Hey guysand girls. My wife has been working out w/me for a few months. She has two herniated or bulging discs though. also degenertive disc disease. I've got her taking Glucosamine/Chondroitin, Calcium and coral calcium plus vitamins. I was wondering if anybody had any suggestions on other supplements. I also was wondering if exercises like squats would be good for her after the inflammation goes down and she feels better or if they should be avoided. Also if anybody has any suggestions for other exercises that would help her or stuff she should avoid I would appreciate it. It has reallly got me worried about her. thanks in advance for any responses.
mhead, welcome to the board!!! Your first post, I see. (grin)
What is the cause of the degenerative disease, either that or what is the name of what she has?
Have you considered working with a really good PT (Physical Therapist, in this case)? She would benefit from an assessment and a well-designed program that strengthens her back and corrects any imbalances.
My PT walks on water. He's got a CSCS to boot.
PT is a good choice. Just make sure that they do more than estim and ice packs!
Also which disks are bulging and herniated?
Don't forget the magnesium. Ca needs it to absorb. Usual recommedations is 1/2 the Mg to 1 unit Ca. But you can increase it to stomach tolerance.
My first post too. I'm a massage therapist specializing in sports and medical. If you can find a good one, we too can help!
Welcome to the board, Baba13!!! First post on the board and you're already helping out?!? Cool beans! I see a new soldier in the making. (grin)
"Healing back pain" by Dr. John Sarno. Its a book. This guy has the highest success rate in the country. If you do anything, read this.
I dont have the report with me. I think it was the L4 and L5. They really arent sure what caused it. But my wife is only 26 and the doc said people her age usually dont have degenerative disc problems like that. I hadnt thought of a physical thereapist. I wonder if blue cross blue shield would pay for a physical therapist? I really really apppreciate you guys posting so quick.
BC/BS usually pays for PT, depending on your coverage, best way is to call them and ask. But you'll probably be stuck with your copay which is usually around 20%.
Since it's probably lumbar area, I'd be carefull with exercises that's gonna compress the spine until you can get it strengthened. Swimming is really good for that, also some back extensions - but being careful to keep the spine straight. Also abdominal work will also help support the low back.
Jarrow Formulas has a good product called Bone-up which helps to build back bone. It's a blend that not only contains Ca but other vitamins and minerals to help the body assimilate the Ca.
Thanks for the kind words, it's good to be here. I've enjoyed reading you guys and am looking forward to growing (in more ways than one!)
Hi there, mhead. I'm female, 33, and have lifted for over 8 years. I think I understand what your wife is going through. I recently injured my back and am in the process of diagnosis, though symptoms indicate some lumbar disc problem. I have been researching this for myself, as well as for a close friend with severe herniation at L4-L5, compression of the spinal cord and accompanying sciatica. Bad stuff.
For the most part, I tend to ignore the "degenerative disc disease" diagnosis. There is a lot of debate over this in the research community, and many credible experts consider it a normal part of aging and not associated with pain. In fact, "degeneration" over time will cause herniated discs to become less painful.
General advice if there is pain (I assume there is some, since a diagnosis was sought):
1) Avoid excessive compression of the spine. Flexing the spine causes compression, and flexing under load magnifies the compression. Compression under load is the cause of herniated discs, and must be minimized to allow herniated discs to heal. For workouts, look for movements that keep the spine in neutral, and minimal loading.
2) Do not flex or load the spine in morning for at least 1-2 hours after rising. The discs absorb water like sponges during the night's sleep, and are decompressed from the lying position. They are therefore more vulnerable in the AM.
3) Avoid sitting for long periods.
4) Do exercises to stabilize the spine. (More on this if you want it.)
5) Walk a lot. Brisk walking has been found to be greatly beneficial for spinal conditions and back pain.
The above recommendations are found in Dr. Stuart McGills's book Low Back Disorders. I highly recommend it. His is the most detailed and compelling research I have found -- and I found out about him from an interview here on T-mag ("Mister Spine"). The book is not meant for the lay reader, but the exercise recommendations chapters are clear.
Reducing inflammation is one key to managing pain. Diet and supplements I have found helpful:
1) Eat an anti-inflammatory diet: avoid sugar and processed grains, emphasize vegetables, fish, and healthy omega-3 fats. Perhaps limit red meat, which is high in arachidonic acid and promotes inflammatory compounds.
2) Take fish oil. Lots and lots of fish oil (ramp up gradually, though, for the sake of the stomach). Fish oil is a potent anti-inflammatory and is highly beneficial to joints. This number-one supplement is really an essential macronutrient.
