T Nation

Disc Herniation/Sciatica

OK, I had no clue which discussion to put this on but oh well.

I’m 17 years old, Football Player(RB/DB), Sprinter(100m) but I haven’t done jack since my serious disc herniation. I’ve had this injury for several months. I hurt it when I was squatting one day, out of nowhere I felt it hurt.

My MRI report says that I did some pretty bad damage to myself. My L3-L4, L4-L5, and L5-S1 are all in bad shape. I have Degenerative Disk Disease in those.

So far I’ve been going to Physical Therapy for about 8 weeks. I get Spinal Decompression therapy over there. I’ve had two Epidural Steroid Injections that have helped some. I’ve also tried acupuncture and didn’t notice anything. This is about all that I’ve done, and I do plan on getting a third ESI.

With all of this treatment, I still have sciatica down my left leg when I do my straight leg raise. At my age, every doctor expected me to be healed by now. Right now I’m missing out on my SR football season that I worked my ass off for since I was 12.

Can any of yall think of anything else I could try to help this problem? Will I ever be able to squat heavy or sprint again? Is there a chance that this injury can heal after my third ESI?

[quote]ku2u wrote:
OK, I had no clue which discussion to put this on but oh well.

I’m 17 years old, Football Player(RB/DB), Sprinter(100m) but I haven’t done jack since my serious disc herniation. I’ve had this injury for several months. I hurt it when I was squatting one day, out of nowhere I felt it hurt.

My MRI report says that I did some pretty bad damage to myself. My L3-L4, L4-L5, and L5-S1 are all in bad shape. I have Degenerative Disk Disease in those.

So far I’ve been going to Physical Therapy for about 8 weeks. I get Spinal Decompression therapy over there. I’ve had two Epidural Steroid Injections that have helped some. I’ve also tried acupuncture and didn’t notice anything. This is about all that I’ve done, and I do plan on getting a third ESI.

With all of this treatment, I still have sciatica down my left leg when I do my straight leg raise. At my age, every doctor expected me to be healed by now. Right now I’m missing out on my SR football season that I worked my ass off for since I was 12.

Can any of yall think of anything else I could try to help this problem? Will I ever be able to squat heavy or sprint again? Is there a chance that this injury can heal after my third ESI?[/quote]

ESIs are supposed to reduce pain. I wouldn’t get a third b/c they can damage ligaments.

Lots of people have degenerating discs and no pain or problems. I think Dr. Sarno is worth a read for you.

Sciatica can also be caused by the piriformis and gluteus medius and minimus.

My PT and Neuro doctor still think that my sciatica is caused by the discs. But with 8 weeks of Spinal Decompression Therapy, you would expect the sciatica to go away.

Try a few sessions with a good chiro if you’r not already getting adjustments in your PT. Preferably one also trained in ART and see how much it helps you, at worst it should provide mild relief, and often can make a huge difference.

Some people report yoga doing wonders for this especially bikram yoga, cautiously give that a try when you’re better.

Also ask Eric Cressey some questions or repost this in his new locker room, he’s a real expert on this sort of thing

I’m really sorry to hear about your injury and it causing you to miss your football season.

With a disc injury, you need to work on lumbar stability ASAP. You want to get started on bird dog variations and plank variations.

Some helpful articles are listed in the lumbar stability thread:

Another recent article with some good stuff is “Making Gains with Pain”:

Especially the One Inch Bird Dog - start there, and do it MULTIPLE times per day.

Also, walk as much as you can. I alternated between walking and laying on the floor on top of an ice pack with my legs up on the bed.

Make sure you DO NOT bend or flex or compress the spine. Give it a chance to heal. Use the golfer’s lift when you have to pick stuff up off the floor. I would not recommend yoga because there are too many postures with spinal flexion.

I personally had no success with chiropractic or ART for my disc injury. I do believe in taking all the pain meds a doctor is willing to give, in order to reduce muscle spasm and avoid ongoing central sensitization to pain.

