T Nation

Disc Herniation/Sciatica

[quote]ku2u wrote:
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]

None of that is going to hurt you IF you focus on maintaining a neutral, stable spine every second of every movement.

I hope you have done your homework by now and know exactly what I mean by “neutral, stable spine.”

If he doesn’t already know about bird dogs and planks, then I’m sorry, but he is ignorant of the best practices and best knowledge in his own field.

He is right, however, about being cautious of loading the spine. BW squats shouldn’t load it too much AS LONG AS your lumbar spine doesn’t round or flex during the movement. If it does, though, which is very common, you’ll be compressing the injured disc at that time, which will delay healing. But single-leg work would be far more beneficial for both strength and recovery than bodyweight squats.

Personally, I would not do the machine stuff. I would do strict perfect pushups up the wazoo. Standing rows with cables or bands. Pullups, IF you can keep your lumbar spine stable while doing them.

For legs, you should be doing single-leg stuff while keeping a neutral spine and not rounding AT ALL in the low position. King deadlifts, single-leg squats off a box, pistol squats, single-leg Romanian deadlifts, Bulgarian split squats. Once you can do all of those with full ROM with perfect form (no knee wobbling side-to-side, no spinal flexion) and plenty of reps with bodyweight only, like 20 or more, then you can add load with dumbbells. Then once you’ve worked up your loads maintaining perfect form, then check your form on bodyweight squats, groove a new movement pattern if need be, and try adding light loads and work from there.

[quote]ku2u wrote:

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]

What I meant is that “degenerative disc disease” is a garbage diagnosis for anyone, and for you it is certainly incorrect. If your discs will heal, then you don’t really have a degenerative disease eating away at them, right? You have injury to them.

MRIs are interpreted by human beings. Different humans will look at the same MRI and disagree on the interpretation.

As I mentioned before, I do not believe that chiropractic will help with disc injuries.

Lay on your back with your feet up on a bed or chair, hips and knees at right angles. Slip an ice pack under the injured area. This will unload and decompress the spine without overstretching any tissues, speed healing, and cost absolutely nothing (except the ice pack - the ones the PTs have are great).

Overdoing the ESIs will do more harm than good.

If you get nerve irritation only from straight leg raises (which do put high compressive loads on the spine), you’re doing pretty good. Hang in there.

I really don’t feel like the stuff that I’m doing with the PT is near enough. Like I don’t feel tired at all and I’m doing that same workout 4x per week. I will probably now thinking of doing some of the stuff that you recommended on my own now. I agree with you on the machine stuff, I really don’t like it, and would rather be doing pushups, pullups, Bulgarians, squats and lunges. I’ll find time to do this on my own.

I don’t think he likes pullups because there is too much thoracic pressure involved. But it doesn’t make sense when he says its ok to do other stuff as long as I keep breathing normally throughout the exercise.

What about jogging? Would this be too much compression on the discs? My PT told me not to do it but didn’t explain.

My PT has me do quite a bit of traction. The stuff he does is called Spinal decompression therapy. He has me in a position like you mentioned, but this machine gives it a pull and decompresses the spine. He puts heat on me but never ice for some reason. Also, do you think it would be harmful to do too much unloading and decompression of the spine?

And I forgot to mention this guys. I most likely won’t go back to football, so I really want to focus on track. I run the 100m, and the relays. Track doesn’t start until february, so I have a lot of time to get healed up and prepare for it. I’m hoping to have a lot of training time to be the fastest I’ve ever been.

You can do track by February.

I don’t have a strong opinion on the traction because I have not researched it, but my instinct says that the lying decompression position I described above would be better. My reasoning is that forceful decompression from the machine may stretch tissues that are meant to provide passive stability for the spine. It WOULD provide pain relief from decompressing the disc, but at the expense of spinal stability, which could potentially lead to loss of strength and increased risk of future injury at another spinal joint.

I also don’t remember McGill using it in rehab.

So if I injured my own back again (heaven help me, I hope not), I would not do the traction unless the PT showed me compelling research that it would promote healing without compromising spinal stability.

The pushups, chinups, and single-leg stuff I recommended would all, if done properly, increase spinal stability which is the critical factor for functional rehab. Just do not allow spinal flexion or extension during any of the movements, including pullups.

If any movement causes pain, you know that either the movement itself or the way you executed it over-compressed the spine, so avoid doing that in the future.

I do not really know for sure about the jogging. I wouldn’t think there would be too much compression from it, especially if you feel no pain.

@ ku2u

I’m sorry to hear about your injury at 17 years old.
But I just have to say that you are very lucky that the American medical technology is 10 years ahead of Europe and other parts of the world in the treatment of disc hernation.

Be more careful in the future though.

[quote]andersons wrote:
You can do track by February.

I don’t have a strong opinion on the traction because I have not researched it, but my instinct says that the lying decompression position I described above would be better. My reasoning is that forceful decompression from the machine may stretch tissues that are meant to provide passive stability for the spine. It WOULD provide pain relief from decompressing the disc, but at the expense of spinal stability, which could potentially lead to loss of strength and increased risk of future injury at another spinal joint.

I also don’t remember McGill using it in rehab.

So if I injured my own back again (heaven help me, I hope not), I would not do the traction unless the PT showed me compelling research that it would promote healing without compromising spinal stability.

The pushups, chinups, and single-leg stuff I recommended would all, if done properly, increase spinal stability which is the critical factor for functional rehab. Just do not allow spinal flexion or extension during any of the movements, including pullups.

If any movement causes pain, you know that either the movement itself or the way you executed it over-compressed the spine, so avoid doing that in the future.

