This post and the follow ups are going to be an overview of how to self treat a herniated disk specifically in the lumbar spine based on my experiences from the past 8 months and advice I’ve had from a wealth of knowledgable health care professionals. This is what worked for me and I hope it helps you too.
Recovery can be a long journey and will require you to be more self aware when treating your herniated disk be it staying concious of your posture during the day, the effects of medication you’re taking or the effects of specific exercises while you’re performing them.
Here’s some background about me and my journey. I was training quite rigourously 5 to 6 times a week and have been training for 6 years at that point mostly doing parkour aka freerunning, but had experience weight lifting and in martial arts. The night before going away to teach a seminar in America I decided to Deadlift, one of my favourite weight lifting exercises ever, and was lifting heavy. My back was straight but my form wasn’t perfect and I felt a slight twinge in my right gluteal or buttock. I attempted to lift the weight again except this time I couldn’t lift it whatsoever and felt the pinching sensation again. No pain at this point. Once teaching the seminar I found my mobility was greatly reduced and tried stretching every day to recover thinking it was the 10 hours of flying. I had some success but I was greatly limited in my physical performance in comparison to the past months.
The week long seminar finishes and it was one of the best experiences in my life, I return home and after one nights sleep find I can’t move. I’m as stiff as a plank. Puzzled by this I try to get out of bed and stretch as I usually do in the morning, again attributing the suddenly wave of immobility to the flight back to London, and as I go to reach over to pick up my stopwatch I feel shooting pains from my glute to my foot on my right leg. This is by far the most painful thing I’ve ever experienced. I’ve sprained ankles. Torn ligaments. Broken bones. Destroyed muscle repeatedly through strength training. Nothing could compare to the pain I experienced and I fell to the floor in that instant. I could barely move but managed to crawl back into bed and was stuck like this for almost two weeks.
After a week of rest I was able to move about once more but again like a plank and experienced duller versions of the shooting pain repeatedly over the course of the next few months. In this time I doubted if I would ever be able to sport again and was even told by a doctor and a physiotherapist that I would not be able to return to my training again and the best I could hope for would be able to live normally possibly swim but certainly no running and definitely no more stretching, being able to touch my toes again (currently I can touch my head to my legs and my hands go well past my toes pain free) or practising my biggest passion of parkour. I was shattered, sank into depression and greatly doubted whether I would be able to do what I love any more which was parkour.
Skip forward to today I am training parkour aka freerunning regularly(an extremely high impact sport), strength train regularly, stretch regularly and even weight train. I do need to build a stronger foundation before I progress to lifting heavy weights again to be safe, 80%-95% of the max weight I could lift, but I can still lift roughly 70% of my max before the injury all pain free.
[ UPDATE November 2012: Recently I just deadlifted the most I have ever have in my entire life by miles. My previous weight when I originally hurt my back was 145kg for 2 repetitions. This month I lifted 160kg for 2 repetitions. Anything is possible!
I entirely place my recovery on the need to practice parkour and be physical again. Not being able to do so in my eyes meant my life would be over and this sink or swim mentality is what drove me to ignore those telling me it couldn't be done and do whatever it took to recover. ]
Pain reudction and elimination is very important in the early stages of treating a newly herniated disk, obviously because nobody wants to experience pain, but it also allows for the real work to be done by increasing mobility and the possibility of strengthening and corrective exercises. Pain is an indicator that something is wrong and will also be a tool we use in the follow up posts to assure safe and steady progression.
Some symptoms to look out for will be:
Radiating or shooting pain
Muscle spasms and tightness
Numbness and tingling
Some of these are more subtle than others but by making sure you take a concious effort to recognise when these arise you will ensure the fastest possible road to recovery by avoiding creating more trauma to the disk
Ok lets get down to business! Here’s the low down on what is most effective
As simple as it sounds this one is crucial. Your body is going to heal itself as best it can. You will be doing your best to allow it to heal correctly, promote recovery and in the long term strengthen it so you feel no pain but essentially your body still needs to rest. The initial pain you feel will most likely be due to an irritation of either the nerve root or spinal cord itself. Even if nothing is currently causing this you may still experience pain i.e the disk is not irritating the nerve. The biggest solution is rest.
Resting means doing nothing. No work, no sitting, no standing simply laying on your back and doing nothing. You should only do this for as long as it takes for you to be able to become more mobile and move more pain free as the longer you take to recover the more your muscles will atrophy, i.e, become weaker. This can lengthen the time it takes for you to recover as you will need to retrain muscular strength and stability to become strong and support your disk one more. For some perspective it approximately takes 1 to 2 weeks for your muscles to begin toatrophy, i.e weaken, and hopefully you wont be spending this amount of time immobile.
I am not a big advocate of taking most medications for the simple reason that for the most part they usually don’t treat the root cause of the problem, simply patching you up, and I feel that general practitioners all too often persue this approach by solving a problem with some type of drug.
That being said without the use of certain medication I would’nt have been able to recover as quickly as I have. They can reduce inflammation and relax stiff muscles both of which will increase mobility and allow for the ground work to be prepared for fixing the herniated disk. Here are their many forms
Non Steroidal Anti-Inflammatories
These are what I used to reduce inflammation when initially experimenting with ways to become mobile again. Enough rest would serve the same purpose provided you did absolutely nothing and stayed in bed. I couldn’t do this as I was determined to find a solution through trial and error.