These discs take quite a while to heal. I had severe pain and disability for 3 months, and chronic pain for several years, but my rehab was interrupted by a chronic illness. The average healing time is 6 months, I believe.

With proper rehab, you should be able to do everything you want to do once again, though you might have to modify your training and activities somewhat. For example, perfect form is no longer just a good idea, it’s an absolute necessity.

[quote]andersons wrote:
I’m really sorry to hear about your injury and it causing you to miss your football season.

With a disc injury, you need to work on lumbar stability ASAP. You want to get started on bird dog variations and plank variations.

Some helpful articles are listed in the lumbar stability thread:

Another recent article with some good stuff is “Making Gains with Pain”:

Especially the One Inch Bird Dog - start there, and do it MULTIPLE times per day.

Also, walk as much as you can. I alternated between walking and laying on the floor on top of an ice pack with my legs up on the bed.

Make sure you DO NOT bend or flex or compress the spine. Give it a chance to heal. Use the golfer’s lift when you have to pick stuff up off the floor. I would not recommend yoga because there are too many postures with spinal flexion.

I personally had no success with chiropractic or ART for my disc injury. I do believe in taking all the pain meds a doctor is willing to give, in order to reduce muscle spasm and avoid ongoing central sensitization to pain.

These discs take quite a while to heal. I had severe pain and disability for 3 months, and chronic pain for several years, but my rehab was interrupted by a chronic illness. The average healing time is 6 months, I believe.

With proper rehab, you should be able to do everything you want to do once again, though you might have to modify your training and activities somewhat. For example, perfect form is no longer just a good idea, it’s an absolute necessity.[/quote]

Are you able to squat now? I’m hoping my chiro can fix this problem. He says he can, but I have doubts.

Pick up Stuart McGill’s books

Also, I’m not 100% sure of this or not. But I’m thinking that there could be a chance that my discs are fine from all of the spinal decompression therapy, but the nerve irritation down the leg is still not normal.

My Neurologist has me do these nerve tests with ankle flexion to see if the nerves are firing 100%. I think the ESI’s have done the most help for this injury so far.

Hey Ku2u,

Andersons is right about giving yourself a chance to heal. Years ago, I ruptured my 3/4 and 4/5 discs, and cracked my L5 (all in the lumbar). Reinjury was a common thing until I went through a physical therapy program called MedRX, and it is nothing shy of a full-blow, body-building program.

I went from sitting in a chair crying (literally), to maxing out half of their machines. When I sit around for a season, my back has trouble…when I’m active, I feel great, and thats exactly what the docs and therapists said happens.

My point is, give yourself time to heal, and you’ll hit it hard when the time is right and you’re body will compensate. From then on, as long as you take care of your body as we all should, your injury will no longer be an obstacle.

Oh, and as far as Degenerative Disk Disease, check out some medical studies on disk response to hydration/dehydration. Most americans would find their MRIs showing dark disks, which would be diagnosed as Degenerative Disk Disease.

The darkness is the sign of a dehydrated disc. Ideally, our disks are to show as bright white on an MRI, which indicated fully hydrated, healthy discs.

In Columbia, MO, I learned about a 72 year old man that had Degenerative Disk Disease from head to tail, and 6 months of exercise and increased water intake changed his MRI to solid white discs and no longer had the diagnosis of Degenerative Disk Disease.

For me, spinal decompression, traction, chiro work, acupressure, acupuncture, massage, and injections only relieved temporary pain…it was eating right, exercising, and staying hydrated that really helped me,

Oh, and choosing to STOP POPPING MY OWN BACK AND NECK, which is an endless cycle until you break it (use ibuprofin to break the cycle, then you’re body will hopefully not keep trying to overcorrect).

Anyway, have faith man, heal up, stay hydrated, keep exercise a progressive goal, and all this will become history. Good luck, I feel for ya - this is the rough part.

