Herniated Disc

[Mantic]

Hi Guys

I've been a lurker here for quite some time and thought that it was time to join in by sharing an experience I've had. Because I gained some indirect assistance from the RossBoxing site, I have started the same thread over there (sorry for the repetition - I won't be transferring anything else, just this initial comment).

For the last 10+ years the majority of my training had been classic bodybuilding but this site (and RossBoxing) had opened my eyes to much more interesting possibilities and also more than hinted at the drawbacks associated with a pure bodybuilding regime.

Back in September 2007 I suffered a left paracentral disc herniation at L4/L5, resulting in compression of the left L5 root (all confirmed with an MRI). I won't go into how it happened, suffice it to say that it was my fault and although desperately irritating, I have long since stopped berating myself. The road to recovery is long enough as it is without making things worse by beating yourself up over "what if".

My symptoms have been major lower back pain, surprisingly bad referred leg pain (up until the second quarter of 08), and major loss of mobility, strength and confidence.

2008 was a very long year with regards to recovery, especially since I have been unable to afford proper phsyio treatment and the GP / NHS / Hospital treatment offered to me in the UK has been shockingly awful. Interestingly enough, it was only when I realised that no one was going to help that I really started improving.

My training has changed from classic bodybuilding (lots of isolation, failure sets, reps in the 8-12 range, etc) to almost a pure strength training routine. As such, my training now includes lost of squats, deadlifts, chins, straight back straight leg deadlifts, bent over bench rows, overhead press, etc and almost all in the 4-5 'not quite to failure' rep range. So it's lots of compound movements, no straps or belts, lots of grip work and solid range of movement on everything (especially squats). I've also been doing considerably more cardio (rowing and XC MTB) and a heck of a lot more core work. I wouldn't have tried this way of training out had it not been for this fantastic site - it really helped me to re-evaluate my training goals and has inspired me to getting a far more functional body.

At this moment I have very little back discomfort, my strength has increased considerably and so has my fitness. My confidence has returned and I'm painkiller free. One area which has continued to flag is my lack of flexibility in my hamstrings - try as I might I cannot get close to my previous levels of flexibility - any suggestions would be appreciated but I warn you, I've tried everything I can think of : )

I must also thank Mehdi for pointing me in the direction of the truly excellent Starting Strength book by Mark Rippetoe and Lon Kilgore. It was this book and the Stronglifts 5X5 routine sourced on this site that really got back on the road to recovery. Many thanks Mehdi and anyone else who contributed!

I guess what I'm trying to get across is that if anyone else has suffered such a seriously unpleasant knockback as this, despite what your body may feel like and regardless of what GPs and doctors and specialists might have you think - there is always a measure of hope, and hope is always worth holding on to.

[Jcraig]

Fantastic story, should be stickied, we get so many posters here who get a little sore and are ready to quit at a moments notice.

Welcome to the boards.

[Mantic]

Hi JCraig

Thanks for your input - forgive the cliche (but it's the truth), quitting was not an option.

Not train????? Now THAT is sheer madness : )

[zizzy80]

This is actually extremely encouraging. I'm 29 years old and recenly suffered a similar disc injury. I'm sure its not as severe but it really scared a hell out of me. I was on 5x5 and was going good but now I'm afraid to take up the weights again.

I feel like by squatting, by putting lots of weights on my shoulder will kill my back and make the discs worse. But I guess that's not the case if you did it too! I should get back out there and start the training as soon as I get well.

Thanks for the post!

[as19700915]

Hi,
Great to hear about your comeback. I have recently experienced the same accident and am trying to "train" through it, though the doctors say i need to operate.
I changed from back squats to front squats and dropped the deadlift. I see that you continued with this..... How did you manage?. I experience problems with the deadlifts directly after the first rep.
I also have lost mobility on my left side and it would be great if you could share any tips.

//AS

[Mantic]

Hi Zizzy80 - yes, I felt very much like that to begin with. However, one thing is certain, nothing can improve unless you work at it (not meaning to preach there). My advice would be to start light (light in weight and light in frequency), work hard at perfecting your form and always train within your pain limits (not just those whilst training but also those for the days AFTER training). I found that, as with many strength trainers, my pain threshold for resistance exercise is quite high, consequently I could train through pain without really noticing it. However, a day or two after and the pain would set it.

If you can manage them, consider full squats (backside almost to the floor) with a light weight. I found that these really helped. I don't do them now as my leg strength is returning but as part of rehab, they really helped me.

as19700915 - to begin with, squats were hard - unpleasant even. I really worked on perfecting my form (the book I mention in my first post is awesome). Deads I also found difficult. I suffered back pain for a few days after doing them but as the months went by, it slowly eased up.

I'll put me training regime up in this post - hold on sec, let me grab it : )

[Mantic]

Hi Zizzy80 - yes, I felt very much like that to begin with. However, one thing is certain, nothing can improve unless you work at it (not meaning to preach there). My advice would be to start light (light in weight and light in frequency), work hard at perfecting your form and always train within your pain limits (not just those whilst training but also those for the days AFTER training). I found that, as with many strength trainers, my pain threshold for resistance exercise is quite high, consequently I could train through pain without really noticing it. However, a day or two after and the pain would set it.

