Herniated Disk, Any advice for future?

[pHEnomIC]

I have been lifting seriously for 3 years using mostly philosophy similar to starting strength and a 5x5. I went from a skinny 6'2 180 lbs to 220lbs lean and maintained around there. My squat got up to a deep 350lbs and the deadlift got to a best of 475.

I had a few back injuries when i started training but form issues were the case. I was fine for a couple years. One day I was squatting ~200 lbs rapidly as a warm up, I went down and came up and something didn't go right, I stopped my workout there. It quieted down then i kept reinjuring it doin the most trivial things even when giving myself a couple weeks off. Eventually saw an orthopedic surgeon and my l5 s1 disk was pretty degenerated and a pretty big hernia out the back. I took my doctor's advice and haven't lifted since (about 3 months).

He said I was too young for surgery at 21 but nothing is really working treatment wise and I've gotten worse sciatica.

Ive seen an gp, osteopath, neurologist, neurosurgeon, and even chiropractor. None have really gotten me anywhere. We have tried NSAIDS, tons of rest, cortisone injection, and even oral cortisone.

I get a lot of good results from inversion table and am considering doing spinal decompression therapy.

My question, do you have any advice for this injury? The neurosurgeon told me to see where I am at after another couple months and then he may recommend surgery.

Will I ever be able to lift again? Weightlifting was a huge part of my life and it really is hard on me lately. Ive been able to maintain bodyweight and mass with diet but I don't know how long it will last.

Do you recommend I get surgery or try anything else? I realize you will say something along the lines that you don't qualify for medical advice, but medical advice so far is really leaving me open ended.

Do you have experience with any other athletes with similar problems? Have they recovered and been able to get back into the sport? My current plan is to wait till Im done with school and try spinal decompression (I've had a consultation and a few trial treatments and they helped temporarily, but I am not sure if it has long term results and it is very expensive (not covered by insurance)).

[Mark Rippetoe]

You can do your own spinal decompression. There are many sources of info on this on the web. It may work well, it may not. But I have heard from lots of people that nothing help their disc problems as much as a return to barbell training. I find it interesting that at the age of 21 you have an injury commonly seen in geriatric patients, coming from an activity that does not commonly produce these conditions. Medical folks will be of no help until the surgery. Just make damn sure you need it before you get it done, and when you know it needs to be done get it done immediately.

[mfromano]

yeah, I had the same thing happen (L4/L5), probably from rowing last year although I'm not sure (I was lifting at the time too, could have been from bad form). I went to a trainer at a crossfit place near me, got my form straightened out, and my back has felt a lot better. Also, give the mckenzie exercises a shot. Huge help to me.

Basically: check form (although I am sure it is good, there are probably some small things you can do to minimize disc pressure), try the mckenzie exercises, and try reverse glute/ham raises.

[Steve Hill]

Nothing has helped my back as much as a return to barbell training. Yes, chiro, massage, inversion all helped, but just lifting again (properly) along with some assist exercises (mainly reverse hypers with a long pause at the top) was what has back to normal. Still have pain and stiffness occasionaly, but it's a lot less than it was.

Two suggestions:

1) Ab-sling knee lifts with as much weight as you can strap to your ankles - like the inversion table, it will stretch your spine, and you get the benefit of doing ab work at the same time. Do LOTS of ab work - it helps the spine immensely, IMAO.

2) Exercise your back to exhaustion in some way, at least 1x evey other week. Doesn't really matter how (I did 4 hour bike rides), but it works by forcing your muscles to relax through being unable to contract in any meaningful way (via exaustion). This breaks the cycle of nerve impingement / tightened muscles / more nerve impingment / even tighter muscles in a way that stretching just didn't seem to. You'll be tired, but your pain shuold be greatly reduced.

Oh, and ICE!

[S.Davis]

Roughly 5 years ago I suffered 2 disc herniations, 1 extrusion and a diagnosis of degenerative disc disease...my doc wanted me to have surgery and have the disc's removed ASAP. I spoke with another doc, who's husband was a powerlifter, and her suggesstion was to wait until the pain was so bad that I couldn't take it any longer. Her husband had undergone a similar surgery and never felt the same again.

I went to see a local chiropractor and underwent several months of treatment which included a home exercise similar to the Cobra Pose in yoga...start by laying flat on the floor and push/lift you chest up while keeping your hips/legs on the floor. Keep going until your arms and back are fully extended then lower yourself and repeat for 10 reps. Perform 2-3 sets every morning and night.

After a month or so I had no lingering issues...occasional twinges through the years but they went away once I completed a couple rounds of the exercise mentioned above.