[quote]hyperphoton wrote:
Hey Ku2u,

Andersons is right about giving yourself a chance to heal. Years ago, I ruptured my 3/4 and 4/5 discs, and cracked my L5 (all in the lumbar). Reinjury was a common thing until I went through a physical therapy program called MedRX, and it is nothing shy of a full-blow, body-building program.

I went from sitting in a chair crying (literally), to maxing out half of their machines. When I sit around for a season, my back has trouble…when I’m active, I feel great, and thats exactly what the docs and therapists said happens.

My point is, give yourself time to heal, and you’ll hit it hard when the time is right and you’re body will compensate. From then on, as long as you take care of your body as we all should, your injury will no longer be an obstacle.

Oh, and as far as Degenerative Disk Disease, check out some medical studies on disk response to hydration/dehydration. Most americans would find their MRIs showing dark disks, which would be diagnosed as Degenerative Disk Disease.

The darkness is the sign of a dehydrated disc. Ideally, our disks are to show as bright white on an MRI, which indicated fully hydrated, healthy discs.

In Columbia, MO, I learned about a 72 year old man that had Degenerative Disk Disease from head to tail, and 6 months of exercise and increased water intake changed his MRI to solid white discs and no longer had the diagnosis of Degenerative Disk Disease.

For me, spinal decompression, traction, chiro work, acupressure, acupuncture, massage, and injections only relieved temporary pain…it was eating right, exercising, and staying hydrated that really helped me,

Oh, and choosing to STOP POPPING MY OWN BACK AND NECK, which is an endless cycle until you break it (use ibuprofin to break the cycle, then you’re body will hopefully not keep trying to overcorrect).

Anyway, have faith man, heal up, stay hydrated, keep exercise a progressive goal, and all this will become history. Good luck, I feel for ya - this is the rough part.[/quote]

Thanks,

But did you ever have the pain that went down the leg when you do a straight leg raise? That’s the only thing that is bothering me right now it seems like. My back doesn’t hurt at all, its just the nerve irritation that’s stopping me from getting back to normal.

Oh hell yeah. Thats common. Basically, your lumbar is staying contracted or tense (“protective contraction”) as a defense against additional injury. Its a physical or biological function related to survival and not optimal living, if you know what I mean.

Also, when a disc is herniated or ruptured (especially), it puts pressure on the nerves that channel out from the spine (in your case the sciatic, which is why you’re feeling pain in your legs).

If you combine the pressure from the buldging disc with the pressure from protective contraction, and then stretch the entire area by bending over or doing a straight leg raise (in your case), sciatic pain is expected.

In the long run, the idea is for the discs to cause less pressure, and for the area around them to calm down and stop contracting (and even swelling).

The therapist may have talked to you about using heat/ice and ibuprofin while at home to reduce inflamation and tension. Right now, your back is afraid to stretch, so it needs to be taught that you can stretch without injury, and it WILL learn from that.

To ease your mind, I have met a load of people with injuries like ours, and absolutely everyone I know went through a season of sciatic pain, but if you work to increase strength w/ flexibility, the pain should go away (unless you had a ruptured disc that left a deposit in the body which will take a bit longer).

I don’t know if you’re a smoker or not, but bare in mind that if you are, you will not heal…I know that sounds extreme and black/white, but I believe its true. Your injure needs as much oxygen and water as it can get right now.

Oh, one more thing, study up on how to become limber…with a lumber injury, its not just about stretching! Its about using and building those hams, gluts, abs, and lower back muscle groups (look up isometric stretching). First hand, this is what helps me the most.

I hope all this made sense. I will keep checking this post, and I’ll be happy to answer any questions I can.

[quote]ku2u wrote:

Are you able to squat now? I’m hoping my chiro can fix this problem. He says he can, but I have doubts.[/quote]

Chiros cannot fix discs. The disc has to heal. All you can do is take pressure off the disc (walking, spinal stability moves, muscle relaxants or soft tissue work to relieve muscle spasms which compress the disc) and promote the healing process (walking which improves blood flow and lowers pain through neurotransmitter release, icing and IB which reduce inflammation).

