5 Mistakes People Make With a Low Back Disc Injury

You're listening to the Restoring Human Movement Podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's your co-host Sebastian with the Restoring Human Movement Podcast. Thanks for joining the show. I wanted to cover the topic of lower back disc herniations today and the five most common mistakes that people make with it. I'm hoping this information will help you guys find faster recovery with your lower back disc injury, as they're super common. I'd say they're probably the number one reason for lower back pain.

Here's a tip. It's usually not a muscle strain. I don't think I've ever seen on an image anyone have a tear of a muscle in the low back. So it is typically going to be discogenic lower back pain and the muscle spasm around it is going to be guarding. Now, if you guys are looking for help ever, then we do have telehealth versions of our services, as well as in person, and we're licensed in different states as well. So we'd always like to help. We have consultations available, 714-502-4243, or you can email us info at p2sportscare.com. We also have an online program that we cover all the exercises and stretches that we'll talk about in this podcast as well on our website.

But they're organized and structured based upon lower back disc conditions. It's all on our website and available for purchase if you want to look at it. Now, the number one mistake that people make is resting too much. Number two is ignoring the pain and pushing too hard. Number three is expecting a miracle solution. Three is ignoring leg pain. And number five is underestimating the importance of exercise. Resting too much being the number one. I would totally agree with that. That is going to be a big, big no-no. But also too, you have to realize when rest is going to be helpful. Now, I have had a disc herniation before, as many of you probably have too.

I've suffered from discogenic pain twice in my life. And I realized that the first time I did it, I definitely rested way too much. It was when I was a high schooler. I was 15 years old. And I think most of my rest came of ignorance because things hurt. And I thought if I did too much, then I may actually hurt it even more. And I'll get to maybe that why doing too much may be an issue a little later. But bed rest is not necessarily required in most cases, as you have to get up to the bathroom. You have to get up to eat. If you have children, you have to get up to help them do things too. And so you'll probably realize that movement, at least some certain movements, can be harmful and hurt you.

But other ones will feel perfectly fine. Most people adopt a movement strategy where their back is stiff and they move a lot about with their hips and knees. And this is actually the way that you should move for a couple days after a severe lower back incident or acute lower back pain from a disc. And that is okay. But what we don't want is complete bed rest all the time. One thing that we do know about disc injuries is actually they sometimes, a lot of times, have an increase of severity in the morning hours, the first hour of the morning. And they say the reason for that is because when you lay on your back, your spine is in the absence of gravity.

And so when it's in the absence of gravity, its natural process for getting nutrition into the disc region is something called imbibition. And you can look that up if you like. There's lots of pictures on YouTube about imbibition. But it's basically where water and other things go into the cell or go into the disc at nighttime when you're resting. And then it plumps up. And when you start moving first thing in the morning, it gets a lot more sensitive because a lot more pressure around that area. Now, when you're laying on your back all day or laying in bed, it plumps up all the time. And so there's not really a lot of time where you can move pain free.

A lot of times people with discogenic lower back pain end up having a lot less pain with walking. And so doing structured rest is important. Resting the structure, not irritating the disc and trying to twist about and bend too much is helpful too. So that's structured rest on that structure. But it doesn't need to be complete rest on the entire body, okay? If I had to guess how long it's going to be helpful to actually do complete body rest, it's probably going to be closer to a day or two. But if you're going much beyond five days and you find that you're not really doing anything, you need to talk to your healthcare professional to evaluate you to make sure that you actually have a big enough injury to merit that type of pain for that long.

But most people are up and about after a couple days and a few days does kind of suck. But it does get better. Just know you will get better very soon. Now, the second mistake is going to be ignoring the pain and pushing too hard. This is kind of like the difference of people. Some people take that initial, I am going to rest this thing out. I'm not going to do anything. I'm going to relax and watch some Lonesome Dove movie series or TV series or maybe some Tombstone. You know, they're hanging out most of the day and other people are like, you know what? I'm going to keep doing what I'm doing and I'm going to push through.

It doesn't matter. Like, I'm good. And it's just different mentalities with it. The trouble when people are doing too much and ignoring their pain, they push through and they challenge the mechanics of the injury that further progresses the injury. So, imagine if I had a dislocated shoulder from it being pushed overhead, kind of like chicken wings. If I continued to do that movement over and over again, do you think the shoulder is going to get any better? Probably not. It's probably going to keep hurting over and over and over again until you get into this chronic injury cycle where things hurt a lot more, even though the tissue may be healing itself.

