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(Respectfully) Calling Cressey! Herniated Disc/Sciatica


#1

Greetings all (I hope people actually post?),

*Let me preface this by saying I am going to do my best to make this short! The next paragraph is the very short version, which is followed by the much longer version. Thank you all sooo much for any feedback you are willing to give!

I have a bulged/herniated disc in my lumbar and I am experiencing sciatica in one limb. I want to have some feedback regarding; 1. Rehab/Prehab ideas 2. Timeframe for recovery (when I will be able to do the things I was doing, like running, squatting, deadlifting, and hitting polynesians with my shoulders) 3. Treatment procedures 4. Other people's past experiences with simialar issues. Thanks and here is the story for anyone that gives a shit.

My name is Kanoa and I am a 26yo Rugby player (no not a social player, but a very competitive and accomplished athlete), westsider (follow all of their methods minus 'gear') and avid crossfitter. I believe that I herniated a disc in my L5-S1 on June 11, 2011 (exactly 4 weeks ago from this post...shit it seems my problems started ages ago, and in many ways they did!). Since then I have experienced my share fair of pain and still I have varying sciatica symptoms that are constant.

I have been dealing with lower back issues for the last 6-8 years as a result of a high volume of very high impact activities including Football, Rugby and heavy weight training (surely with some VERY suspect form!).

I have been living on the South Pacific Kingdom of Tonga since January and I have been working like crazy (as a strength coach for schools and elite Rugby teams), playing Rugby, and training my body. This all sounds good, but I have surely been overtrained due to my high workload coupled with my lack of sleep and lack of proper nutrition. This I feel has been the main culprit to my current state of health.

I go back to the states in about one month (September 2011) and plan on getting a proper scan. In the interim I have had my physio friends give me advice through the net and I have read as much as I can on the topic (the forums on this site have helped a lot!). Ifirst gave myself 1 week of nothing but laying on the floor and doing Mckenzie protocol exercises. I have worked myself up to the point of doing 2xweek lower body bodyweight exercise days where I focus on gluteal firing and core strength/stabilization and 2xweek of upper body bodyweight exercise days where I focus on upper body strength an core strength/stabilization. I also try to swim in the ocean everyday (doesnt always happen) and stretch, although I have been pooping out on that as of late.

Things ahve gotten a lot better, but I am still unable to run and/or do any weight training. Everytime I push myself a bit my leg starts going very numb...and to be frank, this scares me. What I am most worried about is my future in Rugby and weight training. I have a very small contract to play Rugby for a team in Chicago starting in Jan of 2012 and then in MAy 2012 a slightly morelucrative contract to play in NEw Zealand. I know I have SOME time, but I need to make sure I can run, get strong/fit, etc.

I feel like I am rambling and that means I probably am. I guess I am curious to know of ways to get myself right so that I can; 1. get rid of my sciatica, 2. run, 3. lift weights, 4. stop getting fat!

Cheers,
Kanoa


#2

Go for the knife! Joking... but seriously herniated disc are no fing joke man... I have a herniated L5S1 that I believe I herniated in Dec 2008. I believe I officially did it maxing out on back sq before winter break (i ran track in college). But the wear and tear had most likely grown over the years I had been hurdling / jumping/ sprinting basically year round for 5+ years that this point... and aparently my femurs dont fit into my hip sockets straight or some crap.

Anywho, I have been dealing with the pain on/off for 3+ years now. I am going to get another MRI in the fall after I start school and depending on the vertic am considering surgery. I dont want to take the 'quick fix' or what have you. But, I want to get back into training w/o pain and lifting heavy. All I do now is front squat (maybe up to 90 lbs) (i used to back squat like 150 for reps) and hang clean maybe up to 75 lbs. So it sucks!
Plus Im a runner (a hurdler for that matter) I like to pound and send unhealthy shockwaves up my spine.

But, stretching, icing, rehab (i can send you some exercises if you want). Def get an MRI to see the real damage... if it hurts in your ass / leg (its not a pinched nerve in your ass) The lovely and smart athletic trainers in college didnt seem to get that at first. But, basically if you know of anyone with disc issues it kinda doesn't go away. You can stretch and prehab till the cows come home... but if you go to lift or move something and arent careful... the pain or numbness can return.

Anywho, hope this helps! Good luc!


#3

Cheers brother I really appreciate the comments.

I have had nobody check it out as I am on a freakin island with next to nothing interms of health care.

So you have been dealing with this for a few years and are able to do some weights, but...are you able to run? I need to start running for my fitness, vanity and sanity!

