Can you work out with a herniated disc?

Can you work out with a herniated/bulging/protruding disc? Absolutely!

In fact, being inactive is one of the worst things you can do - both physically and mentally. Let’s get real for a second: you can either try everything you can to get your life back, even if you do have 100 setbacks; or be on painkillers the rest of your life, scared to move while your body gets weaker and weaker to the point you may not even be able to walk unassisted anymore.

If you haven’t guessed - I chose to move. In fact, I work out every day with 3 disc protrusions in my lumbar spine that impinge a nerve and never have any pain. I do all kinds of heavy lifting and challenging workouts, I’m not afraid to jump, or run, or try anything physical that I haven’t done before because I know my body so well.

So how can you get to the same point as me and many others?

First thing is first - have you had internal imaging done to support your claims? I have met many people who have said they “definitely have” a slipped or herniated disc purely off what they read online or told while getting a massage. I’m sorry but unless someone has X-Ray vision, they cannot 100% diagnose disc issues, and really shouldn’t claim something like that - with one mis-judged sentence you could literally make someone scared of their own body for life.

 
If you have, what does the report say?

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Lumbar Spondylosis?

Disc Degeneration?

Disc Desiccation?

Disc Bulge?

Disc Protrusion?

Disc Extrusion or Sequestration?

Osteophytes?

Ligamentum Hypertrophy?

Facet Hypertrophy?

Spondylolisthesis?

Subluxation?

Stenosis?

Impinged Nerve?

 
You have no idea the amount of MRI reports I’ve seen that contain some of these phrases. Yeah, they seem scary, but for the most part all those things are simply side effects of getting older or small growths that don’t really cause any problems. The only condition that really requires surgery would be a severe extrusion(*1), or in some cases a subluxation if posture correction is no help


In my opinion surgery is recommended way too fast with an incredible lack of investigative work done (probably says more about the state of national healthcare than individual Doctors themselves).


Say you went to your doctor, had a 15-20-minute appointment after which they send you off for a scan. You then met with a specialist to discuss the results of the scan and “what is wrong with you”, and frighteningly often surgery is recommended... after not even an hour of full assessment & treatment? The most frustrating part is, in the time it takes to complete this process (usually months, if not years) you could have been moving and treating yourself the right way and literally have felt completely better by the time your results come in.

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Not even kidding, I comfortably deadlifted 200kg two days before my own MRI results were in and I was told I “could never lift again”. It can take weeks, if not months, of constant support to get someone back on track - not just a few appointments.



Starting points: investigate and be curious


 
When I work with someone with back pain or a disc injury the majority of the first session will be talking: when are you sore? Is it worse in the morning? Do you find standing for long periods of time make it worse? Or sitting? If you don’t sit is it better? Are the things you can do that don’t hurt at all? Is it mood dependant? Have you been completely fine for a while and then got a flare ups?


I like to help people realised that 9 times out of 10 their back pain is not their whole life. If you have days, times or occasions which are better than others that is something which can be built on! Periods of relief show there is something which can improve your pain, and you just need to find a way you can replicate and work on that.


Next, I’d go through a few tests to locate what someone needs to work on, get them performing some low intensity movements and give them homework to do. Most importantly, I tell them to keep an analytical mindset until the next session – we are logically exploring the pain and movement of their body.


After a week we can evaluate what made an improvement, what might be specific causes of aggravation, for example if someone has a lateral protrusion as I do, they may find that side bends to the opposite side cause a small trigger of pain due to the added pressure. This is what an MRI can be helpful for, sometimes knowing exactly what’s going on and on which side will give you a better idea of what to be careful of… for now. 


When I initially got injured, any kind of bilateral movement such as squats, bending… even standing caused me immense amounts of pain, I had to constantly lean my weight to my right side - my MRI shows my protrusions to the left side, so this makes sense. I worked on increasing my lateral stability using simple exercises such as side planks and my ability to cope with loads bilaterally came back! Now I can comfortably bend, lift stupidly heavy single leg deadlifts and do crazy CrossFit workouts no problem… but only because I took the time to investigate my pain, work out the cause/weakness and worked on it. It wasn’t quick, but it sure was worth it.



A disc diagnosis is not always a bad thing


The really funny thing is that when you look into studies, the less correlation you actually find with symptoms and disc issues. In a study with 98 people with no back pain whatsoever only 36% had all normal discs. On average 52% of the subjects with no pain had at least 1 bulge, 27% had a protrusion, and 1% had an extrusion. Overall, on average 64% of them with zero back pain had at least one thing “wrong” with them and in some cases both a bulge and a protrusion(*2).


