Fitness & Health - Lower Back
Treatment and management options for damaged or herniated spinal disks
My lower back has taken a serious beating over the years as a result of endless home renovations where I lifted many heavy objects with improper spinal protection, eventually causing damage to my L4/L5 and my L5/S1 disks as well as damaging several of my facet joints such that I had a generalized condition known as 'disk instability and I eventually underwent a double spinal fusion surgery procedure in March of 2012 (see Spinal Fusion)'.
Here's what I did pre-surgery (and I still mostly do post-surgery) to maintain my lower back health with a messed up, worn out spine:
Core Exercises
I do a range of core stability/strengthening routines each day. With my misshaped facet joints and worn out disks, my lower back is 'a bucket of nuts and bolts' that will pop out of alignment very easily - the only prevention is having strong supporting muscles that will support and protect the disks. When I do have a shift of a disk, it is inevitably caused by a typical 'bend, lift, twist' movement, and when it shifts I experience an inflammatory response that can put me in bed for several days and cause months of ongoing generalized pain - so I try to activate my core muscles prior to getting out of a chair, or doing any lifting at all. Check out the helpful Core Muscle Activation article on the Peak Sports & Spine Physical Therapy web site FYI.
Stretching
When your back is bothering you, stretching can be a real challenge (as it can make the pain worse if you aren't careful). I have found that a lot of the persistent lower back pain that I experience can be relieved effectively by rolling the cheeks of my butt on a tennis ball. Your hamstrings connect to your pelvis and lower back muscles via your gutes so lie flat on a carpeted floor or workout mat, place the ball under one of the cheeks of your butt, let your weight press you into the ball, then wait until the pain subsides, then move the ball an inch to the left or right, up or down, until you have worked the entire area. Then switch sides. Finally, go back to the other side and roll back and forth, up and down, concentrating on getting all of the knots out, etc.
When you are done with the ball, continue to lie flat on the floor, lift one knee to your chest and then use your arms to pull it tightly towards you to give the hamstrings some tension - be careful of your back though - don't do this if it hurts. Then take your opposite hand and pull your foot sideways across your chest while your other hand holds your knee in place. This will put tension on your gutes. They should be sore after the ball workout. Then switch legs.
The next thing is to stand up and place your foot on a padded chair arm rest or your bed, keeping your leg straight, then, again keeping your back straight, lean forward from your waist, putting stretching tension on your calves, hamstring, and gutes. Now reach forward (without hurting your back) and try and touch your fingers to your toes, then, with practice, wrapping your hand around the base of your foot.
For a really great roller/ball stretch, check out www.travelroller.com. I have one and it is great! I recommend rolling out (and using the balls) to also stretch your side and front hip flexors, plus your calves and quads. If you do this every day, or multiple times per day for the first few weeks, you will start to feel so much better. Trust me. If you are an avid road biker, this will allow you to ride a lot and not mess up your back or leg muscles.
Standing at my desk
I have rebuilt my office so that I stand in front of my computer and also stand during most meetings. Sitting is a real killer if your lower back is trashed. I always sit with perfect posture when I have to be seated - I press my backside into the back of the seat and stick my chest out - I never slouch!
Icing
I use an ice pack as often as I need to calm my lower back and reduce the inflammation response. I have a small pack that I can slip into my underpants and no-one then knows I am enjoying some pain relief.
Back Brace
When lifting any heavy weights I wear a weight lifting belt. A really important strategy for avoiding inflammation episodes. I never do movements where I bend and twist anymore - at home, the office or at the gym. I minimize any of those movements and it really helps keep my back from 'going out'. When my back is experiencing pain from some minor or major inflammatory episode I try to wear a back brace most of the time just to give my back muscles a break and allow them to stop spasming.
Spinal Decompression
I have spent years and years and countless visits to chiropractors and physiotherapists looking for pain relief, and now I pretty much have my own technique for treating my 'flare-ups' via the use of a spinal traction table, stretching, core stabilization work, and icing. The table pulls the spine apart, and in the process re-aligns it nicely, and takes all of the pressure off of the disks and impinged nerves. After 20 minutes of on/off traction, I slip in an ice pad and let the area chill down, reducing the inflammation. The pain is relieved and the spine heals quickly. A very solid investment for anyone suffering from lower back pain (see your healthcare professional first - be careful not to pull with too much force and be especially careful when you have recently torn a disk - don't use a traction table within 72 hours of an initial disk tear, just rest it).
click here for more information on the Saunders Hometrac
Electrical Muscle Stimulation
It is important to get the nerves to calm down and stop over stimulating and tiring out the muscles once you have a sore, aching lower back. I use a TENS unit to relieve the pain and help the muscles to settle down. Without the use of this unit it is very difficult to control lower back pain and allow healing to start. It is also an excellent way to relieve muscle cramps anywhere you might get them. Set the parameters to: ramp for 2s, on for 20s, off for 2s, pulse width 300uS, 100Hz. A much better solution than popping pain killers which can cause stomach ulcers.
click here for more information on TENS units
Some final comments - the journey of recovery
I spent the $ and have had several MRIs and CT scans of my back taken and have spent close to 1000 hours with health care professionals, learning the true state of my lower back, and what options I have for recovery, and doing all of the rehab, over and over. I was a good candidate for an S1-L4 fusion but I held off as long as possible for I eventually got fused. For a long time I didn't have the imaging work done and we were all basically guessing as to what was wrong with my spine. I recommend imaging if you have a serious problem that will not substantially resolve in a month or less (if you can afford it). You can often get away without it if you are careful with your back and do the type of things that I have listed here - under the guidance of a healthcare professional.
When you hurt your back, either by herniating a disk, tearing a disk, or otherwise causing inflammation in or around the spine, it takes a lot of time for complete healing to take place (due to poor blood flow in the disk areas): as in up to a year or more if the injury is significant. One of the biggest problems for people with back problems is re-injury. When the pain is gone, the healing is only half done so keep on with the workouts, etc and keep protecting your back. Here is a typical injury cycle for me:
I have a spinal shift -> tearing my L4/5 disk
Within 4 hours the inflammation kicks in and I am basically immobile for the next 2-3 days. I immediately try and straighten my spine (usually with the traction table) being very very careful not to make the tear any worse than it already is.
By the end of day 1 my back is bent sharply to the side from the inflammation, even with anti-inflammatory drugs and pain killers
By day 2, no matter how much it may hurt, I get out of bed every few hours and start to put pressure on my L4/5 disk to counteract the inflammation - effectively pushing the herniation, slowly, over a period of days, back into place (you will need to work with a healthcare professional to learn how to do this safely). This is the definition of true pain but it speeds the recovery process.
I start to wear a lower spine support belt to keep the pressure off my muscles in my lower back which are all messed up and aggravated. I will keep wearing the belt for any activities that put pressure on my spine, even walking for the first week.
I will try and get off the drugs ASAP as they make me feel strange - usually by the 4th day.
By the end of the first week I try to get back to normal activities.
The inflammation drops off by the end of the 2nd week and the pain drops to a much more manageable level as well.
The pain and weakness in my lower back go away within the first month or 2 if the tear isn't too serious, but sometimes it takes up to 4 months.
My back stays 'vulnerable' for another 3-4 months so I baby it and wear a belt any time I hit the gym, do yard/house work, or lift anything.
I never lifted anything anymore over 30lbs until post surgery recovery. If I did, I paid dearly (the process started over ....)