Have you been doing a ton to strengthen your posterior chain, in particular your glute med?

I have been reading up (a little) on the surgeries they perform. Seems like slicing just a tad of the disc can do heaps in regards to letting things settle. From there it would be PREHAB PREHAB PREHAB I presume.

But like I mentioned, I need to start getting into incredible shape by the end of the year at the latest! So, please send me anything that ya got.

Once again I appreciate everything you ahve said!

Also from what I have gathered just on this forum, Stuart McGill's books are something to look into as are the MAgnificint Movemnet Warmup DVD' or whatever its called. And Cressey is awesome! Read everything he has written. The backsavers articles are great. Hoping he can lend a few minutes to post on here!


#4

http://www.pnbconline.com/pages/ResearchArticles/
Check the studies, get the gist of it, and practice. Start slowly. If you don't understand how to apply the info, send me a PM. :slight_smile:


#5

THE man! I am reading these articles right now. Much appreciated brother...


#6

it was a few yrs ago out of the British medical journal the Lancet, that showed that 50% of all asymptomatic (pain-free population) has some degree of disc herniation...ie - herniated discs don't always (if fact, only half the time) equal pain...Trigger points in the gluteal, piriformis and a few other muscles can 'refer' pain down your leg identical to true sciatica that is caused by nerve compression...most doctors don't test/look for trigger points in their evaluations...and if it is a trigger point, much easier to treat than a surgery...let me know if you want more information...good luck


#7

Thanks again for the info. I have read many things similar to what yo linked to and I definitely have the gist of my situation. I have begun a progressive rehab/prehab program along with general strength training exercises, but have not touched a barbell or dumbell as of yet.

I would love to know if you have some good ideas for specific exercises I should focus on.
I am currently doing 4 days/week of strength exercise that is comprised of mostly bodyweight exercises and 'core' (for lack of a better term) strength/stability exercises.
Included are; push ups, pull ups, dips, mckenzie extensions, ab wheel, reverse hypers (not on a proper rev hyp machine), supermans/bird dogs, mcgill curl ups, leg raises (not straightening my back), plannks/bridges, med ball side throws (light and under control), hip raises, back bridge/hip thrusts, squats (bi + unilateral), low box step ups, bulgarian squat, 1 leg RDL (w/dowel)...prob some others.

Sorry to be a pain in anyway, but if you dont mind letting me know if any of these have potential for being harmful or if there are some exercises not on this list that I need to include. Basically I want to keep my muscle from wasting away (as well as continue to keep a high amount of HGH in my system to aid the healing process) and to focus on gaining more strength/stability in my 'core' (focusing on getting my glutes firing more). I know I also need to do more for my flexibility.

I am fairly confident that I am on the right track and to allow my body to heal without doing anything crazy (I am only now going over week 4) but the thing that worries me the most is the numbness I feel in my right foot. I need to be able to run and train/play at an optimal/maximal level sometime in the near future.

Thanks for any feedback you have and know that I am extremely appreciative. Cheers...


#8

Thanks for the info. Much appreciated.
I think I have a lateral herniation in the lumbar region on my left side. From what I have gathered this has caused some form of obstruction on the right side of my spine (possibly a muscle spasm for protection), which in turn has caused sciatica symptoms in my right. If this is the case, it seems like some soft tissue work would help alleviate the sciatica. I am looking to get some massage done this week.
Anymore info you have on specific treatments/exercises that you think could help would be welcome. Also if you want to check out my response to the last post and give any feedback in that regard.

Thanks again my friend...


#9

Sorry I posted a reply to your previous post, but didnt 'quote' you so yo uprob were not notified. Thanks again...


#10

Cheers mate!
Hope this'll help:
Basically, the idea of what dr. Nelson says is that some, limited flexion should help. Extrapolating, this includes some side flexion, too.
Which means, you could/should find a hyperextension bench, get your navel on the pad, and start doing back extensions. For the lateral flexion, just stay upright and bend slightly from one side to the other, in a slow and controlled motion, without any twisting.
I do a kind of extensions where I bend as much as possible at the waist with my back straight, lock my hips, and then start flexing and extending the spine.
Regardless of exercise, DON'T hyperextend the spine.
Ever since I began doing this, my back feels much better and I got less and less pain...also, I had some numbness with asymmetrical loading, which got better/went away after I began doing some side flexion exercises...
Sadly, the guys at PNBConline didn't answer my emails, and don't give their protocol. I did sets of 12-20.,not to failure
So, give it a try for a few weeks (the pain might shoot up at first). Make sure the movement is controlled, and you don't get into end range flexion (more so, end-range extension): i.e.: some flexion, not full flexion.
I'm NOT an expert...while the advice might be good, it might also be a little risky. Proceed at your own risk. BUT, the study results are incredible...

