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Old 06-26-2009, 04:29 PM   #21
Bryan Stell
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Re: L4-5 Herniation

Awesome advice!

I have L4/5, L5/S1 issues as well, and this sounds exactly what I've been doing (except the reverse hypers). I love doing sit-ups with my ABMAT (GHD sit-ups seem to bother my back). I also try to rise from the down position with a flat back, which I think is what McGill advises.

I don't see the point of stopping weighted squats and deads...these are important for LIFE. I understand one may not be attempting PRs of 600 lbs, but heavy'ish (far below previous 1RM) with PERFECT form is mandatory IMO...if it feels BETTER after the excercise, then keep doing it!...this is pretty much what RIP says...people with lumbar injuries feel better with prudent use of squats and deads.

I'm intrigued by the use of the reverse hyper...what is the big difference b/w that and Back Extensions?

Rene,
Glad you liked the advice. It may be prudent to avoid deadlifting and squatting at first because they place the spine in flexion, however so does sitting. So most of all we must be sure to have good form while squatting and deadlifting or else the disc herniation/bulge and associated symptoms could become worse. You definitely want to be certain that your form is near flawless before adding significant weight.

As for the reverse hyperextension vs. back extensions I have yet to see any quantatative EMG studies but according to Louis Simmons the reverse hyperextension "tractions" and "decompresses" the spine. The powerlifters at Westside Barbell do sets of reverse hypers before and after every heavy squat/ deadlift day. Louis claims they are one secret that allows his lifters to train heavy so often. I have had good success with the reverse hyper. I feel it helped get rid of my sciatic pain and alleviated symptoms at least short term after use. Also, NYbarbells.com sells this machine for 500$ which doubles as a GHD for sit ups and back extensions. It's legit.

Mcgill briefly talks about the reverse hyper in his book and says it is great for athletics but one must be mindful of the anterior-posterior shear loads it places on the spine.

Also, someone asked about the Mckenzie position. It is basically lying on your stomach on your elbows in extension.
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Old 06-26-2009, 05:30 PM   #22
Mike Mallory
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Re: L4-5 Herniation

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Originally Posted by Bryan Stell View Post
Awesome advice!

I have L4/5, L5/S1 issues as well, and this sounds exactly what I've been doing (except the reverse hypers). I love doing sit-ups with my ABMAT (GHD sit-ups seem to bother my back). I also try to rise from the down position with a flat back, which I think is what McGill advises.

I don't see the point of stopping weighted squats and deads...these are important for LIFE. I understand one may not be attempting PRs of 600 lbs, but heavy'ish (far below previous 1RM) with PERFECT form is mandatory IMO...if it feels BETTER after the excercise, then keep doing it!...this is pretty much what RIP says...people with lumbar injuries feel better with prudent use of squats and deads.

I'm intrigued by the use of the reverse hyper...what is the big difference b/w that and Back Extensions?

Rene,
Glad you liked the advice. It may be prudent to avoid deadlifting and squatting at first because they place the spine in flexion, however so does sitting. So most of all we must be sure to have good form while squatting and deadlifting or else the disc herniation/bulge and associated symptoms could become worse. You definitely want to be certain that your form is near flawless before adding significant weight.

As for the reverse hyperextension vs. back extensions I have yet to see any quantatative EMG studies but according to Louis Simmons the reverse hyperextension "tractions" and "decompresses" the spine. The powerlifters at Westside Barbell do sets of reverse hypers before and after every heavy squat/ deadlift day. Louis claims they are one secret that allows his lifters to train heavy so often. I have had good success with the reverse hyper. I feel it helped get rid of my sciatic pain and alleviated symptoms at least short term after use. Also, NYbarbells.com sells this machine for 500$ which doubles as a GHD for sit ups and back extensions. It's legit.

Mcgill briefly talks about the reverse hyper in his book and says it is great for athletics but one must be mindful of the anterior-posterior shear loads it places on the spine.

Also, someone asked about the Mckenzie position. It is basically lying on your stomach on your elbows in extension.
I think your correct Bryan, but maybe not complete;

typically some sort of flexion in the spine (like poor form in squats and deadlifts) is what caused the initial protrusion, and then herniation......So in my opinion, it would be best to stop all these, and regress a bit.

Most folks with a disc injury show both inhibition of the TVA, pelvic floor, and segmental instability at the affected level, along with the ever so common SI joint subluxation. Once these are all under control, then deadlifts are more than fine

If you throw 'em right back into deadlifts (even with light weight), even with good extension in the lumbar spine, they still may not have the right TVA and mulitifidis recruitment, leaving them with a sloppy spine disguised under good form!