Chiro treatments did not provide any pain relief for my disc injury.

I am not doing regular back squats now, but I have had several years of a chronic illness and am just getting back into lifting, AND I’m WAY older than you. So I have different priorities, but don’t let that discourage you.

You can certainly squat again if you are patient and rehab properly. More importantly, even if you end up minimizing back squatting (say, if your body mechanics aren’t suited for it), you’ll be able to accomplish the same goals through other exercises.

Instead of spending your money on chiro treatments, you should absolutely consult with a knowledgeable coach for rehab and programming. The coach needs to be knowledgeable about body structure, mechanics, and effective therapy as well as strength programming. He should be familiar with McGill, Sahrmann, and Gray Cook.

I know these disc injuries can be so painful and disabling and long-lasting that it seems like you’ll never get better, but you will.

[quote]ku2u wrote:

But did you ever have the pain that went down the leg when you do a straight leg raise? That’s the only thing that is bothering me right now it seems like. My back doesn’t hurt at all, its just the nerve irritation that’s stopping me from getting back to normal.[/quote]

Do not do straight leg raises at this time. They put high compressive loads on the lumbar spine.

Remember that when it comes to the spine and nerve pain, where you feel the pain is not always the source.

My PT has me do the straight leg raise as a test to see if any of the nerve irritation has gone away or improved. Also, the straight leg test is the only time I feel nerve irritation. This also causes extreme muscle tightness in my glutes/hamstrings.

And we’ve done stretching at PT, and the tightness does not improve no matter how often I stretch(we have also moved away from that).

The only type of training I’m doing now is upperbody stuff on the machines and some very light lowerbody stuff on a total gym.

Do yall think it would hurt me if I do a crap load of bodyweight squats and lunges as long as it doesn’t irritate the nerves?

I also understand not to use too much abdominal/thoracic pressure that would compress the discs and irriate the nerves.

I think bodyweight squats and lunges are a great idea, because that would be isometric for you. The philosophy is that the your lower torso muscles need to develop as a protective cage for the injury…thats what the compensation is (it sounds bad, but after you heal, the body only needs mild compensation, so no worries).

The main thing I’ve been told by providers is to be careful top-loading with a disc injury, especially free standing squats…a couple hundred pounds across the shoulders causes a lot of spinal compression. Both chiros I saw years ago told me that most of the disc compression injuries they see are from athletes top-loading, mainly with squats…I was warned to stay away from them, and I pretty well do. Fortunately, there are good sleds at the gym, so we can still develop our legs as long as we are flexable enough, and with isometrics, you can be. My sled squats reached about 700lbs before I began to feel minor, temporary irritation. In another post, we’ve been talking about Tony Horton’s P90X system…you might check that out…amazing athletes, and they use very little weights. Oh, Yoga has helped a lot in the past too…I think because its is slightly isometric. It takes about a week or two before it feels natural, but its very, very effective (check out Rodney Yee’s Strength and Flexability DVD).

[quote]ku2u wrote:
My PT has me do the straight leg raise as a test to see if any of the nerve irritation has gone away or improved. Also, the straight leg test is the only time I feel nerve irritation. This also causes extreme muscle tightness in my glutes/hamstrings.

And we’ve done stretching at PT, and the tightness does not improve no matter how often I stretch(we have also moved away from that).

The only type of training I’m doing now is upperbody stuff on the machines and some very light lowerbody stuff on a total gym.

Do yall think it would hurt me if I do a crap load of bodyweight squats and lunges as long as it doesn’t irritate the nerves?

I also understand not to use too much abdominal/thoracic pressure that would compress the discs and irriate the nerves.[/quote]

It sounds like your PT is just as clueless as mine was about disc injury rehab. I stopped going after 2 sessions because it did more harm than good. Really. (This was at a research university, too.)