If you can manage them, consider full squats (backside almost to the floor) with a light weight. I found that these really helped. I don't do them now as my leg strength is returning but as part of rehab, they really helped me.

as19700915 - to begin with, squats were hard - unpleasant even. I really worked on perfecting my form (the book I mention in my first post is awesome). Deads I also found difficult. I suffered back pain for a few days after doing them but as the months went by, it slowly eased up.

I'll put my training regime up in this post - hold on sec, let me grab it : )

[Mantic]

Mantic's Strength Training Routine

Notes: These show how many sets of 4-5 reps I do per exercise. For example, Pullups X3 means 3 sets of Pullups with reps of 4-5 (not quite to failure) with a 2.5 minute rest between sets.

Mon - Off

Tue - Weights
Pullups X3
Lying Dumbbell Row X3
Seated Alt Dumbbell Curls X2
Crunches, weighted X2

Wed - Weights
Squats X4
Straight back straight Leg Deads X4
Seated Med Ball Twists - fast

Thur - Cardio
Cardio, rower, 30 mins
Crunches to failure
Core work - varies

Fri - Off

Sat - Weights
Flat Bench X4
Overhead Press X4
Dips X2

Sun - Weights
Deadlifts X2
Calves X3
Crunches, decline X2 weighted
Crunches, oblique

Each session starts with 3 minutes cardio on the rower and a couple of minutes of star jumps, jump rope, etc.
Most exercises start with an empty bar for 20 reps then half my training weight for 10 reps. Squats and deadlifts have first set with 10-20 kilos off training weight - I still class this as a training set.

After each session, I stretch as follows :
Ab stretch on fitball
Full back stretch (rolling in a ball)
10 minutes for legs - there are loads of stretches I do here, suffice it to say, I cover most of the leg muscles.
Stretches specific to whatever I trained that session.

Finally, on days off I usually do a warmup and full body stretch.

I'm very fortunate in having my own weights (power rack, couple of hundred kilos of olympic plates, olympic bar, olympic ez bar, standard dumbbell bars, couple of hundred kilos of standard plates, incline / decline bench, rower and loads of odd bits and pieces).

[Mantic]

Another thing that I have found to be very helpful is not sitting down in the mornings - sounds crazy but the tissue around your spine is swollen with fluid in the mornings and so pain receptors are compressed more. I've found that any pain-inducing movements in the morning cause discomfort / lack of mobility for far longer than similar movements later in the day. Consequently you need to stop causing yourself ANY discomfort in the morning - at least until you're properly warmed up.

So, once I'm out of bed, I stand for at least an hour. For me, that means eating breakfast stood up, getting the kids ready, etc without sitting down at any point. Finally, I take the dog, which is 30-45 mins. After this my back is warmed up, excess fluid has drained away with the help of gravity and I'm closer to being pain free for the rest of the day.

A word of caution with my routine (above) - it took me a year to get to this stage. Before this, I tried lots of different routines, including 5x5. You may need additional back work (back extensions, for example), additional rest time, fewer sets etc. Never train with pain in the gym and try to train so that you're pain free outside of the gym (though this latter point could be impossible). In fact, for several months I did my pre-exercise warm up routine (as described above) after breakfast every morning regardless of whether I was training later in the day or not - this really helped.

I hope that this is of use, but feel free to ask for further clarification.

[zizzy80]

Mantic - Thank you so much for your helpful posting. This is of tremendous encourage to me.

I think most people hurt their back in the morning after they get up. Since I have the history of back injuries, I tend to be very careful in the mornings as well. I think I never tried to walk in the morning since I have a rather long commute to work (45 min), which means sitting down all the way. I don't think its helping me not a bit.. Maybe I just need to get up a little bit early and give my back about 20-30 min walk around. Never really thought of that before.

I just have one more question though. How soon were you able to start lifting? How long did you have to wait? My pain is almost gone now from the recent injury but twisting motion still hurts me somewhat. It's been about a week for me since the injury. How do you know you are really ready?

[Mantic]

Hi Zizzy80. When did I get back to training? Well, I never stopped. I carried on but always within my own pain limits. If an exercise caused me pain, I either dropped the weight or found an alternative that didn't hurt. For example, I couldn't do squats with a weighted bar, so I did squats with my own bodyweight instead. Overhead press was painful, regardless of how much weight I did, so I did seated shoulder press with light dumbbells. This meant that for quite some time, I wasn't hitting the weights, but I was still exercising - just within my pain threshold.

I would say that this is the key to finding the answer to your question - "when can I start training after being injured?". Answer, whenever / however you can train with little or no pain.

If the injury is a short term thing - a week or possibly two, then you can easily forget about training and take the time off. After all, most of us can benefit from the occasional time off exercising. However with a long term injury, taking the time off until we feel better can be hugely detrimental (lack of exercise weakens us, muscles atrophy and tighten, which leads to more pain so more time off).

