Lordosis Plus Scoliosis (Female Athlete)

Guys,

a dear friend of mine has a problem with her back which has lately REALLY become a problem - she is a women’s group fitness trainer (aerobics and such so no real lifting involved or education about it) so she could even lose her job.

She was diagnosed with hyper-lordosis (probably APT) and, what is probably an even bigger issue, scoliosis. She describes these manifestations and visual observations:

  • disc protrusion in the spinal canal L4/L5 area (diagnosed)

  • pain in her left leg (sciatic nerve, related to the #1, diagnosed)

  • left scapula pulled backwards (subjective)

  • area around right scapula “depressed inward” (subjective)

  • Donald Duck butt (subjective)

  • right gluteus strong and perky, left one a bit flabby and turned downward (subjective)

  • left quad strong, right one not so much (subjective)

After reading numerous articles here at TNation, plus EC and TG websites and successfully “curing” my problem with disc protrusions at L4/L5, L5/S1 I decided to give her a hand in sorting things out. I am not a qualified person to give any official advice on this matter I just wish to help her navigate a lot of info that is available. Specialist is not an option because as far as I know in our country there are no manual therapists (ART) and in hospitals you wait… oh, about a year or two :wink: until it’s your turn.

Seems to me that she has got APT and she has it for some reason. Not being a desk-jockey (quite contrary, a fitness trainer) I believe we should rule out the “caveman/neanderthal” reasons, no? No forward head glued to the monitor, shoulders forward, caved back, sleeping glutes, no weak hamstring. What could be true is too strong illiopsoas.

What they do at these classes is a sh*** load of step-ups, glute bridges, lunges, squats, glute kickbacks, ab work like there is no tomorrow (6 times per week). The usual girls beach-stuff. I’m thinking that this got her hip flexors real strong over time so they kept drawing on her lumbar spine (forward). At some point she might have overdone something so the disc went out. The left side back/right side front seems like the obliques or quadratus lumborum are pulling more on one side than the other?

I’m guessing there will be much more to learn here, as most of the hip muscles have their secondary and even tertiary functions which are all inter-related.

We do have access to decent anatomy sources as well as to the really good gym facility so any help and tips that would steer us in the right direction would be greatly appreciated. I would just tell her go deadlift a bit :wink: but that isn’t really gonna do the trick, right?

Cheers!

P.S. ABSOLUTELY no idea why the image is rotated? :slight_smile:


Side and front view

Where is the leg pain? What does it feel like?

Has she always had the scoliosis? If not she’s in an antalgic lean or having a reactive spasm.

With the disc lesion the priority should be to centralize the pain to her back. Removing the radiating pain should be your first success. There’s no way to suggest what to do without more info. What movements aggravate the pain? Reduce the pain? The disc isn’t necessarily causing the symptoms. Either way, with a posterior lesion she shouldn’t be flexing her lumbar spine, at all. Increase standing and planking ab movements and stop supine and flexion ab movements immediately.

That’s all I can offer right now.

[quote]CroatianRage wrote:
Where is the leg pain? What does it feel like?

Has she always had the scoliosis? If not she’s in an antalgic lean or having a reactive spasm.

With the disc lesion the priority should be to centralize the pain to her back. Removing the radiating pain should be your first success. There’s no way to suggest what to do without more info. What movements aggravate the pain? Reduce the pain? The disc isn’t necessarily causing the symptoms. Either way, with a posterior lesion she shouldn’t be flexing her lumbar spine, at all. Increase standing and planking ab movements and stop supine and flexion ab movements immediately.

That’s all I can offer right now.

[/quote]

good advice,

OP if she didn’t have a bony scoliosis when she was younger she’s not just randomly developing spinal curvatures. What is the source of the herniation? was there a single event?

If the pain is down her left leg then im guessing she has a posterolateral protrusion on the left at L4/5 since this would effect the sciatic nerve roots. However, this is not certain without proper physical examination, disc issues often show up on MRI but are not always the source of pain. In general, if she finds a movement that decreases the symptoms, then stick with it. Guessing, I would say either extension such as prone pushups orrrrr prolonged side bending to the right may help her, I’ve had success with both. If symptoms peripheralize, stop immediately and try a different direction of movement. It looks as if her pelvis is off, but a picture that is not a “selfie” with her arms at her side would help much more. There’s so many different possible scenarios here, back pain is complicated and physical exam is key because of all the issues with MRI.

Guys, thanks a bunch! (I see more fellow Croatians here :wink: that’s good, we’re slowly takin over).

