension, are you referring to holding the finish position of the movement, so the trunk is parallel to the ground, for 2 minutes?

Also, how does the static back extension compare to the bird dog exercise?Would you say that one is more productive or intense than the other?

Lastly, you stated that people rarely build up to the necessary level of strength-endurance.How frequently should a fit individual train for core strength/endurance using the exercises you suggested?

[bkred]

Bill,
Thanks for the input. I don't recognize several of your references (Thomas Test, Ober Test, Planks, Psoas). Maybe we use different terminology. Hopefully my trainer will know what you're talking about and we can give them a try. That's the main thing I'd recommend to folks with back trouble. Try different things and see what works for you. I've got a lot of advice from folks regarding my back, some good, some pretty crazy. I've added my own of course.

When working with the massage therapist he indicated my IT band was tight. The stretching seemed to help.

Ice and snow here in Little Rock. Looks like a white Christmas is in the works. Everyone have a Merry Christmans.

[Bill Hartman]

Bill-Great information in your post.When you refer to the static back extension, are you referring to holding the finish position of the movement, so the trunk is parallel to the ground, for 2 minutes?

Yes.

Also, how does the static back extension compare to the bird dog exercise?Would you say that one is more productive or intense than the other?

One is not a substitute for the other. Because of the contralateral loading of the birddog there is a rotational loading applied. It also is a much lower load on the spine than the back extension ex.

Lastly, you stated that people rarely build up to the necessary level of strength-endurance.How frequently should a fit individual train for core strength/endurance using the exercises you suggested?

It all depends on your needs, tolerance to loading, recovery abilities, etc. If you're doing exercises like lunges, squats, deadlifts, overhead presses, rows, etc. The amount of direct core strengthening that may be needed is minimal. If you can't do such exercises, then a little more variation/creativity is required. What I would do is set up your program and regularly test yourself. If you make progress toward the standards, then you're okay. If not, restructure and retest.

Bill

[Matt Toupalik]

Thank you very much for the reply, Bill.Good information.I appreciate it.