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Old 09-12-2005, 07:08 AM   #1
Eric Cimrhanzel
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I have a person in the Corps, whom I'll just call fish M, who I found out last night has a degenerative disc between his L4 and L5 vertebrae. Because of this, or in addition to it, his spine could, at any time, snap shut and cut off all function to his lower body. Because of this, he cannot do the following: run more than 100m, sprint at all, do any kind of rounded back deadlift, overhead lifting (or any lifting above the High Pull position, any kind of swinging movements.

And guess who's responsible for training him? Ah yes, yours truly.

So here's the bodyweight exercises I'm having M do: Squats, Pushups, Burpees, Situps, V-ups, Leg Lifts, Pullups, Dips. The last two he has the capacity to do, but not yet the strength. He also can do several Yoga positions, and is currently taking Pilates.

Obviously, exact form is used on all exercises (as exact as I know how to teach it, of course). Instead of running, we're trying to get him to the Rec Center on campus at least once a week so that he can either bike or swim. For those of you with knowledge of this, have you found any use for the Concept II Rower? We have three.

Needless to say, it's a little unsettling to train M at all, since everyone else I've trained before has been more or less "perfectly healthy", or at least didn't have a body that could collapse at any time regardless of his level of fitness. However, I think it would be much more debilitating to him if he just didn't exercise at all.

The scary thing is, if he had joined any other Outfit in the Corps besides mine, whoever would have been responsible for him most likely wouldn't have had a clue where to look for help with his health/fitness...

If anyone has any experience with or knowledge of herniated or degenerative discs and what else someone can do with them, especially with just bodyweight exercises or light (less than 55lb) dumbbells or kettlebells, if you could pass some information my way, that would be cool. Obviously I won't take anything here as strict medical advice, but just get additional ideas to what exercises might possibly be safe for someone with this condition.
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Old 09-12-2005, 07:56 AM   #2
William Hunter
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"his spine could, at any time, snap shut and cut off all function to his lower body."

WTF?

Who told him that? That language sounds a bit extreme for a degenerated disk. If you can, have him read the exact wording of his MRI report.

If it was that bad, and he's seen a doc, he'd be in the surgeon's office as we speak, because no MD would let someone walk out of his office and paralyze himself stepping off the curb. CYA you know.

Also, V-ups and burpees would trash a hot disk as well. If he's already done these without exacerbation, then maybe he's not as bad as it sounds.

Don't know what others will chime in with, but I'd be interested in more info, especially the terms used by the radiologist, and is he antalgic (bent over, unable to straighten)?
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Old 09-12-2005, 08:49 AM   #3
Matt Toupalik
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"his spine could, at any time, snap shut and cut off all function to his lower body."

WTF?


I'm going to second this.I have a bulging disc at L4-L5 so I am always wary about doing too much too fast, but I have never heard of a degenerated disc possessing such crippling capacity.By the sounds of this description, he could become paralyzed at any time.I'd have him consult another doctor.Just my 2 cents.

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Old 09-12-2005, 10:52 AM   #4
Michael Keller
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Eric,
That really doesn't make sense. I think a second opinion is in order. I've got degeneration in the same place and have almost totally rebuilt my back with CF and speicifically DL's and superman's. I've dealt with my problem for about 9 years now, and it's better than it has been since before I injured it. Dave Werner has a done a couple of excellent threads on this, so you might search those, but I would definitely have him get a second opinion from a quality ortho doc.
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Old 09-12-2005, 10:54 AM   #5
Michael Keller
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There's also some good info here:

http://www.crossfit.com/discus/messages/27/13859.html
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Old 09-12-2005, 11:42 AM   #6
Eric Cimrhanzel
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Thanks a lot, ya'll. I'm definitely trying to get him to another doctor for a second opinion.

It didn't make sense to me, either.

And thanks for the link, Michael! I completely missed that one when doing a Forum Search for this topic.
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Old 09-12-2005, 02:35 PM   #7
Craig Van De Walker
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A large percentage of the adult male population over the age of 40 have disc degeneration (including me between L3-4 and C6-7 with bone spurs evident on X-ray) I am careful but I take part in martial arts, deadlift, OHS, Olympic lifts, coach soccer and outrun the kids so far, ect. Yes my back often hurts, but I can do more than some 20 yr old men I know that have no back problems. I guess the statement is not innacurate as anyones spine given the right situation could snap, but highly unlikely. Unfortunately you are the one in charge of this person's routine and might be blamed for problems. I used to really resent the P3 profiles in the Army (permanent no PT, of course I never knew any with battle related injuries only overweight chain smokers with mysterious knee and back problems) don't know what they call it in the Marines

(from spine-health.com web site)
Question: I have had debilitating lower back pain for two years. My MRI indicates I have bulging discs. My doctor recommended exercise, but that has not helped. What are some alternatives to keep my discs from bulging?