I do not really know for sure about the jogging. I wouldn’t think there would be too much compression from it, especially if you feel no pain.[/quote]

I asked my PT about your recommendation, he says its good but he thinks that it would be better to use heat rather than Ice at this point. He says that I’m past the point to be using Ice.

Also, what do you think about using an inversion table. In other words, hanging upside down to get traction. I have an inversion table myself, but I don’t use it too often because I don’t know if using too much traction would be good for my back or not.

Hey, I have had similar pain. I have days I can’t even walk. I have a very good rehabilitant. He is able (after 2 hours long session) to make me ready to do pretty much what I want.
What he does is a kind of a massage combined with manual therapy. He believes that what is causing pain is tigh muscles and he is able to loosen them up. Funny thing is thta is never touching the place that actually hurts.

Things that can help in my opinion:

  • cross country running (slow speed, stop or go slower if you think pain) in the soft and uneven terrain
  • mobility drills
  • yoga (but first you have to know what can you actually do here)
  • light gym workouts (when you start loading legs start very light and slowly add weights)
  • all kinds of massages and relaxation techniques,stretching - the more loosy you are, the less pain you will feel

Right now, I’m thinking about getting with a surgeon to find out more details of surgery. I know that if I get a discectomy or a microdiscectomy, that I will be out for at least 6-12 months. That would mean that I would be out for track as well.

I’ve also looked up endoscopic disc surgery. Does anybody here have experience with this or other disc surgeries?

[quote]ku2u wrote:
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. [/quote]

Did they do a nerve conduction velocity test to prove it, or is that just their guess?

[quote]PRCalDude wrote:
ku2u wrote:
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.

Did they do a nerve conduction velocity test to prove it, or is that just their guess?[/quote]

Yes they did.

[quote]ku2u wrote:
PRCalDude wrote:
ku2u wrote:
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.

Did they do a nerve conduction velocity test to prove it, or is that just their guess?

Yes they did. [/quote]

Did they consider this?

[quote]PRCalDude wrote:
ku2u wrote:
PRCalDude wrote:
ku2u wrote:
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.

Did they do a nerve conduction velocity test to prove it, or is that just their guess?

Yes they did.

Did they consider this?


[/quote]

My PT says that he highly doubts it would be Piriformis Syndrome. I’ll ask my DR. tomorrow.

[quote]ku2u wrote:
PRCalDude wrote:
ku2u wrote:
PRCalDude wrote:
ku2u wrote:
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.

Did they do a nerve conduction velocity test to prove it, or is that just their guess?

Yes they did.

Did they consider this?

My PT says that he highly doubts it would be Piriformis Syndrome. I’ll ask my DR. tomorrow.

[/quote]

Hasn’t your PT bothered to touch your piriformis to see if it’s painful/twitchy?

[quote]PRCalDude wrote:
ku2u wrote:
PRCalDude wrote:
ku2u wrote:
PRCalDude wrote:
ku2u wrote:
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.

Did they do a nerve conduction velocity test to prove it, or is that just their guess?

Yes they did.

Did they consider this?

My PT says that he highly doubts it would be Piriformis Syndrome. I’ll ask my DR. tomorrow.

Hasn’t your PT bothered to touch your piriformis to see if it’s painful/twitchy?

[/quote]

Yes. What he does is puts pressure on my glutes with this hands. When he does it, he looks for a tender spot that causes the sciatica to hurt. Depending on where he puts the pressure at, the sciatica either stays in one spot or goes down the leg.

Am I making any sense? And does this sound anything like piriformis syndrome?

[quote]ku2u wrote:
PRCalDude wrote:
ku2u wrote:
PRCalDude wrote:
ku2u wrote:
PRCalDude wrote:
ku2u wrote:
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.

Did they do a nerve conduction velocity test to prove it, or is that just their guess?

Yes they did.

Did they consider this?

My PT says that he highly doubts it would be Piriformis Syndrome. I’ll ask my DR. tomorrow.

Hasn’t your PT bothered to touch your piriformis to see if it’s painful/twitchy?

Yes. What he does is puts pressure on my glutes with this hands. When he does it, he looks for a tender spot that causes the sciatica to hurt. Depending on where he puts the pressure at, the sciatica either stays in one spot or goes down the leg.

Am I making any sense? And does this sound anything like piriformis syndrome?

[/quote]

Yes, it sounds exactly like piriformis syndrome. I had it on both sides.

I’m betting your pain got worse after you were diagnosed with this “disc problem” as well.

Really?! I’m going to definitely tell my Dr. this tomorrow. Because I have no lower back pain at all. And when I do my straight leg raise, the pain starts from the glute, not the lower back.

My PT said that piriformis syndrom is a very rare case so that’s the reason why he doubted this.

If I do have piriformis syndrome, then all of this spinal decompressions, etc. has been very pointless.

He sounds mentally retarded. Fire him. Piriformis syndrome is not uncommon.

Yes. You’re only 17, for crying out loud. There’s not a damn thing wrong with your back that wouldn’t heal on its own completely in 6 weeks. A lot of people have significant disc herniations and have no pain at all.

Search “Dr. Sarno” and read some of his stuff. It sounds to me like your doctors got you worked up over nothing and made the problem out to be a lot worse than it is in your mind.

I’d definitely reconsider going under the knife. At 17. For back pain.

PS: Your doctor will probably not know what piriformis syndrome is. He will probably not know how to check for it if he does. He will probably push surgery even if he knows what piriformis syndrome is and how to diagnose it.

Its all making sense…

Would Piriformis Syndrome show up on a nerve conduction velocity test?

Also could the tenderness of the glute and sciatica be caused by the disc herniation as well?