So, generally the movements with disc-related pain that bother people the most is going to be rounding their spine, but that's not always the case. Make sure that you're not using that as a gold standard because there's plenty of people who have disc pain who respond well to lumbar spine rounding and actually that can make them feel better. But usually what we use here at Performance Place with some of our telehealth and our in-person ones is we take people through what we call a directional preference examination, as well as other orthopedic tests to identify, is it from a disc in the first place?

Is there nerve tension associated to it? Do you need to treat the nerve first or the disc? But directional preference examination is a really, really easy way to figure out with a trained eye and a good understanding of what you're looking for, of what directions may be more detrimental to the person. So, what this looks like is the protocol is from the McKenzie Method series and usually what you would do is have someone move or be statically in a position such as rounding or extension for a little bit of time or for like 10, 20, 30 reps and you just see how they feel. Personally, I like to see the, have them lay on their stomach first and go up onto your elbows just to relax in this position, have them wait for just one minute.

Sometimes the first 10 seconds is, is very painful and other, other times it feels comfortable immediately, but usually after about a minute, people feel better. And then you can deem extension looks okay. And then you can start allowing that person to spend more time into extension for comfort and to heal the area, but also warn them about spending too much time in flexion. In that case, we'd coach them out of having bad posture and stuff like that. Other people who have different types of disc injuries, maybe the complete opposite. Laying in their belly, laying on their belly must, would hurt a ton while rounding their back feels a lot better.

But everybody's a little bit different, but a directional preference examination can give us the information about which direction is preferred and which one feels better, but also the opposite one is typically detrimental. Again, not always the case. Sometimes people don't fall into one category or another, but many times they do. So when we do this examination and we figure out that rounding is detrimental to the person, we may decide to look at their exercise program or their activities that they like, that they're bothering it with, and we start to remove aspects of lumbar spine flexion temporarily.

So do they deadlift with a round? Get rid of that. Are they squatting too deep and rounding their back? Get rid of that. Are they doing sit-ups or Russian twists? Get rid of that. If they're doing bird dogs, it's extension-based. Keep it. So you can take good gambles on potentially what's bothering them and allow them to work around the pain, but not push through it, and also become more educated about what Bob is doing at that point in time. Number three is expecting a miracle solution. We are actually a chiropractic office. We have chiropractic degrees, and unfortunately, we get a lot of calls with people saying, hey, can I just, I can barely stand up.

Can I just get a quick adjustment? No, probably not. Probably not. And the reason is, is because there is no miracle cure for this, and we need to make sure that we do a good detailed examination, and don't assume that just one adjustment, one stretch, one exercise, since it worked for everybody, it's going to work for you as well. You need to be examined first to figure out what your body's tolerances are, just like the directional preference exam, and then typically what we have the person do is we would have them do some version of a home stretch, home exercise, home joint mobilization in lower force techniques.

Now, I'm not saying people shouldn't get adjusted. Again, we prefer not to adjust discogenic low back pain, especially in the acute nature, because we don't want to force their body into a position that doesn't feel good. What your chiropractor does, or if you're a chiropractor yourself, it's totally up to you. This is just our preference with it. But we found out with gently nudging the things around and doing it with higher dosage tends to work better for us, and it seems like everyone's a lot happier. The mistake number four is going to be ignoring leg pain. Leg pain is kind of one of those things which is present with a lot of people with discogenic lower back pain, but it's not everybody.

For the lucky people who don't have it, they don't have to deal with the thought of what is more helpful, stretching the leg or not stretching the leg. They also don't have to deal with typically the aspects of possibly motor loss or sensation changes to the foot or to the back of the calf or the hamstring area. But leg pain is, it's not like you have to go run off and have surgery for it, but leg pain is something that typically needs to be addressed in a structured fashion. It may be a similar scenario to what you do with your lower back disc if you didn't have leg pain. For example, it would be those McKenzie press-ups that a lot of people do.

Great. They can help out with the peripheralized lower back pain into the leg, or they may end up making a leg pain worse. And you may have to play chess with it. So this is where the skills of a experienced practitioner with this can be of help. I always talk to people about the idea of centralization and peripheralization. And with leg pain being further down the leg, this is what we call peripheralized. And whatever you've done in the last 10 seconds, 10 minutes to make that happen, like, so you're sitting and all of a sudden after 10 minutes, your leg starts to go symptomatic. Burning, stabbing, shooting, aching, numbness, et cetera.

