Successful Rehab of Lumbar Herniation

**paleocaveman** · 07-15-2013, 11:42 PM

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!

**jg42058p** · 07-18-2013, 06:50 PM

Thats great! Good for you. I am searching for recovery methods for my L5S1.

How long was it from injury until you were feeling 100% again? Can you do crunches and over head presses now?

**paleocaveman** · 07-19-2013, 03:23 PM

Everyone is different. I guess it would depend on the severity of your injury. However, I would say the minimum would be roughly 1 year to recover. 3-4 months of rest to allow the initial pain and swelling to subside, 2-3 months of pt (only after you are completely pain free), and 4-6 months of very carefully planned progressions (I personally started with 15-20lb kettlebell swings and fixed the mobility problems I had in my hip and thoracic spine). Looking back, my biggest mistake was trying to take strides as opposed to baby steps. I reinjured my back twice doing this.

I would recommended flexionless core development but if you insist on doing crunches make sure you purchase an AbMat (this is crucial). Overhead presses are not a problem, what you really have to look out for are exercises that require continuous flexion of the spine and create sheer forces. Be smart and take your new found time to learn how to correctly prehab your body. The gym will always be there. Nothing worse than having to start all over again just because you were too eager to get back to the gym.

**jg42058p** · 07-20-2013, 06:30 AM

Cool. Yeah it takes a while. I reinjured mine twice, and now I'm being super careful. Probably not as severe as yours is but its been about a year and still phucked up because i reinjured it. So now I'm not doing risky crap and taking baby steps.

What was your kettle ball routine like? How often did you do it, how many sets/reps?

**yosimitesam** · 07-20-2013, 05:11 PM

Thanks for the post. Very informative.

**paleocaveman** · 07-21-2013, 08:05 PM

As long as you focus on these 3 main concepts, your rehab will be going in the right direction. Just make sure you are 100% pain free before starting a rehab program.

1) Gaining Hip Mobility/Utilizing your Glutes
-When your hip flexors are tight and your glutes don't fire properly your hamstring will normally have to take on a double load (some call this gluteal amnesia). I like kettlebell swings because A LOT of people have difficulty engaging their glutes and hinging their hips properly. We can thanks technology for this (computers, cars, sofas, tv, etc.). We as modern humans spend too much time sitting and being sedentary. Here is a great hip mobilization exercise from Kelly Starrett

Episode 1: First of Many Beat Downs - YouTube

2) Stabilizing your Core (remember, flexion is the enemy)
-The primary function of the lumbar spine/muscles is stabilization. Most people have decent lumbar strength but lack ENDURANCE. Planks, side planks, glute bridges are all examples of safe static exercise that will build endurance. Once you’re ready you can add dynamic core stabilizing exercises. Just be careful here, hubris can bring you back to ground zero.

3) Mobilizing your Thoracic Spine
-The primary function of the thoracic spine is mobility. When you lose mobility here your lumbar and cervical regions will start to compensate and become sloppy.

If you haven’t noticed, there is an alternating pattern.

C-Spine = stability
T-Spine = mobility
Lumbar = stability
Hips = mobility
Knee = stability
Ankle = mobility

The key to a successful rehab and prehab is to ensure all joints are doing what they are intended to do. If you skip this step, you will most likely reinjure yourself later down the road.

*First purchase should be a foam roller. Think of this as simple but much needed maintenance. I personally recommend the Extra Firm Rumble Roller ($75). I use this everyday before I train and whenever I’m sitting or on the computer for too long. Rolling your low back may feel good but will not fix anything. Spend the bulk of your time mobilizing your t-spine, glutes, and hamstrings.

As far as a kb routine, this is what worked best for me but I am sure there are many ways to skin a cat. My routine started with 5 sets of 10 swings with a 15lb kb. Instead of performing high reps till failure, make sure you leave some in the tank when rehabbing an injury. If you feel good the next day, increase the reps by 5 every workout. Once you reach 5 sets of 25, I would start using a 20lber, then 26, 35, 44 and finally a 53.

*If you ever wake up the next day and feel any discomfort or “bad” pain, DO NOT PUSH THROUGH!

Take time off to rest and allow enough time for your body to fully recover. You might want to think about decreasing the weight, reps, and sets. Ice and rest should be the only thing you for the time being. Btw, just in case you don’t know the difference between good and bad pain. Good pain is DOMS, bad pain is how your grandpa feels if he’s been gardening for too long.

Some other great progressions I took from Grey Cook include 1) chop and lift 2) Turkish get-up and 3) cross-body one-arm single-leg deadlift. You can find a bunch of these videos on YouTube.

Lastly, I would avoid heavy barbell squats until your have complete confidence. Here’s a nice video of Mike Boyle on the death of the squat. Not saying that I completed agree but he makes a good point, especially if you’re not a bodybuilder.
Death of Squatting - Mike Boyle Strength and Conditioning - YouTube

**yosimitesam** · 07-22-2013, 10:07 AM

Originally Posted by paleocaveman

As long as you focus on these 3 main concepts, your rehab will be going in the right direction. Just make sure you are 100% pain free before starting a rehab program.

