MRI: L4-5 Disc Herniation

Bigger Stronger Leaner
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[quote]For inhibited muscles, I recommend 1) the exercises in Stuart McGill’s book; 2) some of the moves in the Maximum Mobility DVD; and 3) Pete Egoscue’s book Pain Free.
[/quote]

I would recommend Sarno as well.

My critique of Egoscue is that he never deals with trigger points and myofascial pain and his writing style makes one think he’s impressed with how smart he is. Also, his exercises take a long time to perform.

The best treatment I’ve found for the back is to get a lacrosse ball, sit in a chair, and release those paraspinal trigger points up and down the back.

The psychosocial aspect for you may be huge, as judging by your participation on this board, you are probably an overachiever, perfectionistic, intelligent, and have a bunch of other predisposing factors towards repressed anger in your subconscious.

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[quote]bushidobadboy wrote:
(A lot of helpful stuff)

Seriously though, stability exercises are everywhere, BUT unless you are being closely monitored by a PROFESSIONAL, you won;t have the first clue about exactly where you are going wrond, and how to work to correct it.

It really is worth finding a specialist in your area and paying them to teach you how to look after your back. It’s the only one you got and is probably the most vulnerable skeletal structure in your body.

Bushy[/quote]

Hey, thanks for writing all that, I really appreciate it.

My MRI didn’t show any extrusion in the disc, just protrusion. I am currently doing physical therapy consisting of a lot of stability exercise, stretching, soft tissue work and other recovery therapy. The pain has for the most part gone away, I just wanted to know what to expect regarding the state of the disc itself.

Just to be sure I didn’t misinterpret a few things:
-The disc does not de-protrude (technical term?) on its own.
-Many times, an individual with a protrusion/herniation can still lift.
-The disc can still support a spinal load?

I know you haven’t looked at my back yourself, so I understand that you may not have concrete answers. I’m just young, looking to continue training, and very aware that you don’t get a second back if you mess up the first one.

Again, thanks.

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What worked for me:

Chiro work in the acute phase
no deadlifts (while i was in pain)
SPRINTING, relaxed fast powerfull sprinting with an upright torso and correct form. This strengthened my hamstrings, glutes, and abs and gave me instant spinal stability= no pain.

No amount of front squats, back squats, plank stabilization work, crunches or ab work seemed to help in my case.

Whenever i stop sprinting for a significant amount of time, the pain slosly starts to creep up, its not unbearable but it’s there.
As long as i do this primal activity, i can lift heavy, hard, squat big weights, and deadlift too, just like pre-injury.

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Bushy-

You give some great ideas. If I may ask, and it might already be in here somewhere so forgive me…

I seem to have reocurring pain in my tailbone area and now in the left hip and buttock area. I looked up the last bit of info given to me as far as the piriformis muscle. Can you advise what would be a good exercise to fix this issue.

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I forgot one other question. I have read a lot about muscle imbalances…Could that be my problem? and if so is it single leg work that helps straighten this out. Thanks again.

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WOW you guys can really write a lot!

I had this same problem. However I decided not to pay attention to it and it gradually got worse until I lost about 10% strenght difference between the left and right leg.

I had the microdisectomy done 7 years ago…

The most important thing, whatever you decide to to, is to find a gym that has a reverse hyper machine or a 45degree hyperextension and perform about 100 reps every day.

From my experience and dicussion with the doctors (both neurosurgeon, ortho and family) they concluded that most disk herniations go unnoticed because the user has a high endurance level in that region. So in essence the muscle acts as a “cushion” and prevents the protruding disk to move and you don’t get all the symptoms. However when you sleep all muscles relax and that is when you get irritation.

By working on the muscular endurance of that area you protect it, nourish it and prevent the hernia from further damage.

Not as technical as Bushy’s, but been there done that and this is the “after the war” experience I can add to this thread.

Good luckk and keep us posted.

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[quote]bushidobadboy wrote:
acidhell wrote:
What worked for me:

Chiro work in the acute phase
no deadlifts (while i was in pain)
SPRINTING, relaxed fast powerfull sprinting with an upright torso and correct form. This strengthened my hamstrings, glutes, and abs and gave me instant spinal stability= no pain.

