Training with a L4/L5 Herniation

[Michael P]

Hello Mark,

I have an athlete that has come to train with me, and he has a L4/L5 disc herniation. He has mild numbness, and some weakness in his right leg...an interesting side note is that he is a resident in neurology locally.

He has had this situation for a while...it hasn't progressed and he wants to train. His form on the lifts are spot on! My question is this.

What would be your recommendation with respect to training and athlete like this? Would you not train him with heavy sets, keeping things lighter with higher rep counts?

Your thoughts will be very much appreciated. Thanks for your time, expertise, and such an amazing resource.

[Mark Rippetoe]

I would use 5s as with any novice, make sure that his lumbar extension is a perfect as possible, and monitor the effects of the work on his symptoms. He will either get better or stay the same, in which case you can keep increasing the loads conservatively, or he'll get worse, in which case you don't. Most of these things heal. He's your best resource regarding his response to the program, and this will be a very valuable addition to the education of 2 people.

[kziwarrior]

I have a similar injury (actually two disks) and can add a bit if I may. When I first started the program (and even now, over a year later) my lower back is still the weak point. I found that adding good-mornings and hypers were essential for me (but I spent years avoiding any back work to avoid injuring my back so it was relatively week). But even now I find that my squat will stall because of my lower-back and I'll have to strength the back considerably (good-mornings, hypers) before I can advance on the squats. Also I've found that, for me at least an inversion table is invaluable for keeping the lumbar area loose and flexible. Oddly enough dead-lifts don't really give me problems, but I'm guess it's because my lower back is already built up and because of my frame/build.