3) Consider other anti-inflammatories such as low-dose aspirin, curcumin, quercetin, bromelain, ginger, and Wobenzyme.
Glucosamine probably isn't going to do much good here. It helps build cartilage, and cartilage is not the problem with a herniated disc.
In addition, for pain:
1) Apply heat. Those Thermacare low-back wraps are great!
2) Use topical capsaicin cream. I have had GREAT results with this. (Follow directions and use sparingly at first.) Pain from compression of nerves does not respond well to any known pain medications, whether OTC or prescription -- not even morphine. So I would avoid them, since there are many negative side effects, including joint degeneration from NSAIDs. (I have, however, taken Aleve during short periods for acute inflammation in addition to the above listed.) Topical capsaicin has been shown in studies to relieve nerve pain.
I am not as inclined as Tampa-Terry to recommend PT. I would certainly consult one or more (and have done so), but for the spine they routinely prescribe exercises that Dr. McGill has shown to cause extreme forces that, in turn, cause the herniation in the first place. Prescriptions to do these exercises have never been based on evidence, just on assumptions. (These same basic exercises are recommended all over the web, too, and even at government health sites.) McGill's evidence, by contrast, is impressive: he tests spines in vivo and in vitro, during movement, modeling just about every component of the spine's motion based on measurements from EMG (including deep intramuscular EMG). Amazingly careful work.
I don't know what to advise for working out. I am in the middle of my own problem, trying to figure this out for myself. Just from avoiding flexion of the spine, one will do a ton of bodyweight squats every day. For me, I'm not loading any weight on squats, because of spinal compression. I have also eliminated a lot of movements McGill showed to be injurious.
I have noticed that the more I lift weights, no matter how careful I try to be, the more pain I have. I recently had a 4-week layoff due to travel, and had virtually no pain during the layoff from lifting. This could be because I moved around a lot more than I typically do at my sedentary job (walking, swimming, etc.), and/or that I probably was more relaxed (despite visiting my mother for 10 days, haha). Today was my first day back with weights; I tried to emphasize exercises that shouldn't compress the spine too much, like pushups, and yet my pain has increased significantly today.
My belief is that I have to get this healed and be pretty much pain-free before I can resume normal lifting again. And I am determined to get there.
I hope your wife will too!
andersons, Thanks that was some really helpful advice. You said you had more information on exercises if I wanted it. If you dont mind taking a few more minutes would you list these. And maybe some stuff to avoid. I really appreciate everybodys help. Also what do you and everyone else think about chiropractors?
mhead, sure, I'll describe exercises that are supposed to help rehabilitate people in pain. But exercise prescriptions vary depending on the stage of injury, pain, and recovery. How long has your wife been in pain? When was she diagnosed? And, how severe is the pain? Does she have sciatica or referred pain (common with L4-L5)?
At the early stages of injury or with acute pain, movements are the most limited. In other words, you do just a few stabilizing exercises a LOT, and avoid almost everything else. Hopefully, with recovery, many exercises can be re-introduced (at least, I'm still hoping that).
Recommended exercises involve keeping the spine in a position with neutral S-curves. Avoid movements with a high degree of flexion, or a high degree of extension. In the worst stages of pain, putting on socks in the morning may involve too much flexion.
The rationale for these exercise prescriptions is this. Disc injury is caused by either
1) a single incident of flexion under above-maximal load (i.e., more than the spine could support), OR
2) repeated flexion under sub-maximal load
To rehab the back, avoid those 2 conditions. Avoid flexion with loading. This includes bending over to pick up a 2-year-old.
Injured discs are going to heal and do not have to be a source of ongoing pain. Proper exercises help speed healing and avoid re-injuring.
1. Plank. Lying flat on stomach, push yourself up on your elbows. Basically, forearms and toes are the only things touching the ground. It's good to use a mirror to check spine alignment and make sure there isn't too much kyphosis or lordosis (excess thoracic or lumbar curve). Many people with herniated discs may have excessive lumbar curve and have to get used to finding and keeping neutral. Start out by holding this position as long as possible. If she is in too much pain to do the basic plank, try supporting from the knees or even leaning against a wall to reduce the load. I can do these with feet on the floor, but my friend with severe herniation started by leaning against a wall.
Side planks (don't remember "real" name). Same idea, with forearm and feet toucing the ground, but facing the side. Pay attention to a side that may be weaker and work that side more.