Here are her replies:

  1. The leg pain is in the left leg and it feels like sciatica. It starts from the lumbal area, goes over the buttock, through the middle of the hamstring, over the knee laterally, all the way to the foot

  2. I was first diagnosed with the scolio when I was 16 or 17. I had some X rays taken (small town Croatia, questionable reading), doc said I should have surgery. I am constantly in antalgic lean and spasm

  3. I can’t sit, I can’t walk from the pain, high heels are killing me, jerking movements (dont laugh) are killing me. Single leg deadlifts and lunges hurt, hip extensions start to hurt after a few reps. Anything on one leg (especially this left one) hurts, one leg hip bridge on Bosu ball also sucks

  4. Foam rolling quads, glutes, piriformis and iliopsoas, hip flexor stretch and back extension (Cobra) - this makes me better but only temporary. Flexion based moves hurt

  5. I think no hernia, it’s just a protrusion. It probably happened during the 12 years 2-3 hours per day, fitness classes
    Although, now when I think, when I was 22 I tried exercising without warming up… I flexed my spine (throwing legs over your head on the floor) that’s when I heard a click and it hurt for days

[quote]astrbac wrote:
Guys, thanks a bunch! (I see more fellow Croatians here :wink: that’s good, we’re slowly takin over).

Here are her replies:

  1. The leg pain is in the left leg and it feels like sciatica. It starts from the lumbal area, goes over the buttock, through the middle of the hamstring, over the knee laterally, all the way to the foot

  2. I was first diagnosed with the scolio when I was 16 or 17. I had some X rays taken (small town Croatia, questionable reading), doc said I should have surgery. I am constantly in antalgic lean and spasm

  3. I can’t sit, I can’t walk from the pain, high heels are killing me, jerking movements (dont laugh) are killing me. Single leg deadlifts and lunges hurt, hip extensions start to hurt after a few reps. Anything on one leg (especially this left one) hurts, one leg hip bridge on Bosu ball also sucks

  4. Foam rolling quads, glutes, piriformis and iliopsoas, hip flexor stretch and back extension (Cobra) - this makes me better but only temporary. Flexion based moves hurt

  5. I think no hernia, it’s just a protrusion. It probably happened during the 12 years 2-3 hours per day, fitness classes
    Although, now when I think, when I was 22 I tried exercising without warming up… I flexed my spine (throwing legs over your head on the floor) that’s when I heard a click and it hurt for days
    [/quote]

  6. That’s unfortunate that it goes all the way down the leg. If the radiating symptoms get worse go see a doctor IMMEDIATELY. Any changes in bowel or bladder control or numbness around the groin? Should have been asked by your other docs.

  7. If you’ve had it since adolescence it’s most likely a structural scoliosis and it will not improve. Do you still have the Xray or could you access it somehow? Re imaging the area and comparing may be helpful because if it progressed past a certain point it can become dangerous.

  8. High heels are an absolute nightmare to those who deal with musculoskeletal issues. They screw up everything in the kinetic chain and wreck feet. At the very least stop wearing them until your symptoms resolve. It might be time to drop a lot of those exercises and some remediation is in order. Once again, no more spinal flexion. If you need to go buy some kinesio tape and extend the lumbar spine and stretch tape over the erectors vertically. It will give you instant feedback if you attempt to flex forward.

  9. Keep doing what makes it feel better, even if only temporarily.

  10. Disc lesions are cumulative in nature and come to a sudden climax of pain and spasm. Healthy spines don’t have disc lesions because the annular fibers are intact and healthy. Cumulative trauma has allowed the goo (nucleus) in the center of the disc to press out against a weakened wall causing a bulge. With limited flexion the disc can resorb and heal, but it will take time. Walking is good because it will imbibe the disc bringing in extra blood and nutrients.

Again, your first goal should be the radiating leg pain. Find someone who will give you rehabilitative exercise and cater to your needs. If a practitioner only spends a few minutes on you or hooks you up to electricity and leaves then they probably don’t have your best interests at heart.

Good luck.

Croatian rage, thank you man! I’ll copy this and send it to her immediately.

Thanks once again
Alex

[quote]astrbac wrote:
Croatian rage, thank you man! I’ll copy this and send it to her immediately.

Thanks once again
Alex[/quote]

Alex,

I saw You successfully cured disc protrusion L4/L5 and L5/S1! I have same diagnosis.

Could You pls give advice how You did it!
I have posterior pelvic tilt, so therefore weak ass, weak hip flexors and tight hamstrings.

Recently I managed to reduce pain in right leg, probably with exercises and physical therapy.
So at the moment, I feel pain occasionally in lumbar area only but when pain arise it is quite sharp and I can not sit nor stand. Only horizontal position helps, swimming or bed and icing of area.

Please advice how You managed to get rid of/ cure Your protrusion.

Thanks a million,

Best regards,
Sasa

Hello fella Croat! :wink: If you speak Croatian you can contact me via PM, if that is easier for you.

I can’t say I “cured” my problem, you can never really cure these things, just make them more or less better. My injury was at it’s worst in 2007 (seven years ago!) and during the next few years I didn’t really train seriously. I tried a bit of gym, a bit of swimming but I didn’t know what I was doing at the time.