The tightness is neurogenic, meaning that your CNS is increasing the tone or co-contraction of muscles to splint, stabilize, or even immobilize the damaged area. Trying to stretch out neurogenic tightness does more harm than good, even though it can sometimes feel good for a few minutes.

This is what is happening: when you do the straight leg raise, a lot of force compresses the discs, including the injured one. The pressure receptors freak out, causing the CNS to increase the tone of your hams, glutes, piriformis, spinal erectors, QL, etc. The disc also compresses the nerves, causing prolonged nerve pain.

I would be very cautious even with bodyweight squats, because at your point of maximum depth I bet you get flexion in the lumbar spine area. You don’t want any flexion, or extension either, while this is healing.

At this point, I would recommend only single-leg squats with a neutral spine. Look up Michael Boyle’s article on single-leg training. There are lots of good variants, and the unsupported ones are hard to do.

Upper body stuff is probably OK AS LONG AS you get your spine into neutral and keep it rock solidly neutral as your move your arms.

Spend most of your energy at this point doing tons and tons of bird dog variations and planks. Maybe pushups with the spine in PERFECT neutral position every second. Disc injury is associated with lack of stability in the small, deep stabilizer muscles - not the big, prime movers.

In fact, the big prime movers (like the back extensors) tend to be overactive and dominant, and the small stabilizers underactive and inhibited. Doing more stuff for the prime movers, like squats, may only perpetuate the problem. So be patient and do plenty of stuff for those small stabilizers.

[quote]ku2u wrote:

My MRI report says that I did some pretty bad damage to myself. My L3-L4, L4-L5, and L5-S1 are all in bad shape. I have Degenerative Disk Disease in those.

[/quote]

I forgot to address this before.

You are 17. You do not have “Degenerative Disc Disease” – whatever the heck that might be. Virtually all older people have “degenerated” discs. MOST people, even those who never have pain, have various disc injuries and even herniations.

You do not have some sort of horrible unknown disease eating away at your discs. What you have done is damage them through cumulative microtrauma from mechanical forces of your activities.

For example, you probably sit for hours in school with your lumbar spine in flexion. Then when you squat, you probably have some lumbar flexion at the bottom position. You might even have hyperextension at the top position.

You probably do all kinds of other loading with some of your spinal joints not in an optimal position during the load. This has caused “wear and tear” on your discs.

The good news is, even the worst kind of damage WILL HEAL. I had a friend with a ridiculous herniation of L5-S1, to the point where she could barely move one of her legs because of sciatic nerve compression; she did no therapy and did a lot of things wrong, and still healed within 6 months.

Now if you want to continue as an athlete, you’ll be a lot better off if you figure out what sorts of activities and loading was causing all this wear and tear of the discs. You’ve got to learn. You need to alter your movement patterns, and maybe even forgo some movements in favor of others.

You really should read McGill’s books, and articles on this site by Cressey, Robertson, Boyle, and Tumminello. If you fix your imbalances and focus on PERFECT form through a progression of the safest lifts, you’ll be absolutely fine.

OK here is the only stuff my PT has allowed me to do so far:

Upperbody stuff on machines
Chest Press - 3x10
Reverse Flyes - 3x10
Chest Flyes - 3x10
Rowing machine - 6x10(various grips)
DB curls - 3x20

Upperbody stuff on Total Gym
Pullovers - 3x10
Tricep extentions - 3x10

Lowerbody stuff on Total Gym
Single leg squats - 3x15(feels very light)
Calf Raises - 3x30

Cardio: 15min Bike Ride

He keeps the weights pretty light just because he’s worried about abdominal pressure compressing the discs. Right now I feel like I can do some BW squats and lunges, and even some jogging without feeling any nerve irriation. I don’t know why he won’t let me do that stuff yet though. Do yall have any other suggestions of what yall would add or take away from this routine? I have talked to him about adding birddogs/planks and I think he plans on doing that soon.

