Herniated and bulging disks are an all too common injury for the general public.
Due to prolonged poor postures and sometimes bad training protocols, these injuries are a huge issue.
I even remember on Day 1 of work I was excited for my first group, yet still half asleep at 6 am. I head out to the turf area where everyone gets loosened up before the warm up and that is when the reality came. I had not been out there for more than 30 seconds and one of the clients told me that we had 2 herniated disks in his back.
I was completely thrown off. If I went back to my schooling and certifications, then the procedure would have been not to train him and have him go to his doctor/physical therapy.
The only issue is that he was cleared for all activity and had been discharged from PT already.
Needless to say the first thing I had to learn (and quickly) was what disk herniation really is, how it happens, and how to train around it.
Luckily, herniated disks can be extremely painful but simple to train with.
The most common mechanism for a herniated disk is lumbar flexion and rotation. This either needs to be repeated for a long time or have a heavy load added to it.
When we sit down in a chair we are in lumbar flexion. Add that to rotating around, maybe for work etc., and we have trouble brewing.
If we think about the vertebral column as bones stacked on top of one another with jelly donuts in between each, it starts to paint the picture.
When we round our back forward, the bones start to pinch the front of the disk closest to the front of the body. This anterior pinching causes the fluid in the disk to start to move towards the back of the body.
In a normal spinal column, the disks stack right on top of each other and fit together perfectly. In flexion, there is a space that opens up between the disks in the back.
Imagine squeezing the front of the jelly donut. All of the goo is going to move towards the back. Add enough repetitions or load to it and the jelly is going to leak/explode out of the back.
This is a very painful injury and can often affect the nerve root which causes pain or tingling all the way down to the foot.
This injury can sometimes heal in about 6 weeks or good care but sometimes it requires surgery.
From a training standpoint, someone who is in pain should be in PT. We are stuck when these people get clearance from other healthcare professionals for all activities “as tolerated.”
It is my job as a coach/trainer to provide the best possible strategy to avoid symptoms.
Introducing Overhead Single Leg Work
There are a number of reasons why single leg work is great for those with back pain. Getting overhead is also highly beneficial.
1. It reduces loading on the spine
We are not as strong on two legs as we are on one. Therefore, we can limit the amount of axial loading we put on the body.
Reducing load means that there will not be as much pressure on that disk. This is essential for alleviating symptoms and starting the road to recovery.
It is very difficult for someone to recover from such an injury while continuing to squat and deadlift super heavy.
2. It activates the core
A stable core is the best measure of injury prevention when we talk about back injuries.
If the body’s musculature is up to par then the passive structures of the spine are not under as much stress.
When we get overhead the anterior core (abdominals and obliques) must activate to prevent hyperextension through the lumbar spine. This can also be called excessive arching through the back.
Even more, we can use weight in one arm at a time to add a challenge to the lateral core as well.
Anytime we can work on stability at the same time as the lower body, we are building towards back recovery.
3. It gets the person into extension
If rounding the back is problematic because of the lumbar flexion, then we need to train people to get into extension.
Extension does not mean leaning way back into a huge arch, a neutral spine is extended. Getting the arms up overhead is an extension movement and promotes good habits.
Flexion based problems got the person in trouble in the first place so we need to get them into a better posture. Overhead single leg work is the right medicine for the job.
The exercises you can use for these guidelines include step ups, lunges, split squats, and kneeling to standing.
Starting to use these variations will reduce the back pain and develop lower body strength. You can also use the proper variation to get a conditioning effect from your workouts by shortening the rest time.
In order to relieve disk herniations we must see the right health professional. Once the person is cleared, we can get into the exercises that to enhance the recovery process.