1) Gaining Hip Mobility/Utilizing your Glutes
-When your hip flexors are tight and your glutes don't fire properly your hamstring will normally have to take on a double load (some call this gluteal amnesia). I like kettlebell swings because A LOT of people have difficulty engaging their glutes and hinging their hips properly. We can thanks technology for this (computers, cars, sofas, tv, etc.). We as modern humans spend too much time sitting and being sedentary. Here is a great hip mobilization exercise from Kelly Starrett

Episode 1: First of Many Beat Downs - YouTube

2) Stabilizing your Core (remember, flexion is the enemy)
-The primary function of the lumbar spine/muscles is stabilization. Most people have decent lumbar strength but lack ENDURANCE. Planks, side planks, glute bridges are all examples of safe static exercise that will build endurance. Once you’re ready you can add dynamic core stabilizing exercises. Just be careful here, hubris can bring you back to ground zero.

3) Mobilizing your Thoracic Spine
-The primary function of the thoracic spine is mobility. When you lose mobility here your lumbar and cervical regions will start to compensate and become sloppy.

If you haven’t noticed, there is an alternating pattern.

C-Spine = stability
T-Spine = mobility
Lumbar = stability
Hips = mobility
Knee = stability
Ankle = mobility

The key to a successful rehab and prehab is to ensure all joints are doing what they are intended to do. If you skip this step, you will most likely reinjure yourself later down the road.

*First purchase should be a foam roller. Think of this as simple but much needed maintenance. I personally recommend the Extra Firm Rumble Roller ($75). I use this everyday before I train and whenever I’m sitting or on the computer for too long. Rolling your low back may feel good but will not fix anything. Spend the bulk of your time mobilizing your t-spine, glutes, and hamstrings.

As far as a kb routine, this is what worked best for me but I am sure there are many ways to skin a cat. My routine started with 5 sets of 10 swings with a 15lb kb. Instead of performing high reps till failure, make sure you leave some in the tank when rehabbing an injury. If you feel good the next day, increase the reps by 5 every workout. Once you reach 5 sets of 25, I would start using a 20lber, then 26, 35, 44 and finally a 53.

*If you ever wake up the next day and feel any discomfort or “bad” pain, DO NOT PUSH THROUGH!

Take time off to rest and allow enough time for your body to fully recover. You might want to think about decreasing the weight, reps, and sets. Ice and rest should be the only thing you for the time being. Btw, just in case you don’t know the difference between good and bad pain. Good pain is DOMS, bad pain is how your grandpa feels if he’s been gardening for too long.

Some other great progressions I took from Grey Cook include 1) chop and lift 2) Turkish get-up and 3) cross-body one-arm single-leg deadlift. You can find a bunch of these videos on YouTube.

Lastly, I would avoid heavy barbell squats until your have complete confidence. Here’s a nice video of Mike Boyle on the death of the squat. Not saying that I completed agree but he makes a good point, especially if you’re not a bodybuilder.
Death of Squatting - Mike Boyle Strength and Conditioning - YouTube

Once again, excellent advise! I, too, have had major back issues. Not nearly as bad as what you've gone through, but enough to put a long hiatus on my love of squats and deadlifting.

Funny thing, though. As I was a prime example of the definition of insanity, I kept thinking I could get right back in there, and continue doing what I was doing. Well, as your body ages, it gets tired of trying to tell you something only for you to ignore it until it forces you to stop.

So I quit lifting for nearly 10 years, thinking I was just too injury prone. Then, I finally got tired of being afraid and losing out on the benefits of weight resistance training and baby stepped my way back into it. This time around, I'm taking my lifting technique, prehab and assistant muscle groups much more seriously. My back sucked because of a very tight left side and easily strained piriformis. My shoulders hurt because I was ignoring my external rotators, and my hamstrings ached because I was neither strong nor flexible. I also realized if I strengthened my core and used my supporting muscles during squats and deadlifts, I could lift relatively pain free.

I'm not 100%, but I'm also not sitting on the couch complaining and thinking I cannot do certain exercises anymore. I didn't realize just how weak my spinal erectors were (and really still are). I was using a lifting belt all wrong, and had horrible technique on my bench press and squats.

Am I lifting what I was before succumbing to injury? Well, no, but I'm continuing to get stronger, and look better thanks to working my entire body and not just parts of it. I'm also not afraid to back off, and strongly believe in alternating how you do certain movements. i.e. I have multiple specialty bars for squats, bench, shoulders, etc. Expensive, but cheaper than an MRI and constant trips to PT. It's also less painful than shoulder surgery and the recovery process (which I've had the pleasure of enduring before).

I also agree with you in that squatting can be beneficial to everyone. It's just how you squat and how it's important to master technique rather than just stacking weight on the bar. Especially since there are so many variations, almost all people can find one or two versions that work well for them without causing pain.

Thanks again for the excellent background and information, and I'm glad you're feeling better.

**keep fightin** · 07-22-2013, 09:43 PM

great posts and comments! paleo, does pain free mean tingling and numbness free? have been reluctant to do anything rehabish with the constant twinging, again, no sensation of pain after two months post injury

**paleocaveman** · 07-22-2013, 11:49 PM

Wow!! Out the game for 10 years?! Your whole insanity phase is all too common. Often times, people ignore well intentioned advice and suffer serious re-injuries as a result. In life, one must learn to evolve and sometimes change their way of thinking in order to stay ahead of the game. I'm glad you're on the road to recovery Yosimite!

**paleocaveman** · 07-22-2013, 11:56 PM

How serious was/is your injury? Did you get an MRI, if so what are the results? Currently on any pain killers, anti-inflamatories, corticosteroids, etc? Where do you feel the tingling/numbness and has your symptoms subsided since the original injury? How active are you currently? Feel free to add anything else relevant that I may have missed.