[quote]andersons wrote:
ku2u wrote:

My MRI report says that I did some pretty bad damage to myself. My L3-L4, L4-L5, and L5-S1 are all in bad shape. I have Degenerative Disk Disease in those.

I forgot to address this before.

You are 17. You do not have “Degenerative Disc Disease” – whatever the heck that might be. Virtually all older people have “degenerated” discs. MOST people, even those who never have pain, have various disc injuries and even herniations.

You do not have some sort of horrible unknown disease eating away at your discs. What you have done is damage them through cumulative microtrauma from mechanical forces of your activities.

For example, you probably sit for hours in school with your lumbar spine in flexion. Then when you squat, you probably have some lumbar flexion at the bottom position. You might even have hyperextension at the top position.

You probably do all kinds of other loading with some of your spinal joints not in an optimal position during the load. This has caused “wear and tear” on your discs.

The good news is, even the worst kind of damage WILL HEAL. I had a friend with a ridiculous herniation of L5-S1, to the point where she could barely move one of her legs because of sciatic nerve compression; she did no therapy and did a lot of things wrong, and still healed within 6 months.

Now if you want to continue as an athlete, you’ll be a lot better off if you figure out what sorts of activities and loading was causing all this wear and tear of the discs. You’ve got to learn. You need to alter your movement patterns, and maybe even forgo some movements in favor of others.

You really should read McGill’s books, and articles on this site by Cressey, Robertson, Boyle, and Tumminello. If you fix your imbalances and focus on PERFECT form through a progression of the safest lifts, you’ll be absolutely fine.

[/quote]

My MRI report said that I had Degenerative Disk Disease. I don’t know if it actually meant that though, because I’m sure that at my age that my discs will eventually heal.

And can a chiro help reduce the nerve irritation possibly? The only thing that has helped reduce the nerve irritation thus far is the ESI, and I’ve had 2 of them. I have the option to get one more injection, and I will most likely take it if I don’t find anything else to work.

I don’t think a chiro will help.

[quote]ku2u wrote:
andersons wrote:
ku2u wrote:

My MRI report says that I did some pretty bad damage to myself. My L3-L4, L4-L5, and L5-S1 are all in bad shape. I have Degenerative Disk Disease in those.

I forgot to address this before.

You are 17. You do not have “Degenerative Disc Disease” – whatever the heck that might be. Virtually all older people have “degenerated” discs. MOST people, even those who never have pain, have various disc injuries and even herniations.

You do not have some sort of horrible unknown disease eating away at your discs. What you have done is damage them through cumulative microtrauma from mechanical forces of your activities.

For example, you probably sit for hours in school with your lumbar spine in flexion. Then when you squat, you probably have some lumbar flexion at the bottom position. You might even have hyperextension at the top position.

You probably do all kinds of other loading with some of your spinal joints not in an optimal position during the load. This has caused “wear and tear” on your discs.

The good news is, even the worst kind of damage WILL HEAL. I had a friend with a ridiculous herniation of L5-S1, to the point where she could barely move one of her legs because of sciatic nerve compression; she did no therapy and did a lot of things wrong, and still healed within 6 months.

Now if you want to continue as an athlete, you’ll be a lot better off if you figure out what sorts of activities and loading was causing all this wear and tear of the discs. You’ve got to learn. You need to alter your movement patterns, and maybe even forgo some movements in favor of others.

You really should read McGill’s books, and articles on this site by Cressey, Robertson, Boyle, and Tumminello. If you fix your imbalances and focus on PERFECT form through a progression of the safest lifts, you’ll be absolutely fine.

My MRI report said that I had Degenerative Disk Disease. I don’t know if it actually meant that though, because I’m sure that at my age that my discs will eventually heal.

And can a chiro help reduce the nerve irritation possibly? The only thing that has helped reduce the nerve irritation thus far is the ESI, and I’ve had 2 of them. I have the option to get one more injection, and I will most likely take it if I don’t find anything else to work.[/quote]