Now I feel I am much smarter because I have educated myself A LOT. This is what I think:

During the few years (after 2007) the disc has probably “healed” a bit on its own. These typs of injuries do retract a bit with time, some sort of fibrous tissue forms, the pulpous gel gets absorbed (sometimes only via surgery) and you move on. In the worst cases disc dessicates and your vertebra fuse together. Firt time I read that I was in comlete shock but then I heard that Mark Ripperoe has two vertebra fused in his neck (?) and no major issues there. I may be wrong with this

During the past year (2013) I was training religiously in the gym. Starting strength was the first program of choice an somewhere around Jun/Jul I switched to Wendlers 5/3/1. That had to be the best thing I have ever done because it makes you work up slowly, it is simple to do and it makes you really strong over a long time.

My back feels excellent, nothing hurts, I have learned to use my glutes, better use my hip hinge, I am focused more when I lift other weights (when I’m not in the gym)… The reason I stopped doing it for now is to give my spine a bit of a break (decompress) and because my knee is acting up. I have some serious knee issues but that is another story.

So, what I think you should do:

  1. take pictures of yourself
  2. read “Neanderthal no more” series of articles here at TNation
  3. Analyze your posture, you will really learn A LOT during this process
  4. Find or draw up a training program which will bring up your weaknesses (you can’t really stretch over-tight/strong muscles, you need to strengthen weak ones)
  5. Not do any of the movements that accentuate the side where your protrusion is! (For example, if your protrusion is located posteriorly in your spinal canal, no flexion; if it is toward the front of your vertebral column then extension is out for you)

How did you get injured?

Did I just type like a zillion sentences and they all went to h** because my Flash player crashed? :confused:

[quote]astrbac wrote:
Did I just type like a zillion sentences and they all went to h** because my Flash player crashed? :confused: [/quote]

Looks ok to me :slight_smile:

My problem is caused by pelvic tilt (according to me being my own doctor).
What I do now is a lot of backbendings of all kinds and squats without additional weight and swimming on my back,approx.one hour per day daily. At the moment, leg pain is more or les gone and occassionaly is located centraly in lumbar area. So I assume, I am on right track.

Thanks for advices, I really appreciate it.
As for some reason I do not have permission to send PM, I suggested my good friend whose picture You posted that three of us low back painers should go for a coffee in Zagreb some time next week.
Idemo brate na kavu da ne tipkam ovde satima. Jos cu i vrat iskrivit. :wink:

Cujemo se
Sasa

Your post is fine but mine really did went to h***

ENGLISH
I don’t know why you cant send PMs, I also sent one to WEndler and another one to someone but they never did end up in SENT messages. Also, notiffications about new posts on subscribed topics aren’t functioning properly.

Yes, it may be that your issue is improving because these things do improve. As I mentioned, they never seem to completely heal because this tissue is avascular (no blood supply so cannot properly regenerate) but certain liquids do reach it overnight and it does improve a bit.

Once again, this seems to be the common wisdom:

  • if you have extension caused protrusion (towards front of your body) → avoid back extensions
  • if you have flexion caused protrusion (towards back of your body) → avoid back flexions

CROATIAN
Haha, dapace kafa. Javi mi se ovdje na PM ili na email astrbac (at) gmail

Hey astrbac I have some questions for you.

I’m from the United States but have Croatian heritage. We’re looking to plan a trip to Croatia in the next 3 years or so. Where are some good places for tourists to visit? How many of the citizens speak English?

[quote]CroatianRage wrote:
Hey astrbac I have some questions for you.

I’m from the United States but have Croatian heritage. We’re looking to plan a trip to Croatia in the next 3 years or so. Where are some good places for tourists to visit? How many of the citizens speak English?[/quote]

Almost everyone speaks English so you’re ok there. Of course, you will let me know when you get here, won’t you? :wink:

Best things to see:

  1. Dubrovnik area (with Cavtat)
  2. Split area (with islands Hvar, Vis, Brac)
  3. Istria penninsula (Rovinj, Motovun, Groznjan, Pula)
  4. Plitvice lakes national park
  5. Zagreb (capital)

I have ranked the stuff in order of importance so to speak or in the order of the “beauty” :). What type of stuff are you interested in?

Theres also nice mountain paths (Velebit, Risnjak national parks) but the sea is where it’s at

Spending some time near the water, museums, maybe hikes, FOOD, etc. We really want to start adding to our passports. She doesn’t even wan’t a diamond engagement ring, she’d rather use the money for travel, lol.

So mostly touristy stuff. If there are some nice wineries/breweries that would be a big plus.

How common is the surname Kolic / Kolich?

Museums and culture → Zagreb (no water however)

Water → Dubrovnik, Split, Islands, Rovinj (Istria)

You’ll have great fun! Let me know when you’re coming maybe I can assist with some arrangements. Hit me at astrbac (at) gmail so we don’t spam the boards

Cheers!