And you stand up and walk around and it goes away. I bet the sitting is probably a big part of it. And so the more time you spend sitting is probably not going to be a good thing for you. Same thing goes with certain stretches, certain treatments, certain exercises, certain activities or sports that you may be doing that have a similar type of experience. Usually, if you stop doing that thing for a little bit of time, it can go away and the leg pain centralizes or comes out of the leg and goes up to the back. And then what you're left with, my back is just stiff and tight and achy again and feels like my muscles are tight.

But what you don't have is a leg pain. You have to get rid of the leg pain first in order to deal with the low back as well. But you cannot solve the lower back unless you deal with the leg pain first. Now, I'll tell you one of the mistakes a lot of people do make in this subcategory here is that when something is really peripheralized into the foot, sometimes their back pain goes away. But the problem with that is that when people have some of the leg or foot symptoms or the calf symptoms, sometimes those symptoms are not as intense in nature and they actually feel more comfortable. They're more manageable.

Oh, it's just a tingle. It's just numb. It just feels a little tight, but at least it's not on my back anymore. That's an example of peripheralized pain or peripheralized symptoms. We can't have that. It needs to move out like a thermometer, at least most commonly. And that means that if it takes getting your lower back to feel more uncomfortable than your leg pain was, and we have to deal with that for a little bit of time as we rehab or treat around it, that is what it has to be. Normally, the foot goes away and it comes in the calf. And once the calf goes away, it goes into the hamstring and into the side joint and into the back and then it's gone.

But this is the most common process. And this is also a really big mistake that people make is don't realize realizing how much the leg aspect can come into play and the process of getting rid of that leg pain. Number five is going to be underestimating the importance of exercise. Now, I've done recent YouTube videos. And by the way, there are going to be YouTube videos on this on the description in the podcast player. We've done it about discogenic low back pain. We've done it on sciatica. And you're going to see that unfortunately with sciatica, there's back pain, lower back discogenic pain too, is that everybody's a little bit different.

So you're going to see some like wishy-washy, like some do this, but don't and do this, but maybe you should. You're going to hear a lot of that stuff. And the problem is, is because we don't have you as a version of to make a definitive answer on. But I can tell you what most people respond well to in exercise with disc related pain in the back. Most people feel really good walking. Sometimes people feel good with running. Sometimes they don't. Too much twisting, maybe. A lot of times they feel really good with hip dominant versions of deadlifting with sloppy knee position, meaning they don't actually stiffen the knee.

It's not a stiff legged version. It's not an RDL version. It's a deadlifting version, more conventional. So there's a little bit more knee bend involved. And they also feel typically really good with something called a split squat, which is a non-moving lunge. This keeps the spine in neutral. So it helps a lot of people with various different types of discogenic pain. Typically, the feet need to be a little closer than you think. If it's too wide, then it doesn't feel good on everybody. And those are a really easy way to load the legs and spare the back because the name of the game is you use the exercises to spare the back.

If you get your legs to become weak and lazy, then it will continually load the back and then becomes this endless cycle of I feel better and I do something and then it comes back again. So you don't want to be a back mover. You want to be a leg mover. And so if you can get your exercises to be leg dominant when you're even having lower back pain, you can actually work out very quickly after having the original symptom rise. So within the first week is usually a good time to start people and it makes it so their legs stay strong throughout the process. Now, other things that are going to seem like they're not really helpful, but they can be pushing exercises, pulling ones, carries, hanging, pull-ups, et cetera.

There's tons of these larger movement categories that can be helpful because it requires your core to stiffen in order to press away or pull yourself up to a bar. So we need to keep the core active and part of this because we know that core is important. Everybody knows that whether they've experienced or not, they've heard it continually throughout various different articles and podcasts and YouTubes and so on. Everybody says the core is important. So it is important in an easy way to keep the core involved while you're dealing with lower back pain and trying to get rid of it is going to be using the arms to get the abs to become active, even the hoop mechanism of the core.

So these are the five big mistakes that people do make with discogenic lower back pain. If you guys are looking for help with this, remember we have telehealth, we have virtual and in-person services, and we have licensing in different states too. So we'd love to help you out. We are excellent virtual, especially with discogenic pain. If you guys are looking to find references to all the free content we have, as well as the paid content, check the link description below. We have a templated program that I designed myself, which is excellent. It shows you most of the exercises we use, but it's more specific.

You actually just work with us and I'll see you guys next time. Hope you like the podcast.