Similar to the podiatrist who told me to stop lifting due to the potential for reinjuring my foot the other MD's told me to not lift weights due to my back. I have ignored that advice and have not had any issues with my back since coming back to weight training...and that's with a 1RM squat of 420, 1RM DL of 450 and RDL of 3x8x245.

[pHEnomIC]

Im about willing to try barbell training again, it has helped so much in my general development, ive gotten big, strong, fast, flexible, coordinated very easily.

How do you recommend I work my way back into training?

I really have lost a lot of respect for the medical community after this injury because it has gotten me nowhere. My orthopedic surgeon specializing in "sports medicine" didn't seem very familiar with weightlifting whatsoever and told me not to bench or squat anymore. I don't even see how benching could possibly hurt my back more.

[Mark Rippetoe]

"Sports Medicine" means the medical treatment by a physician who is himself a runner or cyclist of overuse injuries that are thought to be the result of running or riding your bicycle. It is a wonderful waste of money for lifters. As for your return to lifting, I'd recommend some version of the injury sticky protocol.

[Spud]

Read "ULTIMATE BACK FITNESS AND PERFORMANCE" by Stuart McGill he has his bacl clients squating benching doing cleans chains bands and other goodies add his knowledge to Rip's and some of the other very knowledgable guys on this forum and you"ll not go wrong

Cheers Spud ;)

[pHEnomIC]

I ran this plan by my GP because I was picking something up from the office. He agrees that the worst thing for an injured patient to do is lay in bed all day. He told me that the plan was reasonable and to just listen to my body and take stuff slow.

[Chucky]

Nothing has helped my back as much as a return to barbell training. Yes, chiro, massage, inversion all helped, but just lifting again (properly) along with some assist exercises (mainly reverse hypers with a long pause at the top) was what has back to normal. Still have pain and stiffness occasionaly, but it's a lot less than it was.

Two suggestions:

1) Ab-sling knee lifts with as much weight as you can strap to your ankles - like the inversion table, it will stretch your spine, and you get the benefit of doing ab work at the same time. Do LOTS of ab work - it helps the spine immensely, IMAO.

2) Exercise your back to exhaustion in some way, at least 1x evey other week. Doesn't really matter how (I did 4 hour bike rides), but it works by forcing your muscles to relax through being unable to contract in any meaningful way (via exaustion). This breaks the cycle of nerve impingement / tightened muscles / more nerve impingment / even tighter muscles in a way that stretching just didn't seem to. You'll be tired, but your pain shuold be greatly reduced.

Oh, and ICE!

I agree strongly with this post. Though I can't comment on icing because I've never tried it. Get back to lifting (properly) and realize your back is not fragile, it is structurally very strong, and when doctors attempt to find mechanical failures with MRIs, the evidence from many MRIs actually show structural problems with people who have no pain, and show no problems with people who do have pain. Disk herniations are commonly over-diagnosed, and the few painful disk herniations that do occur may even resolve spontaneously, the disk retracting back into place.

I know a little about back pain myself as a 51 year-old who has spent years as a furniture mover and several years as a tree worker who's tossed my share of logs into the chipper. I've had many back strains and I've always taken it a bit easy for a couple days and was back full tilt just a few days later. The fact is, the vast majority of back pain results merely from stressed muscle tissue, myofascial pain syndrome (MPS), as it's called, and the quicker you recognize this and thus allay your fears of structural injury, the better, because believe it or not, your mind very likely is at the root of much of your back pain.

Consider this:

"After the age of 40, perfectly normal vertebral columns rapidly become rarer and rarer. It is unusual after that age to see spines without x-ray evidence of aging, including thinning of disks and thinning of articular surfaces. The longer a man lives, the more impressive the radiologic changes in his vertebral column become."

--College of Physicians and Surgeons of the Province of Quebec

But statistics show that low back pain is a phenomenon of people in their thirties and forties, and In fact, people actually get less back pain as they age. So if back pain is structural, and not muscular, then how do you explain this?

Unless you're in the very small minority of people who actually have severe structural back issues, get over your fear of back pain and get back under the bar lifting again with proper form. And note that there's evidence that people with poor back-muscle endurance, rather than poor back-muscle strength, are much more likely to develop back troubles. Perhaps that's why Rip's injury rehab method for muscle-belly injuries works so well.


http://www.sportsinjurybulletin.com/archive/low-back-pain-exercises.html

[pHEnomIC]

From this point on, should I use a belt when squatting? I have a nice inzer suede 4inch belt.