On another note, if you don't have time for the morning walk (or it proves to be ineffective) you could perform a morning warmup routine and light stretching (very light).

Hope this helps : )

[Monk]

Hi Mantic,

Great to hear your story, I just wish some of my clients would take a leaf out of your book.

Going back to your original post you are dead right that the only person who can really help you is YOU!! Regardless of where you live and your financial constraints people like me (I'm a sports Therapist) can only do so much to get people going again. I'm glad you have found some advice that is working for you and it sounds like you are well in control of your injury which is great.

A couple of things came to mind whilst I was reading your posts, the first was that your tight hamstring symptom may be due to some neural tethering. (scar tissue binding to nerves) Do you have any neurological deficits? (eg areas of numbness or inability to differentiate pain from normal touch or weakness in certain plains of movement etc) These may be very mild and you may not even know you have them but if you do then this might indicate neural tethering.

Sit on a table with your legs dangling off at the knee. Sit up straight in an exaggerated 'perfect' posture. Slowly straighten one leg at a time? Do they both go the same distance? Now try doing the exercise in the same seated position with your feet fully dorsiflexed (i.e bent up at the ankle) and then plantarflexed (bent down) What difference does that make to your range of movement?

If you try all this both at the start and end of the day and let me know how you get on. I'll be able to give you some advice NB none of these should be painful.

[Mantic]

Hi Monk

Sorry taking so long getting back to you. Thanks for your interest. I ran through the tests and here are my results:

1. In the morning the sit test : right leg almost goes straight, left leg is slightly less. Results are much the same in the evening.

2. Plantartflexed is easier for both - almost no difference between them regardless of time of day.

3. Dorsiflexed is worse for both with a prickly sensation in the heel of both feet (worse in left).

My lower back / hamstring flexibility is truly awful in the mornings but it improves after a couple of hours. If I train then my flexibility is much better (though still a long way from it was prior to the injury).

Once again, thanks for any help : )



 
 

[sean]

Thanks for posting that story, Mantic. My story is pretty similar (herniated L4/L5), but lucky for me I never had any lasting back pain; just a lot of numbness, weakness, and lack of mobility in the legs. I'm almost fully recovered now - amazing what squats can do for your body.

Anyway, as far as hamstring flexibility, that's always been a hurdle for me as well. Just remember to do some leg swings before you squat and you should be fine.

[Monk]

Hi Mantic,

sorry for the delay getting back to you: Here are my thoughts based on what you said and in the order you said them:

1) This is a good sign. Disc protrusions are usually worse in the morning as the disks hydrate overnight. The fact that your continued symptoms are unaffected by time of day indicates you are very much on the mend... as I think you already knew!! Now with left being worse than right, and assuming there is no obvious reason for this such as history of trauma to the left ham or calf then I am very inclined to think, neural tethering... ie when the old injury was inflamed your body has laid down collagen fibres in response. Bad news: you cannot get rid of them. Good news: you can remodel scar tissue but it takes time... lots of time.

2) Again this indicates your tight hamstring symptoms are actually likely to be due to tethering rather than actual tight hamstrings. Planter flexing takes the stretch out of your sciatic nerve but should not affect your hamstring (muscle) tightness. ie you have found more range of motion by releasing neural tension.

3) Very strongly confirms the above, you have put extra stretch on the sciatic nerve, the 'tight muscle symptom' seems worse and this is double confirmed to because you also report mild neurological symptoms.

4) your symptoms improve slightly with training. This does not support what I have said above but doesn't disprove it either. I think this is a different thing. It's a complicated neurological symptom called 'facilitation'.

By training (especially squats) you are firing your core muscles which means less neurological firing needs to go through your other postural muscles in the affected area which causes less associated firing.

(How good is your physics?) If you imagine your nerves as shitloads (thousands) of copper wires all in close proximity. If you send a current down 1 wire the magnetic field that that creates will induce current in the wire next door. Now this doesn't mean that that current will necesserily be powerful enough to do anything but it will mean that less stimulation IS required to do something. This combines with the electrical fields of the nerves that are being stimulated by the presence of scar tissue and then you see that if the nerves that go to your hamstrings might be having a false current induced in them which you can't turn off with your brain. It may, therefore, cause them to feel tight when a better description might be a 'mild contraction'.

So when you exercise you are activating other core muscles which may be inhibiting the amount of firing in affected area and therefore reduces the peripheral firing making the symptom feel easier.... phew, does that make sense?

So Exercises:
To beat neural tethering you need to re-model the scar tissue. Imagine your nerve as a piece of cotton in a hose pipe. That hose pipe is full of scar tissue. If you gently tug on the cotton eventually it will come free but don't tug too hard or you may damage the cotton. Basically do the sitting test, extending the knee with the foot dorsiflexed. Gently bounce on the end of range about 10-15 times 3 times per day. Be patient it will take time, don't over do it and stop if symptoms are aggravated.

To beat facilitation. Do everything you are already doing. work the core muscles and also work the flexibility... plenty of low back stretching after work outs but lay off the hamstrings. Remember when you stretch them you are probably stretching nerves not muscles.

Hope this helps, let us know how you get on.