Also, a guy whose name I won't mention, keeps shooting me e-mails about how traction therapy (using, for example, an inversion table) can be so effective as to make one no longer require surgery (the negative pressure created will pull the disk back into its place - theoretically; sounds plausible); you could also try this, but you'll need an inversion table or a designated apparatus.

Finally, Pavel's guys (the Kettlebell fellows) swear by swings for rehabbing their hernias...

Hope this helps,
Eisen


#11

Hey sent you a PM with some stretches / rehab i do

Also, I still do run... remember I herniated it 1/2 throguh my junior year so I sorta kinda continued to train/compete for the rest of college and this 1st year since graduation. But some days / workouts I'll have to not do anything or stick to the bike / eliptical or aqua jogging... I also try to do a lot of my running on grass / turf. I've also had to stop workouts short bc during I'll start getting sharp pain in my ass that I can't slash shouldnt push through

Best, Kerry


#12

Did you really just say that you are an avid crossfitter (with bad form) and train elite athletes?!?! EEEEKK!


#13

Are you referring this rather rude comment to me? If so, is there a particular reason you have concluded that I am ANY kind of exercise practitioner "with bad form?"

Thanks for your awesome contribution to this forum by the way.


#14

The time you have spent replying is much appreciated. Thanks for that.

I have been doing just 45deg extensions on a back ext bench, but plan on doing full extensions and isometric extension holds.

As for hyperextension...I do the mckenzie lying extensions (lyingg face down i push myself up on my palms) and it feels quite good, but it is obviously putting my spine in a state of hyperextension. You are familiar with the mckenzie protocol?

When you do side flexion, you are simply standing upright and bending to each side without twisting, correct?

And sorry to seem like I didnt checkout the link you gave me, but I did read all of the articles on there, and could not find a source of exercises. Maybe it was in the bottom of one article, past the references?

As for traction therapy; I have started doing 10 second holds on both a dip bar and a pullup bar. I tense my whole upper body, then breath out and slwoly release my bodyweight. It feels 'funny,' but ultimately seems to be doing some good for my back. Apparently besides pushing anything back in it also helps the healing process by allowing more fluid to enter the area (more oxygen, etc).

Thanks again...


#15

45deg with or without spinal flexion? (i.e. do you also flex the back or do you only flex at the hips?)

http://www.pnbconline.com/pages/ClinicalEffects/
He gives some images of the exercises he used, and a description, the take home points being "isolated lumbar spine exercise with the pelvis tightly fixed". So, you could use the 45 degree hyper bench but place yourself so that the pad is under or just beneath your belly button; the point being that the pad should be placed so that you can't flex from the hips and are forced to flex from the spine. Depending on whether you did such exercises before, it might burn a lot ("the burn"...oh yeah), and you might get very sore (you are isolating the back extensors).

Yes, I am familiar with the Mckenzie protocol, especially the press-up/hyperextension exercise. If you feel better, it's not my place to make any comments. Just that for the past few years I found it written in a lot of places that hyperextension of the spine is unhealthy. But, as I said, if it feels good do it.

For deloading, if you don't have an inversion table or other dedicated equipment, I'd recommend the techniques listed in this article (superb article, by the way - except the part where it says not to bend; as written above, some flexion every once in a while is very good):
http://www.T-Nation.com/free_online_article/sports_body_training_performance/conquering_enemies_of_the_spine.
It's the fact that this way you can gently pull on the spine. If you completely hang from something and try to relax, there seems to be a lot more tension. Try and see which works better.

You're welcome.
Hope this helps,
Eisen


#16

And I had previously read that article and have been incorporating their ideas in my spinal decompressions. Thanks again for everything my friend.


#17

Everybody's advice here is great. To add my own experience - I'm a 27 year old male. Got a 5mm disc bulge at L4-L5 impinging on the nerve about a year ago. I work as an athletic trainer and constantly rehab low backs and other orthopedic injuries. Because of this, I'm probably the worst patient there is because I will refuse to believe it is the worst case or I over-analyze it all. So, with that mindset, I tried to take care of it myself and finally saw an ortho 2-3 months after the injury, got the MRI to confirm the size and location of the bulge, and continued with conservative treatment options. I ended up getting 2 epidural steroidal injections which helped significantly. Like you, I struggled with advancing past the basic rehab exercises until I got the injections.