[Mark Rippetoe]

If you already know how to use it, yes. I'd hate to introduce something into your training right now that has the potential to change your position for the few sets it might take to learn how to use it and during which your back may get re-tweaked.

[OITW]

See, Rip, that's why I asked for some general guidance on how to fit the belt for different lifts. You say here, "know how to use it" and "potential to change your position," which implies there's more to using them well than sucking in and strapping tight. I found that mine either interfered with tightening the lumbar, or jammed my ribs (4" all around), and I felt that it was interfering more than helping so I dropped it. No one else in my gym knows how to use a belt. I'm guessing my experience isn't unique among your readership.

If Rip isn't going to write the guide, does anyone else have any good links to help?

[Mark Rippetoe]

Goddammit, O, there's not a guide for everything. There's stuff in the book and stuff on here. People have been using lifting belts for about a century that I know of, and it just hasn't been that big a problem.

[Polynomial]

If Rip isn't going to write the guide, does anyone else have any good links to help?

Usually I put on the belt, then if doing squats I squat without the bar to get the belt situated where it wants to be, and if doing deadlifts, I get into my starting position then stand up again.

If it's too loose, you'll know, and if it's too tight, you'll know as well. One thing that I found helpful in terms of figuring out if I got the tightness correctly is doing a walkout. Loading my back while wearing a weight feels more stable.

And as Rip says, use the belt on at least your last warm up set since it changes the movement a bit.

[Stuffed Olive]

I also have a herniated disc in my lower back. I had a thread about my back problems a couple of weeks ago, but I couldn't get on the internet for a while then I remembered, but my threads several pages old now!

I suggested to my chiropractor the piriformis/SI-Joint pain but he seems pretty certain it is a disc and we didn't discuss it at length. Fortunately it appears to be minor and after 2 1/2 weeks of treatment it is already feeling better. I do a few exercises as instructed, lying down on your front with your forearms under your chest and pushing up to extend your back, lying on your back with feet on floor knees bent and rolling them side to side. Also ice it regularly.

Although I think I have reason to be optimistic now, I can walk fine and the sciatica in my leg is practically gone (comes on occasionally), I'm also worried about sport/weightlifting in the future. My chiropractor also advised against weightlifting, not just now but forever which is discouraging. It is quite worrying hearing about people reherniating discs when you have the injury yourself and still haven't recovered.

This injury will certainly teach me to be very careful what I do with my back and how I lift things - it seems that most people who herniate a disc and recover then get back to lifting don't repeat the injury again in a hurry. I tend to worry about my injury, would anyone recommend a MRI scan perhaps in a couple of months when I'm looking to get back to sport to see how my disc is then?

I hope your recovery goes well from here and good luck.

[Row B]

Phenomic,

I herniated the same disc (L5/S1) back in September. To this day, I'm still on Celebrex everyday and sometimes can't sit through a meal because of discomfort.

I'm continued to train quite hard the whole way through, taking only my regular rest days(7 in a 28 day cycle). And as much as I do agree with getting right back into it, this is not your normal back pain. (As I'm sure you know) I've had my share of back strains, but this is more comparable to torn hamstrings along with numbness in the feet.

I've had all the medical attention you mentioned and still months later, with strength training, I continue to have pretty serious symptoms. Situps, deads, and any rounding kills me.

Without any professional qualifications I can only offer this from my experience. Train everything that doesn't bring what you feel is "bad" pain. Be an absolute form junkie. And be weary of taking any advice from someone who hasn't experienced a painful herniation.

I've been able to PR with this injury, but my 300lbs front squat is humbled by the fact that I can't put my socks on.

Good luck.

[OITW]

Goddammit, O, there's not a guide for everything.
No, but there's space for one more item on your line of products, and you are all-knowing and I'm a persistent SOB. That is one of those cosmic alignments that change everything. Besides, you owe me--I stopped sending you my piddly-ass squat videos to critique, didn't I?

I'm feeling especially weak after that chick in the white tiger pants squatted only five pounds less than my new PR. Crap, she's strong--but she had a belt, dammit! (If it was the pants, I don't care, I'm not wearing them.)

[MarkW]

I herniated the same disk (L5/S1)18 years ago when I was in the Marine Corps. I tried many of the remedies described above with limited success. Every time it I returned to strength training I ended up re-injuring it. I ended up having back surgery 5 years ago from an orthopedic surgeon who specializes in back injuries. While I won't say my back is "as good as new." It rarely gives me trouble now. I have been using the Starting Strength program with no problems. I recommend getting a second opinion from a different surgeon.