Successful Rehab of Lumbar Herniation
I wanted to write this post to help others find the truth and to clear up any misunderstandings about spinal injuries. Unfortunately, it is impossible for me to give you the answers to your questions in a simple paragraph or two, as the scope of spinal injuries are beyond a single forum. This is not a quick fix but rather a comprehensive and permanent solution. Nonetheless, I can assure you that the information here is your best bet towards a successful lifelong rehabilitation. I am not a doctor or physical therapist, just an athlete and trainer devastated by a spinal injury who spent years studying and rehabilitating others. Don’t expect this to be an end all, but rather ground zero, as I am simply pointing you towards the right direction. As for my story…
I was diagnosed with a ruptured (L-5, S-1) and bulging (L-4, L-5) disc in 2009. The Grim Reaper had finally come to collect on over a decade of powerlifting, mma, surfing and movement errors. An MRI confirmed the severity, showing a 9mm protrusion that left me bed ridden for several weeks and on crutches for even longer. My doctor put me on cycles of painkillers, anti-inflammatories, and corticosteroids that helped alleviated some of the symptoms but did nothing to fix the problem. He told me that surgery was not a permanent or complete solution, and that I may risk more severe and irreversible nerve damage if I continued to compete in mixed martial arts. Questioning his propositions, I sought advice from another specialist who confirmed the recommendations and also suggested that I stop competing and stick with “swimming or something low impact.” For most people, this would have been the end of dynamic recreation or an active lifestyle. However, I wasn’t ready to accept an end to this chapter of my life and continued pursuing both conventional and alternative solutions to rehabilitate my injury.
First stop, an inversion table. This seemed logical and sounded like a good idea but only made me lightheaded and left $200 in the hole. I hate to admit it but I also tried the Back2Life Continuous Motion Massager (As Seen on TV). My injury was still fresh at the time; thus, I was highly susceptible to snake oils and talismans. Not the magic bullets I was looking for.
Second stop, the chiropractor. By this point I was off of crutches. I went twice a week for close to three months. Although electronic stimulation therapy, massage beds and back adjustments felt great, they only momentarily relieved some of my symptoms. If you have insurance it might be worth it to go in order to help manage some of your pain, however, if you don’t, I would simple skip this step or only use it on a as needed basis.
Third stop, spinal decompression (a.k.a. traction). After navigating through forums online, I stumbled across mixed reviews of a procedure called spinal decompression. The science behind it seemed legit and there were many videos of health care professionals and patients on YouTube making extraordinary claims; I had to try it! I searched through my insurance’s chiropractic provider list and called every office in my vicinity in order to track down a machine. Unfortunately, spinal decompression was not covered under my insurance so the chiropractor gave me a deal on a package of 10. The weight setting on the first three treatments was very conservative, and did not do much, maybe a placebo at best. On the fourth treatment, the chiropractor merely increased the resistance to the next weight setting (+10lbs) and re-aggravated my injury. I went to Kaiser the next morning and received an appointment for another MRI and more meds. This incident left me unable to work again for a week; however, looking on the bright side, I received a brand new set of crutches and was able to catch up with my DVR.
Fourth stop, physical therapy. I wanted to start as soon as possible; however, Kaiser did not have the capacity at the time. There was nothing I could do to get in any earlier. Nonetheless, was very motivated to partake in a program under a licensed physical therapist. During the consultation with my PT, he told me he practiced jiu jitsu and has been with Kaiser for over 15 years. I was excited to be working with someone with similar athletic experience and left with a renewed sense of hope. However, after eight sessions of manual therapy, practicing intra-abdominal pressure techniques and core strengthening, my PT was honest with me and conveyed his inability to help improve my situation. I left disheartened and still unable to train.
Fifth stop, an epidural. Epidurals work by reducing inflammation at the nerve root via corticoid steroid injection. Although the injection simply masks pain temporarily, I opted for the procedure as I didn’t know what else to do. Again, I left with no solution, as the injection was unable to reduce my inflamed nerve and residual pain in my foot. I didn’t even bother coming back to “try again.” I am aware of the science behind an epidural and know that these work for half the people out there. However, the trouble of having to schedule another appointment, taking time off work and having someone drive me was too much of an inconvenience for another chance at temporary relief.
Sixth stop, acupuncture. At this point I was starting to get desperate, as my preconceptions associated acupuncture with voodoo. I am a strong supporter of science; yet I also reserve judgment for the unexplained or things I don’t have knowledge in. I’ll just be frank, four sessions, zero improvement, waste of time and money, for me at least.
Seventh stop, ART (active release technique). I went for about five or six sessions but stopped as I was seeing little progress and continued to have residual pain and tingling in my foot. I was still unable to workout effectively or train.
Final stop, “The Four-Hour Body” by Tim Ferriss. A friend told me that there was a chapter in the book called Reversing Injuries. In his book, Ferriss conveys several mindsets and approaches to the field of fitness that were groundbreaking to me. One of the most helpful I continue to apply in most areas of life and learning. I forget the exact wording but Ferriss stated that in order to find the best solution to a problem simply find the top expert(s) in the world and see what they are doing. Also, look for successful anomalies, not what everyone else is doing. Why waste your time learning from anyone else? SOLD! Below are three experts that provided me with the tools I needed to get myself back stronger than ever. This didn’t happen over night and was more than simply improving my core endurance and strength. I spent months methodically progressing from my injury to get my body to where it is now. Thanks to their philosophies and concepts, I set a new PR for my max deadlift (450) and am able to train in mma at a high level. I know that 450 isn’t competitive in the world of powerlifting, but am not looking to set records. I simply want to give anyone reading this some hope and an idea of the possibilities. 450 is more than I could lift in high school, so in that respect, I guess I can say my back is stronger than ever or at least 100%.
In terms of rehabilitating, managing, and preventing injuries, Grey Cook is one of the world’s leading experts and the creator of the Functional Movement Screen (FMS). He works with clients whose bodies and wellbeing are worth much more than the average Joe; athletes in the NFL, NBA, NHL, military special forces, etc. If there is a way to prehab your body to avoid further injury, he’s the guy to go to. The most important concepts I took away from Cook were the joint-by-joint approach and mobility before stability. Here is an article that summarizes the joint-by-joint approach.
Also, Dr. Stuart McGill (world’s foremost expert in spine mechanics). McGill is truly at the top of the spine rehabilitation food chain. Other experts in corresponding fields trust and value his ideas. I highly recommend his books if you want to gain a comprehensive understanding of spine mechanics. Here is a short clip I found that expels some of the myths surrounding lumbar injuries.
Another person who has good information on how to prevent further injuries and mobilize your hips is Kelly Starrett. Starrett has up-to-date in-depth knowledge and takes on a practical approach to mobilization. Although he specializes with CrossFitters, his concepts can be applied successfully to athletes of all disciplines. Here is a link to his website.
One thing to remember is despite the credentials of anyone in the healthcare industry, you know your body better than anyone else! It’s challenging, to say the least, for someone to effectively rehabilitate your injury if he or she has not experienced similar debilitating symptoms and restrictions associated with a rupture. No amount of reading, education or practice can do that. Successful rehabilitation is accomplished with methodical and very prudent progressions; let time be your friend. In this game, the turtle always wins!
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Originally Posted by paleocaveman
