T Nation

L5 Herniated Disc Rehab Advice


#1

Hello,

History:

L5 disc herniated around last November.
Finally had the balls to get the op because the pain hadn't gone away; June 6th was that special day.

We're now in early Sept and things are going well. I've got my Physio regularly and I've got a neuro. The neuro is of course very conservative, whereas the Physio has a more flexible attitude and is taking a slow, but 'see what it feels like at a light weight first' approach.

In other words, the Physio refuses to proscribe a list of lifts to avoid, whereas the neuro is just wanting me to get out of lifting all together.

From my own research, and from what the Physio harps on about, I'm building and I've got to continue to develop a strong core, so I've been doing some basic/intermediate core work. I've been focussing a lot on stretches - particularly the hamstrings which are tight as.

Because I've got to shift the weight I put on from the 6 months of idleness, I've done a 6 week programme of cutting (3 days a week doing HIIT in the gym and every Sunday doing swimming alng with circuits of the resistance machines). I took a week off, and now I'm onto my second 6 weaker now doing similar stuff.

The only aches I'm feeling are after the horizontal leg press, which is annoying my back, but I think that's my hamstrings being tight, since the more I'm stretching, the less painful that's getting.

Future:

I've been told by the neuro that I can go back to free weights in Jan. And he's said 'avoid lifting things over your head'. He's also mentioned the whole thing about 'not loading the spine'.

So I'm thinking that things like military press is out along with:

  • DL
  • standing bent over rows
  • front squats
  • 45 degree LP
  • all types of power lifts like cleans
  • shrugs?

Am I right with this?
Or should these lifts be viewed with more of 'something to progress to'?
I know there are alternatives like hack squats to the front squats etc. but I know the situation I've got myself in.
Can/has anyone progress(ed) to these after building up the muscle and the lower back that these exercises require? Or is it just a 'set in stone' thing where you should never try these lifts again?
Like can you build up a strong core, get your hamstrings fully loosened and strengthened, and then go back to squats after good progress and a reasonable length of rehab?

My physio has said that the lumber spine does harden and the injury does heal with a good training regimen.

Finally, in the short term:

  • Should I avoid shrugs and upright rows?
  • Can I do a seated versions of lifts, such as the military press, or does that put the same amount of pressure on the spine?
    (I've been doing resistance shoulder press machine and I've got no back aches)
  • Are there any other lifts I've missed off that list, which load the spine, and I should thus avoid for the short term at least ?
  • are dumbbell versions of lifts better than barbell?
  • should I use a smith machine to build my calves?

So, I've got the medical side of things.... now I want to hear what those with actual experience and specific knowledge have to share.

Cheers.

(P.S. I know it's a long post but I've been needing to ask these questions for a week now and I can't find much on the internet that's helped.)


#2

focus on hip and thoracic mobility, too. the lumbar spine will move (or try to) to compensate when the hips and thoracic spine cannot.

i've got a compression fracture of the L/T junction and i don't think it bothers me much. i mean... my lower back does fatigue pretty quick - but that is because my legs are weak.

pay strict attention to your form and don't feel dumb learning the movement (with proper muscular activation) and just gradually adding weight. only you are going to know what you can and cannot do. mostly... when people really really want to then they figure it out.

luck.


#3

oh...

loading is what helps the bone heal, dude. i've got compression fractures in my feet, too. crushed heelbone etc. best thing i could be doing for them is deadlifing and squatting etc. loading is what helps the bones become denser to prevent osteoporatic fractures etc.

you can lift with pins and plates and all kinds of hardware. i don't really see any reason why you can't do whatever it is that you want to do. just learn to listen to your back. oh... and work your hip and thoracic mobility or you are going to have lumbar problems...


#4

uh... do you hold your lumbar arch (you know, to keep your spine safe) on the horizontal leg press???


#5

Can you explain the hip and thoracic mobility bit? I'm unsure what you mean - like what exercises get them 'mobile'?

And with the LP, at first I just did the LP with what felt comfortable for my legs, hence the back pain. But after I'd finished my cardio, I went back just to see if I could reduce the pain by holding my lower back firmly against the back of the seat, but it felt a bit unnatural. It did however reduce the pain there.