Doctor’s response: Bulging discs in and of themselves are not necessarily painful. 30-60% of patients with no pain can have the finding of an asymptomatic bulging disc on their MRI scan. The MRI scan is not necessarily diagnostic as to what is the cause of your pain. The more accurate the diagnosis you receive the better your treatment plan will be.

Depending on what is causing your pain, there are various treatment options. Consult a spine specialist, such as an orthopedic spine surgeon or a physiatrist. Treatment options for conditions such as degenerative disc disease may include medications, physical therapy, manipulation (e.g. by a chiropractor), injections, and occasionally, surgery or other invasive procedures.

Your doctor is right in that exercise is an important component of your rehabilitation in almost all cases of back pain. However, doing the right exercises the right way is essential. I usually recommend working with an appropriately trained physical therapist to develop a home exercise program.

(Also from site)
The degenerative process
It is important to note that disc degeneration is part of the natural process of aging and does not necessarily lead to low back pain. MRI scans have documented that approximately 30% of 30 year olds have signs of disc degeneration on MRI scans even though they have no back pain symptoms. It must therefore be stressed that not all degenerated discs that are seen on MRI scans are pain generators.

As the population ages, it is even more common for individuals to have signs of disc degeneration without pain, and by the time an individual reaches 60 years old, disc degeneration is an expected finding on an MRI scan. In fact, the incidence of low back pain actually declines as we age, despite the fact that our discs are degenerating.

A fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position (see Figure 2). While many people over the age of 60 have degenerated discs, it is highly uncommon for them to suffer from degenerative disc disease.

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Old 09-12-2005, 06:13 PM   #8
Eric Cimrhanzel
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Outstanding info, Craig. I didn't even know about spine-health.com. I don't know why Google didn't pick that up... maybe I was searching for the wrong thing.

Problem: He got his note from a doctor in Plano, Texas at the Back Institue of Texas, so I'm not going to assume that I know more than them.

Solution: We have a health center here, as well as a very good Kinesiology and Physical Therapy program, so I'll see if I can get in contact with some P.T.s around here about M's problems.

Problem: It seems very strange to me that a doctor would prescribe no Olymipic lifting or overhead lifting at all, including swings with light dumbbells or even OHS with broomsticks.
I also saw this post by David Werner when doing a little more searching around here:
"Now for some contrarian advice. You can't afford NOT to O-lift. Disks degenerate (assuming no serious bone disease) because of instability, instability is caused by weakness, strength stabilizes the structure and stops progress of degeneration.
Start over very light, master form, get coaching if needed and strengthen your back as if your health depends on it!"
I've also read Patrick Johnson and Kelly Moore's opinions on back problems and CrossFit movements helping them starting with light weight and proper form.

Solution: I can get a copy of his MRI and post it here, as well as asking around the Health Sciences department around here about it, keeping M anonymous, of course. I need to meet more weightlifters around here, too...

Also, everyone I've heard from that's ever done swings has said something to the effect of "this has really helped my back", so I'm wondering what the inherent dangers are if one doctor says one thing and several Dragondoor posters and article writers (as well as anyone around here? I don't know) say something completely different.

I know that good abdominal work (maybe Janda situps, slow V-ups, and lying leg lifts?), as well as instruction on Power Breathing and Zipping Up (a la Pavel's Naked Warrior) is in order. Along with that, Superman's (which he does now), and... what other bodyweight exercises help strengthen the back safely? I looked through my NSCA texts and couldn't really find anything.

Thanks a lot to everyone for all of your help with this. I'll talk with my Commanding Officer here about this, and see what we can come up for a training schedule for M (what kind of time frame, equipment, etc we can get).
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Old 09-13-2005, 05:08 AM   #9
William Hunter
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Eric,

I know about TBI (Texas Back Institute). I think most of us involved in multi-disciplinary treatment of back pain use that group as our template. I actually used them as an example when I landed my postition with the neurosurgeons and pain management specialists that I work with now. They're known to be top notch.

This makes their recommendations all that more strange. A copy of the MRI report would be great supplemental info.
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Old 09-13-2005, 05:59 PM   #10
Eric Cimrhanzel
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William,

Will do. I should be able to get it by the end of the week.
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