I'd skip the situps altogether. I must admit, I don't understand McGill's reasoning for a lot of his stuff. Why would someone with a disc injury do situps at all!? And why be bothered about A to P shear on a reverse hyperextension? Simply doing a deadlift with a 15 rep weight would put 100x the shear force on the spine of an easy ol' reverse hypo!

I like reverse hyperextension, I do them on a swiss ball.....It's a good exercise to switch up the neurological recruitment patterns, and challenge the stability of the lumbopelvic area
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Old 06-26-2009, 06:17 PM   #23
Justin Emmons
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Re: L4-5 Herniation

I have to chime in on this one. I'm a Certified Athletic Trainer and I work for an orthopedic physical therapy practice. I too have had herniations in the lumbar spine. I saw a spinal physiatrist doctor he specialized in spinal injections. I was in very bad pain. He did an injection on both sides of the injury which hurt like hell when he did it. It was sore for about a week and afterwards it began to clear up. I also worked with a spinal PT doing therapy that entire time. It took me a month and slowly ramping up my weights focusing on form. Now since I spent so much time focusing on core I've come back stronger and am hitting PR's in lifts that I never hit before. You have to take it slow, listen to your PT and doctor, check your ego , and you will be back soon enough. Focus on core control, multifidus and TVA training, McKenzie exercises can help if you work with someone that is trained in them, also many PT's are trained in manual therapy which can also help. Don't do dead lifts until your PT gives you permission it puts alot of pressure on the anterior aspect of your lumbar spine even when you have good extension. Good luck.
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Old 06-26-2009, 06:29 PM   #24
Anthony Rubino
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Re: L4-5 Herniation

Brad,

Thanks for the advice. You did not come across as "gruff". Your point is right. I'm 40 with a wife and 3 kids. I need to heal and be safe.

Thanks,

Tony
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Old 06-26-2009, 10:46 PM   #25
Bryan Stell
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Re: L4-5 Herniation

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Originally Posted by Mike Mallory View Post
I think your correct Bryan, but maybe not complete;

typically some sort of flexion in the spine (like poor form in squats and deadlifts) is what caused the initial protrusion, and then herniation......So in my opinion, it would be best to stop all these, and regress a bit.

Most folks with a disc injury show both inhibition of the TVA, pelvic floor, and segmental instability at the affected level, along with the ever so common SI joint subluxation. Once these are all under control, then deadlifts are more than fine

If you throw 'em right back into deadlifts (even with light weight), even with good extension in the lumbar spine, they still may not have the right TVA and mulitifidis recruitment, leaving them with a sloppy spine disguised under good form!

I'd skip the situps altogether. I must admit, I don't understand McGill's reasoning for a lot of his stuff. Why would someone with a disc injury do situps at all!? And why be bothered about A to P shear on a reverse hyperextension? Simply doing a deadlift with a 15 rep weight would put 100x the shear force on the spine of an easy ol' reverse hypo!

I like reverse hyperextension, I do them on a swiss ball.....It's a good exercise to switch up the neurological recruitment patterns, and challenge the stability of the lumbopelvic area
Right. We need to get back to Anthony and see what exactly caused the herniation. This exercise may be contra-indicated until we can be assured your motor patterns and form are pristine. Also, how long has it been and have your symptoms been getting better or worse?

As for McGill, he is definitely not a fan of sit-ups basically in any population as he states they mimic the exact herniation mechanism especially when performed often for high repetitions. He recommends crunches with your hand under your lumbar spine to support the normal lordosis. He suggests a small range of motion, just elevating the shoulders off the ground, keeping the thoracic and cervical and lumbar spines neutral, the goal being a hard iso-metric contraction of the core musculature. Try them, they are tough and spine sparing. I think he may recommend this move simply because most people can't get the idea of some sort of abdominal flexion move as part of their core training reportoire, but either way this is much safer than the sit-up.
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Old 06-27-2009, 03:25 AM   #26
Anthony Rubino
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Re: L4-5 Herniation

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Originally Posted by Bryan Stell View Post
Right. We need to get back to Anthony and see what exactly caused the herniation. This exercise may be contra-indicated until we can be assured your motor patterns and form are pristine. Also, how long has it been and have your symptoms been getting better or worse?
The injury was caused doing dl's. IMO I worked past fatigue and lost form on last rep.

When it first happened, there was no immediate pain. About, 10 minutes later, my lower back (belt line) got real stiff. This lasted for about 3 days. During this time I was doing air squats (about 30 per day). On the 5th day, I started feeling pain down my left leg after sitting. The pain would subside after taking a few steps, but would continue to come back after sitting. The left leg pain has decreased everyday since it started.