Exercises that involve breathing, like the vacuum and power breathing.
Vacuum: Lie on back with knees bent, inhale deeply, then exhale ALL the air out of the belly forcefully. Contract the abs toward the spine and hold.
Power breathing: Inhale, filling belly with air (i.e. use the diaphragm), then make a small space between tongue and upper teeth and blow out forcefully, as if blowing air out a straw.
The idea is to build stability and endurance in the spinal support muscles. Not flexibility or strength. I have done these 10X a day, like once every hour, a la "100 reps to bigger muscles" type of idea. People with disc problems often have hyper-mobile spines, poor stability, and impaired motor patterns.
At acute stages of pain and injury, avoid anything on hyperextension bench or Roman chair; full sit-ups; and virtually all machines for abs and back. The machines that place a padded bar across chest during a crunch-like movement, or against the back for a back extension, are to be avoided. All of the machines are frequently used in back therapy, but Dr. McGill has quantified and documented the excessive forces on the spine for each of these.
[If anyone with other back problems reads this, please note that these recommendations are ONLY for disc problems in the lumbar spine.]
Chiropractic? For certain spinal problems, good adjustment can be extremely helpful. But chiropractic isn't indicated for bulging or herniated discs. In fact, many chiropractors refuse to adjust someone with a known herniation, particularly if there are referred pain symptoms like sciatica. It is contra-indicated for spondylolisthesis.
Spinal manipulation is helpful for postural backache, mechanical imbalances, and muscle sprains (the cause of 80% of back pain incidents).
I'm currently trying to stabilize my spine with the exercises listed above. When my pain is gone, I THEN plan to start a phase of aggressively treating postural/mechanical imbalances, using chiropractic, ART, physical therapy, and an expanded choice of exercises.
Besides "healing back pain" are there any good books with similar info about this problem.
Is she a candidate for surgery?
If so, PM me, I can probably point you to good Neurosurgeons in your area.
Dan "As a last resort" McVicker
Dan, I'm hoping it wont be surgery. thats why i was asking about exercises so surgery can hopefullly be postponed for a long time. thanks fo rposting though and ill keep it in mind if it comes down to that.
Hey guys, thanks for the advice on this back pain situation. I seem to be in the same boat as the guy's wife is. I am 19 and I have the same degenerative disease which seems to stem from my genetics. I have slight bulges in my L5,L4,L3, and I have lost most of the fluid in the discs between these three levels. I am still able to workout fine through the pain, nothing too severe, but I just seem to stiffen up a bit. I can't do squats any more because of the weight that would be placed onto the lower levels of my back through vertical pressure. But not with standing, I can do most of what I want to do. But I just wanted to thank you for giving such good advice on the topic of lower back pain. There are alot of us who need it.
Agreed, I have saved this thread.
Thank you everybody.
There are a couple of well-done studies on surgery for this problem. The results of these studies are the best predictor possible for a prognosis. (I keep saying "this problem," because cervical surgery, for example, has different outcomes than lumbar disc surgery.)
The bottom line on lumbar disc surgery is this: it may help 1 out of 10 people to improve in their pain reduction, more than non-surgical treatments alone, in the short term (3-12 months post-treatment). About 7/10 surgery patients had good improvement 3-12 months post-surgery. About 6/10 non-surgery patients (following conventional non-surgical treatments) had good improvement 3-12 months later.
So, the odds of benefitting from disc surgery, where "benefit" is defined as good improvement in the primary symptom, are 1/10. Even this small surgical advantage disappeared over time: 2 years later, pain improvement was the same regardless of surgical intervention. This narrowing of the small surgical advantage was due to improvement in the nonsurgical group, not deterioration in the surgical group. Therefore, it appears that long-term chances of pain improvement are the same whether surgery is chosen or not, but surgery patients are more likely to experience pain relief in the short term (3-12 months) after the surgery. Nonsurgical treatment is slower.
There is a slight wrinkle to the prognosis. More surgical patients report that pain is COMPLETELY gone (27%) than non-surgical patients (11%).
Benefits of surgery also are optimized after 3 months of symptoms, so don't consider surgery before then.
I strongly believe that this study, well-executed as it was, OVERSTATES the benefit of surgery for three reasons. First, the benefits of non-surgical treatment depend hugely on patient compliance. Patients have to keep doing their exercises, going to the chiropractor, etc. People tend to stop once they see some improvement and pain levels they can live with. Surgical patients, on the other hand, just go have the surgery.