Ah yes, strengthening the posterior chain and the muscles that prevent anterior pelvic tilt/lumbar lordosis, can often work wonders. It would seem then that your back pain was mostly caused by facet irritation, due to more laod being carried on the posterior motion segment because of the (minor) loss of disc height.

No amount of front squats, back squats, plank stabilization work, crunches or ab work seemed to help in my case.

Whenever i stop sprinting for a significant amount of time, the pain slosly starts to creep up, its not unbearable but it’s there.
As long as i do this primal activity, i can lift heavy, hard, squat big weights, and deadlift too, just like pre-injury.

I am glad you have found an exercsie method/modality that works for you. Unfortunately not everyone can sprint, plus it’s a hard exercise, which could feasibly cause more damage than good, in an individual unused to sprinting.

Here’s a possible ‘experiment’ for you…

Compare your lumbar lordosis during the periods when you are pain free to those periods when you are in pain.

If there is a noticeable difference ,i.e. there is greater lordosis during painful periods, then this reinforces the facet irritation idea.

It also means that you might also wish to begin stretching your hip flexors, since they will have a tendancy to tilt the pelvis anteriorly, increasing lordosis and the load on the facets.

Best wishes

Bushy[/quote]

Very good observations, Bushido! My lordosis DOES increase when i am in pain, no doubt about that! When i am not in pain, my APT isn’t so noticeable! The pain free periods are when my hamstrings are hypetrophied through sprinting , along with my lower abs/core.
Facet Joint Irriation huh? a very interesting and likely scenario!

Btw, my hip flexors are very supple, so are my hamstrings

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[quote]PRCalDude wrote:
For inhibited muscles, I recommend 1) the exercises in Stuart McGill’s book; 2) some of the moves in the Maximum Mobility DVD; and 3) Pete Egoscue’s book Pain Free.

I would recommend Sarno as well.

My critique of Egoscue is that he never deals with trigger points and myofascial pain and his writing style makes one think he’s impressed with how smart he is. Also, his exercises take a long time to perform.

The best treatment I’ve found for the back is to get a lacrosse ball, sit in a chair, and release those paraspinal trigger points up and down the back.

The psychosocial aspect for you may be huge, as judging by your participation on this board, you are probably an overachiever, perfectionistic, intelligent, and have a bunch of other predisposing factors towards repressed anger in your subconscious. [/quote]

Sarno is interesting but not really helpful IMO. He seems to think that chronic pain is caused 100% by psychologically mediated muscle tension, and that’s just not true. And to the extent that the mind exerts an effect, what can you do about it? He would argue that if you use that lacrosse ball to work on a trigger point, you’re reinforcing the fear that something is actually wrong and therefore doing more harm than good.

Egoscue’s writing is very bad. And he probably overestimates the importance of the postural issues a bit. But the back menu in the book “Pain Free” does not take too long, and even a quick runthrough of them is tremendously helpful.

Trigger point therapy is critical in my experience. My approach is first do the trigger point/soft tissue work, then Egoscue, then some activation and mobility stuff from Maximum Mobility and McGill. I also use Zostrix HP (helps reduce Substance P and may cause cell death of hypersensitized pain transmitters). Then I ice the heck out it.

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[quote]bushidobadboy wrote:

Ultimately though, single leg work should be a staple of back pain sufferers in my opinion.[/quote]

I believe it, but why is this?

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Sorry for the dumb question, but what is PIR stretching. Is that for the piriformis? And if so, what stretches do you recommend?
As for ART…Can it be done with a ball at home? I have tight scheduling, getting to the PT is sometimes difficult.

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[quote]bushidobadboy wrote:

Because it develops the strength and co-ordination of the lateral stabilisers of the hip, knee, ankle and spine. It also improves balance and proprioception too, if done right.

Bushy[/quote]

Got another question for you, Bushy. (Hope I’m in the right thread.) What do you recommend for the facet joint irritation? In terms of therapies but also especially how to train.

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Bushy-

Thanks a lot for all your advise. I did get to the PT yesterday. He agreed that it sounds like piriformis. He gave me stretches and exercises to do. It does feel a little better already. You are a great asset to this site.