I have been going to PT and doing a mix of various exercises with the therapist. Stretching and core development. The PT's feels that I have good core strength, however, I am very tight in the Hamstrings and across the hips.

I am thinking about starting to body weight exercises (pullups, air squats, dips, muscle ups, etc) as well as biking (upright road bike).
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Old 06-27-2009, 03:52 AM   #27
Bryan Stell
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Re: L4-5 Herniation

Anthony,
That was my exact scenario. I herniated the same disc deadlifting heavy in a 5x5x5x5x5 workout. I was getting the pain down the leg too a few weeks after the injury. I actually got that pain only when I started PT. So I stopped going to PT. My PT also felt I had tight hamstrings so they would have me lie on my back and stretch them with a band.

I wouldn't worry about stretching the hamstrings right away. Especially in a seated position which would be bad for the posterior herniation. I think the same for riding your bike right away. I'd atleast wait until your sciatic symptoms are taken care of and the pain is intermittently in your back at the site of injury. Biking just places the lumbar spine in a fully flexed position. If you were to bike I'd think it'd be best to do so standing. As for the exercises plug away. Just be sure with the air squats to maintain your lumbar curve and if this means not getting as low as usual, then back off. Try for a more olympic style squat with an upright torso.
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Old 06-27-2009, 11:54 AM   #28
Brad Davis
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Re: L4-5 Herniation

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Originally Posted by Anthony Rubino View Post
...Thanks for the advice. You did not come across as "gruff". Your point is right. I'm 40 with a wife and 3 kids. I need to heal and be safe....
That's good. I hate it when things come across wrongly.

I'm about like you--38 with 3.8 kids (one due in Sept.). There's no sense in doing an awesome strength and conditioning program, but then being worse off at 50 or 60 than if I had just spent 30 min., 3x per week on an elliptical machine.

This has been on my mind lately because I just had a bilateral inguinal hernia surgery about 10 days ago. Even that has risks of permanent problems such as nerve damage. I also have what I hope is not a permanent case of golfer's elbow, although that doesn't affect everyday life for me. Lumbar injuries scare the bejezzus out of me partially because I've seen family members struggle with them.
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Old 06-28-2009, 11:27 PM   #29
Laura Marin
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Dear Anthony,

I did my disc L4-L5 in October last year and I am pretty much back to normal. It has taken me a good 9 months.

I was doing a full work out of all OWL movements, includding DL with 50k.
5 rounds, I probably would have done just 3/4 and be happy about it but I did not. Just 15 hours later I felt the soreness and the pain increasing all over my body. I did not do anything for 48 hours and then on the 4th day I had a heavy but mostly fast lifting session with kettlebells, cleans and OH swings with 20kg -I weigh about 56/57kg-
On my third roung my back could not take anymore and I was frozen then and there, had to put the KB down and almost crawling to stretch my back.
Painkillers, relaxing pills, no training and physiotherapy.
I seemed to be much better after 8-9 days when only by sitting down the same pain triggered back on my spine...so obviously I thought I was healed just too soon.
After that the only thing that made me feel Pain-Free was walking and walking fast. I avoid lifting any weights as I could feel it directly on my back.
I did not even do push ups or anything related as I felt my psoas-abdominals and lumbars under a huge pressure like melted together as one piece.
But after a while I started much slowly Pull ups, dips, squats, body weight work outs.
I did my first KB work out on the 8th month, I stretched after and did not touch them again in a good 10 days, hey, it's working and as far as I am concern if you can move then exercise.
Avoid the movements in which your body is telling you 'this does not feel good, please do not do it' and as for the rest focus in Body Weight and slowly start to include weights.
I do squats and the other day I was back squatting 42k and my back was fine afterwards, once again I have not done it again in a good week.
So, -sorry if I am getting you bored-, I personally think that as soon as you reach a certain level of recovery, anything in moderation will be all right, make sure you do your warm ups and your cool down stretches at the end.
Whenever you have a power lifting session have a Body weight one the day after, do not abuse it and you have a good chance to recover safely.

Now, I am very aware of this but yesterday I was swinging again 8-12 and20kilo KB, snatching 8k non stop and then I tried the snatch with 12k-which I was scared to try before I did my disc-. What I do not do is going overhead with the swing, as for the rest I definitely feel the strength coming up and let me tell you it is a great feeling.
I hope this helps, if you have more questions write again.
You will get better, it is a question of time as you probably know by now.
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Old 07-01-2009, 08:57 AM   #30
Anthony Rubino
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Re: L4-5 Herniation

Steve,

What are your thoughts about kipping pullups with regards to my situation?

Thanks,
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