Similar to Anti-Inflammatories Corticosteroids will reduce pain and are also used for a number of other injuries. They usually come in the form of a localised injection at the cause of the pain and effects can last for one week to a year but beware as this is not a cure. This approach when alone is always temporary even if the effects last a year and if used must be combined with an appropriate rehabilitation program. The greatest down side to using corticosteroids is that if the effects are longer lasting, i.e 3-6 weeks or even more, you will be truly unable to recognise whether or not the rehabilitation program is working effectively due to the numbing of the pain. Remember we need pain to be an indicator, letting us know if we’re improving or not.
Diazepam or better known as valium is an example of a muscle relaxant and was what I was given in conjunction with anti-inflammatory medication, but I avoided usage. The approach here is to improve mobility and reduce potential neural tension by relaxing muscles. This is temporary as when the muscle relaxant wears off the muscles will restore to their earlier degree of stiffness. There are much more effective and longer lasting methods which will achieve the same effect such as spinal manipulation, myofascial release, heat and stretching.
Codeine is an example of a painkiller and would be used in very extreme cases. Again I stress here that this does not address the root cause of the pain and only treats the symptom.
Heat was an essential part of the initial recovery stages. Using a hot water bottle on my lumbar spine where I herniated my disks allowed the muscles in the area to relax slightly and provide me with greater mobility. At the time all the muscles localised to herniated disk were extremely stiff, e.g erector spinae and quadratus lumborum, a protection mechanism your body uses to ensure you’re unable to enter potentially dangerous ranges of motion and cause the disk to further herniate or protrude further. This being said due to the extreme stiffness I experienced an extreme state of Lordosis and had an elevated hip on my right side, the side I had the shooting pains, which needed to be addressed before an strength work could begin.
Heat will also stimulate blood flow to the area carrying essential nutrients required for recovery.
Being Aware of Posture
This one is crucial. Being mindful of your posture will prevent you from reinjuring yourself. Learning to keep a neutral spine during mundane and repeitive tasks will create good habits and lay some of the foundations necessary for future strength work and minimise injury. Postural awareness is especially key during all future exercises you perform either during your rehabilitation phase or playing a sport. Again, in case you missed it. Postural awareness is key during all future exercises you perform. You must remain cognisant of your posture as often as you can and force good habits. This is important in general, for example not rounding the shoulders at the computer, as this will translate to poor positioning prior to the start of any strength work we do in the future. You will require corrective exercises fixing posture to minimise risk of any future injury and leverage mechnaics to increase the maximum output from you body during th exercises, i.e be stronger.
This is not to say that you will no longer be able to round your back, quite the contrary, it simply means do not enter into positions of high neural tension or positions that create pain.
Spinal decompression is a method of spinal relief by absoliving the effect that gravity places upon the spine day to day. It can be achieved many ways but traditionally in medical profession will be via inversion therap, haning upside down thereby creating some space between the spinal vertibrae using gravity, or by use of a traction machine such as the drx9000. These methods of treatment are expensive to say the least, often starting from 300 per session, and their effectiveness is still uncertain as there has yet to be enough research on this area yet.
That being said there are ways in which you can perform spinal decrompression yourself.
The first of which is quite simple. Hanging from a bar clasp both hands around the back so that the bar remains under the knuckles of both hands and wrap your thumb around your fingers. Keeping your shoulders retracted and depressed (back and down) simply hang from the back trying to relax.
A second method requires a bosu ball and is slightly less effective. Again quite simply rest prone on the bosu ball placing it on your abdominals keeping your arms out infront of you and relax.
Adjustment exercises and spinal manipulation combined with myofascial release and stretching
This method has been the most successfull for me in my initial stages of discomfort and recovery as whole. Any spinal adjustments must be performed by a trusted trained therapist. That being said after seeing multiple therapists I had ammassed a collection of effective exercises to combat my herniated disk. Ontop of this I also tried to replicate the manual therap and spinal manipulation they performed upon me, experiementing to find what felt as though it was helping and what wasn’t and even some times making the problem worse. I do not recommend this at all but I must be honest and say that it helped me immensely in the speed of my recovery especially as how expensive the therapies were, I simply couldn’t afford to repeatedly see the best therapists.
These exercises combined with myofascial release techniques and stretching is what greatly enabled me to restore mobility and begin strengtheni ng my core and the rest of my body so this would never happen again.
The main idea here is to not restore yourself to your previous capabilities but to greatly exceed them so that when there is a load on your spine you will be able to cope with it easily and the damaged disk will remain supported. An example of this would be considering your flexibility prior to injury. If you had poor flexibility in your hamstrings and calves when performing any movement in which you would have to bend over, provided you have poor postural awareness and don’t bend at the knees, the load on your lower back would be high and would put you in a possible compromising position as you reach the end range of your hamstrings there would be a greater pull on your lower back. Comparatively speaking if you hamstrings were more flexible there pull on your lower back would be far less even though it is still a compromising position.
When combined with basic strength work you will be undoubtedly able to live day to day without even having to think about your posture constantly.
To return to a sport will require a deeper level of mobility and strength work and as the risk of reinjury is higher. Combined with addressing structural dysfunctions and consistency you will be pain free, at minimal risk and feel super human.