#6

sorry i keep adding bits...

basically... your lumbar region is supposed to be stable. so part of that is about strengthening your core (as you know). part of it is also about really mobilizing the regions to either side (your hips and thoracic spine) so that movement quite generally comes from those regions rather than your lumbar spine.

so with overhead pressing, for instance, your lumbar spine is supposed to be held stable by your erectors and your abs and the movement is supposed to come from your thoracic spine. so long as you do the movement in this way you shouldn't feel any pain from it and you should be able to progress your overhead press the same as everyone else. which is to say you should be able to make progressive gains on it and keep adding weight with the standard caveat of 'so long as you retain good form'. good form is of course important generally, but particularly important in your case.

with squatting and deadlifting the idea is for you to hold your lumbar arch to keep your lumbar region safe. your hips need to be flexible so the movement comes from knee / hip extension and your lumbar spine doesn't move at all. so long as you can hold your lumbar arch these exercises are safe. just like they are for everyone else.

i don't suppose you have someone you can trust to work with you on your form?

you know... in a way... learning to do these exercises correctly and doing them... is probably the best thing you could possibly be doing for your rehab. are you able to take vids and post them for feedback? as always... start with no weight / the bar and get the movement good. only when you can do it safely should you think about loading it.


#7

I went back just to see if I could reduce the pain by holding my lower back firmly against the back of the seat, but it felt a bit unnatural. It did however reduce the pain there.

I don't mean hold your back firmly against the seat... I mean hold your lumbar arch. Like you would if you were squatting or deadlifting correctly. Think 'sexy pose' (for chicks, I guess) where you reach your butt back like you have a scorpian tail that is trying to curl around up to your shoulder blades.

See Ripptoe on holding your lumbar arch (some guys seem to have trouble with it):

http://www.T-Nation.com/free_online_article/most_recent/proper_back_position_for_power

Only when you have mastered it is it safe to load (IMHO) - or I guess some people seem to get away without it... But not those with history of injury...

Mobility:

http://www.T-Nation.com/free_online_article/sports_body_training_performance_repair/a_jointbyjoint_approach_to_training

The whole 'joints are stacked alternating mobility / stability' thing was a bit of a cognitive breakthrough for me. Hope it helps you :slight_smile:


#8

The seated version of lifts will definitely result in a higher intradisc pressure. See the attached photo that I got form McGill's work. When seated, you have the pressure/forcing coming down your spine and also coming up from your sacrum/buttocks that is contacting the bench. When standing (assuming you can control and stabilize your lumbar spine and have proper muscle activation of the glutes, etc), the force gets dispersed while having to travel up the legs so you don't get as high of intradisc pressure.

I may be looking at your intensions for this part completely wrong, but to me it shows that your priorities are spread far too thin. If your concern is your low back health at the moment, who honestly cares about the calves? Take the time that you would have given to doing calf work and instead use it on hip mobility drills, lumbar stability exercises, tspine mobility, and other things that will directly and positively impact your low back problems.

Didn't feel like quoting a bunch of your stuff but those 2 sections just stood out to me for some reason. Other bits of advice, while I agree that you find the need to "cut weight" because of the added weight you put on post-surgery, you need to be very careful with that in a few ways.

1) You are only 3 months post-op from a spinal/disc surgery. You need to relax a bit on things and continue with your rehab. I don't know the specifics of what they did, and some methods of surgery allow for a quicker recovery than others, but worrying about power cleans, squats, DLs, etc after only 3 months of recovery is starting to think of those things a bit quickly. I agree with your physio's comments saying to progress slowly into things and just doing very light weights, until your body is ready to handle the larger loads, assuming that you've corrected and fixed any mobility issues and increased stability at the lumbar region.

2) I understand your desire to want to drop some weight from what you've gained in the post-op period, but make sure your nutrition is still up to par. During a recovery from injury/surgery, your body's caloric demands will be a bit higher than during a maintenance period. I'm not saying to go out and gorge on crap food; it's as much about what you eat than getting the right amount of calories. Just don't go into high caloric deficit situations just to "look better" and cut weight, as it will likely impede on your recovery. Also, just be aware of your technique and body during your HIIT sessions, especially towards the end. Again, just make sure your priorities are in check - do you want to look good or fix your back?

Best of luck with it all.


#9

Cheers for both the replies.

Thanks alexus - and yes, I do as it happens. I'm living with a bit of a bodybuilding junior champion next year so he should be able to keep an eye on my form when I train with him.


Thanks LevelHeaded. And you are right. I suppose I'm just thinking ahead - I like having things to look forward to, goals etc. I wouldn't be attempting any free weights until Jan anyway.
I take it the hip mobility drills, lumber stability exercises and spine mobility stuff are what is in those articles alexus has referred me to?

Cheers once again.