Another interesting thing to notice is that the analysis of the scans was carried out by two separate neuroradiologists to improve accuracy of the results and get an average. This table of results shows the difference between their analysis:

Despite both working to the same criteria, Evaluator One diagnosed 2 more bulges in Asymptomatic subjects than Evaluator Two, 7 more protrusions, and 2 Extrusions where Evaluator Two diagnosed none. This is not to criticize either of the Doctors involved, but just to highlight that diagnosis is still a victim of human subjectivity. Having a bulge/protrusion/extrusion isn’t black and white, you’re not either fine or broken, there is a scale of severity which doesn’t necessarily correlate to pain or physical function.


Another 10-year study of the relationship between MRI findings and low back pain showed there was no correlation with past MRI results and the predictions of future lower back pain, and in fact 76% of participants who had no low back pain showed disc generation on their follow up study(*3).


Though studies like this are hindered by standard issues such as sample size and subjectivity, I also feel like they’re missing a big part of the picture: what activities/rehab/prehab/training etc. do those people with back pain or disc issue do or not do? It would be impossible to do such an in depth study over such a broad amount of people, but I can only assume from my own experience with working with people with back pain - if you move badly you’re probably going to hurt, regardless of disc abnormalities. People that take the time to improve their movement will generally tell you that they feel better.
 

Like SMM-er Carl Johnston who came to one of our seminars:

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December 2017, severe sciatica, trip to hospital. MRI = right sided Disc Protrusion, left side Stenosis + grade 2 Spondylolisthesis. Recommend 3 level fusion (no thanks!!). Couldn't walk or weight bear. 2 months later, contact Tom. Next 2 months hips, core, walking in swimming pool, back training very lightly […] Now back 100% and listening to my body!

 
And Dave Rodgers who went through a prolapsed L4/L5/S1 on BOTH sides - even had complications with surgery and ended up with sepsis! Imagine having 5 surgeries and still being in pain. He decided he needed to take control of his own treatment and once he did was back successfully training, lifting, jumping, running – he was fitter than he’d ever been in his life.

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A natural part of aging?


Scary things that you read in an MRI report often are just part of the natural process of getting older, like getting wrinkly. There are many examples of studies which show prevalence of disc conditions dramatically increases with age, suggesting that many conditions such as degeneration, bulges and protrusions may be part of normal aging and not necessarily associated with pain(*4). All studies suffer from bias, so it is hard to draw definite conclusions, but really, back pain is such a personal topic that trying to quantify pain in a study is almost impossible – you always need to put the scans and experiences into context.

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I think that yes, imaging is important, and you should never discourage or discredit expert advice, but I also think that the limited options offered to people after their results come in is disparaging. Information is sometimes hard to find, and people can be left feeling helpless, not knowing what to do or where to look through fear of making themselves worse.


 

Be proactive


 
Thinking logically is hard to do when you’re in extreme pain and there’s nothing wrong with being afraid, but having a proactive approach and an analytical mindset where you try and discover what you can do far outweighs popping pain killers daily or waiting to be cut open. If you’re planning on having surgery anyway - what have you got to lose?! The success rate of specialists who get severely injured people out of needing back surgery is high, so isn’t it worth trying?
 

Though even if you can’t go and see a specialist, 3 important things that you can analyse and assess yourself are:

Your Hip Mobility
For example, can you pass the Deep Lunge Test on both sides? Or maybe just one side? Lack of good hip movement forces your lower back to do more than it should.
 
Your Thoracic Mobility
For example, can you easily lift your arms straight up overhead? Or do you have to arch your back to do so? Using thoracic rotation exercises such as Zenith Rotations will help your thoracic spine become more mobile, so your lower back doesn’t need to compensate anymore.
 
Your Core Strength
Your core is more than just your abs; bracing is your way of keeping your spine safe when you lift something heavy. See how well you do at all 3 types of core strength exercises as you may be missing a crucial element.

 

If you spend more time focusing on improving those three things and less time focusing on what is “wrong” with you, you’ll find yourself going down a very different path. Maybe even the road to recovery.

Have you struggled with a back injury and overcome it? Maybe with the help of The Simplistic Mobility Method? We would love to hear your story!


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References:

1. Understanding Your MRI of the Lumbar Spine

 

2. Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain

 

3. The associations between magnetic resonance imaging findings and low back pain: A 10-year longitudinal analysis

 

4. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations

 

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