Second, surgical patients also follow some rehab protocols similar to non-surgical treatment. So it's hard to say how much benefit comes from JUST the surgery.
Third, and most important, the standard non-surgical treatments followed in this study are absolutely not the best available. I am confident of this because of OTHER research comparing different non-surgical treatments (such as the study of different movements and exercises done by McGill). Another example is the recommendation of bed rest in this study, which has been proven to make bad backs worse after only 1-2 days.
There are also serious risks and drawbacks to disc surgery. A significant number of people have to have additional surgery to correct problems in the first (30%). These people have a low chance of pain relief. It's very tricky to perform disc surgery without damaging something else. Surgery also tends to de-stabilize the spine, leading to other chronic back problems later.
Based upon the research to date, I consider lumbar disc surgery a last resort only when sciatic symptoms progress to cauda equina -- loss of bowel and bladder control. This problem obviously interferes unacceptably with life. I can certainly understand if someone elects surgery to attempt to fix it, even if back pain (considered aremains unchanged or gets worse.
I apologize for the article-like length of these threads. Obviously, this exact problem has been important to me, and I have done a great deal of research on it over the last few months. This post, for example, condenses the high points of a 6-page research summary I wrote to help a friend. And the best of the research does not seem to be incorporated into mainstream practice and knowledge yet. I do hope the information is helpful; I know that there are a lot of low-back pain sufferers out there.
ScienceGuy mentioned Healing Back Pain by John Sarno. I've recommended this book on another thread, but I usually recommend it with reservations, along with a related book, Rapid Recovery to Back and Neck Pain by Fred Amir. I'm writing reviews of these to post on Amazon. Here's a draft:
The good: Sarno claims that muscle tension, induced by the subconscious, causes back pain. To many lay people as well as some doctors and scientists, this claim sounds "out there," but, to the contrary, a great deal of research supports "psycho-social" factors of back pain.
Muscle tension IS undisputedly ONE of the causes of back pain. And the subconscious (as well as the conscious) mind CAN cause muscle tension.
This book is good for people who are in fear or even panic about their pain. This is why I recommended the book in another thread. There are enough counter-examples in this book to show that even severe pain does not have to ruin one's life.
In fact, emotional responses to pain have a large effect on pain. Fear, anxiety, and other negative emotions actually increase muscle tension and make pain far worse.
The bad: Sarno and Amir are evangelical. In their books, subconsciously-induced muscle tension is the ONE and ONLY cause of back pain. All treatments - exercises, chiropractic, epidural injections, surgery - are ALWAYS useless for ALL kinds of back pain (unless caused by a tumor). These sweeping claims are just not true. I fear that someone reading this book in the initial stages of pain may fail to seek some of the truly helpful treatment they need.
There are several alternative lines of explanation for Sarno's "success" treating people with chronic, ongoing back pain. First, he eliminates anyone from treatment who doesn't believe his claims, because recovery supposedly depends upon believing. He does not include these eliminated people in his success rates.
Second, he sees patients who still have continuing back pain despite "trying everything." It is known, through other research, that people with ongoing, chronic, and complex back pain differ in psycho-social factors (e.g., more likely to receive Worker's Compensation, score high on fear and negative emotions scales, display avoidance behaviors for pain, etc.). So, the small, non-random, self-selected sample of people he sees are the very type to benefit most from reducing fear and anxiety.
Also, many of his patients have undoubtedly already fixed structural back problems that really did need fixing. They come to Sarno with structural problems fixed, but with the dorsal horn centers for pain signals still sensitized. "Fixing" the psycho-social factors for back pain is probably the last link of the chain that they need.
There are several major factors for back pain, bio, psycho, and social. Bio would include biomechanical postural problems, injuries, and ill-understood inflammatory conditions. Psycho would include fear, anxiety, stress, hating one's job, and subconscious issues. Social would include Worker's Compensation and other factors like that. More than one factor may be present in a person to contribute to his pain. And all factors may have to be treated independently to get rid of the pain.
Sarno/Amir focus on a major factor that many doctors may ignore. However, they also dismiss other proven factors involved in back pain.
So I recommend reading Sarno and Amir to convince yourself that the mind plays a role, and that you don't have to fear back pain. And DEFINITELY read McGill's book Low Back Disorders to learn how to treat the structural causes of low back pain. (Don't be scared away by the scientific terminology; you don't need to understand it all to learn a lot of practical things.) Back pain is complex; you've got to tackle all the factors that create it.