From my personal experience and experience working with athletes with disc issues, it just takes time. Patience it the best thing you can have. Disc injuries are one of the most frustrating injuries to deal with as a person and as a therapist. Even now, 1 year out, I have had a recent minor flare up of the disc, but was able to calm it down with basic intervention techniques. Just slow into it and realize that you will have to make LIFE changes to maintain the improvements from the disc. I continually return to do the basic McKenzie drills and lumbar rehab techniques to keep things status quo and to settle/prevent any set backs.

It is a shitty situation that you won't be able to see a physician until you are back in the states, but just make due with what you have for now and definitely go see a doc when you get back. I would start with some decompression activities and continue with the McKenzie's. Also, I'd recommend continuing with the body weight exercises and if you are going to try to advance your S&C exercises, I would stick with single leg variations for now.

Best of luck with it all and keep us all posted.


#18

Not sure I agree with single leg stuff. Not that its necessarily bad. But, if the glute isn't firing bc it doesn't know how anymore... kinda makes doing single leg work obsolete. I learned that last summer at my internship one of the coaches told me I prob shouldnt waste my time on single leg work, esp if my glute wasnt firing then he did a hand full of tests/tricks and turns out the lights are off and no one in home in my left glute.

I do however agree with you on epidural injections but I heard you should only or can only have a total of 3 or 4. I already had 2 in college and they did work great and I was pain free and able to compete for about 3-6 months. But then the pain returned and I had to get another shot. If I could just get a shot 2-3 times a year and train how I want / used to, I would. But, I dont think thats the brightest or healthiest of options.

Just my opinion...


#19

I completely agree with you kik. If the glute isn't firing, than gluteal activation work, etc should be the focus of the training sessions. I may have not stated myself clearly enough but I was saying that if he was ready and going to try to advance his S&C program to stick with single leg exercises while the disc is still healing. Thanks for pointing out the possible misinterpretation of what I was trying to say.

Also with the epidural steroidal injections (ESI), like with any cortisone/steroid shot, overuse of the injection can degrade the joint juncture and tissue. They are generally prescribed in series of 3 injections, but is recommended to only do the amount of injections needed. Future ESI's can be prescribed, but physicians will generally want to wait a good amount of time before prescribing another series. Getting a shot 2-3 times a year would not be the healthiest option for sure. In your specific case kik, your body and disc were likely not ready to compete and train at that high level, which is why your pain returned. That is the one drawback to the ESI's; they make the area feel better and can mask remaining issues. I've always strongly encouraged athlete's I've worked with for disc issues to continue to not progress their training immediately after they complete their ESI injection series. The injection can potentially "shrink" the disc some and help with decreasing the surrounding inflammation, but there is still tons of rehab that should be done before progressing to higher level training. One athlete I worked with was unable to perform any sort of significant training for upwards of a year and then afterwards, once she was ready to push, made gains very quickly.


#20

Thanks a lot, your info and suggestions are all helpful.

Although this has been somewhat of a chronic issue (a bulged disc for some time), Im coming up on being 5 weeks out from the incident that seemed to have turned a bulge into a herniation. I must keep reminding myself of this, as I start getting extremely frustrated. The thing that worries me the most is the numbmess I feel in my right leg. I understand that this is the last thing to go away, but its a bit unnerving (pun intended) all the same. I know all cases are different, but what is a general timetable for getting back to at least light running? My goal is to be back to full on strength and conditioning (weights, running, metcons [crossfit specific]) by December. This is realistic, yeah?

I have been focusing on getting my glutes to fire more and although I feel like my right glute/s are a bit weaker and respond a little slower, things are coming along. Low box step ups and hip thrusts/bridges seem to work best. Any other suggestions for glute intensive exercises?

As for steroids; I am not very interested in epidural steroid injections as I would not want to mask anything (the little knowledge I know about them is that they operate similar to localized cortisone injections, correct?). I am thinking about responsibly (is this possible :wink:) using anabolic steroids for a 6 week cycle when I start to get my body back into shape for the upcoming season (around the end of the year). I have never done this and I am considering it for a variety of reasons, but to me it seems that if I do the proper exercises, I should be able to increase the strength and stability within my 'core' (frick I hate using that word) by a significantly larger amount than without cycling. What do you think of this idea? Pros/cons?

If you had to pick 1 thing that has helped you with your own back problems what would it be?

Once again I really appreciate the feedback.
Cheers...