“The bad news is time flies, the good news is you’re the pilot”
If you – like millions of Americans – experience chronic low-back pain or pain that shoots down the buttocks while bending forward or exercising, you may have what is known as a herniated disc. Exercising with a herniated disc can be painful and even dangerous if done incorrectly. Knowing how to exercise safely with a herniation requires some basic knowledge of the spine. Unfortunately our bodies age, and the gel-like structures between our joints is certainly no exception. Between each vertebra we have membranous structures called nucleus pulposus which are surrounded by a protective ring called an “annulus”. These two together form what is known as a “disc”. The purpose of this structure is to act as gel-like shock-absorbers between the vertebrae. As we age these rings get worn down and lose elasticity, sometimes leading to cracks or tears. Imagine a jelly donut; soft on the inside (nucleus pulposus), and firm on the outside (annulus). Now you leave it on your counter for a couple days and the breading on the outside becomes hard and brittle. You place a small force on one side and BOOM, the hard shell cracks and out comes your delicious raspberry filling. This is a disc herniation.
When you bend or lean forward, your spine becomes rounded. This rounding squashes the front portion of the disc while also pushing it towards the back. This bulge is where your “raspberry filling” is expelled and is the most common cause of a herniated disc. People who already have a herniated disc may experience pain in this part of the lower back, as well as their buttocks and thighs during exercises and day-to-day activities that involve rounding or twisting of the spine. Now keep in mind that just because you have a doctor’s note or MRI results saying that you have got a herniation does not automatically mean that these guidelines are necessary. Instead, follow our guidelines if you have pain and symptoms consistently occurring during the following exercise mistakes. Remember that exercising with a herniated disc can be very safe and effective if done correctly!
Not sure whether you have a herniation or not? Have no fear! There hasn’t been (nor will there ever be) a medical professional who knows your own pain better than yourself. First off, any chronic pain warrants a simple visit to your healthcare provider or physical therapist to rule out other – possibly more threatening – variables. That being said, here are a few self-diagnostic tests you can perform to lead you in the right direction.
Seated Compression Test:
- Sit upright on a stool with your arms straight down towards the seat.
- Neutral Spine Test: Grab the underside of the seat and, with a neutral spine, pull yourself into your seat. Does this cause pain?
- Spinal Flexion Test: Repeat the process, but this time while slouching forward.
- Spinal Extension Test: This time arch your shoulders backwards and pull on the underside of the seat.
If the neutral spine test was painful, you likely have a compression pain trigger. If the spinal flexion test was painful, you likely have a flexion pain trigger. Lastly, if the spine extension test was the painful one, you’re looking at an extension pain trigger. What this means is that if you avoid movements that mimic your trigger position, your back will be given time to properly heal. If you find that more than one of these positions is painful, a neutral spine will be your best friend. Find your neutral spine and avoid deviating from it!
Standing Heel Drop Test:
- Stand up straight with your head looking forward, lift your heels off the ground then drop them back down quickly.
- Do the same thing but now with your chin tucked down to your chest.
- Now once more with your head tilted back.
As with the seated compression tests, pain during any of these tests indicates that you need to avoid activities that may put you into these positions. Avoiding these positions, especially while under load or during dynamic movements such as running, will expedite the healing process. Experiencing pain while your chin is tucked down but not while tilted back indicates nerve stress and tells you that proper neck posture should be your focus during rehabilitation. Think about changing your daily life to accommodate better posture (adjust office chair, position tv and monitors higher, sit all the way back in your seat). Find a position by either bracing the core and/or the shoulders (think about squeezing your shoulders down and back, away from your ears) that reduces your pain sensitivity. If you find that bracing helps with the pain, then bracing is what you must focus on during movements of daily life and during workouts.
The goal of training should be to minimize the movement of the spine by strengthening the core. Think about building up endurance BEFORE strength. Much like the guy lines on a tent – if you tension one side completely before even staking down the other side, your tent will be uneven and the poles will be under stress. We recommend you avoid the following exercises if they cause any pain or if you have been diagnosed with a disc herniation. If you have a minor herniation and you don’t feel pain during these exercises then they can be continued, assuming you use proper technique. While this degenerative condition is caused by the inevitable process of aging, science tells us that there are some big mistakes we can avoid making in our workout routine that will help delay and even treat this condition. The following are some exercises to avoid as well as some spine-sparing replacements that will allow you to safely continue exercising with a herniated disc.
5 Exercises to Avoid:
While core strength is crucial for rehabilitating a herniated disc, the goal is to reduce spinal movement. If you remember our jelly donut analogy, flexing the spine squashes the front portion of the disc and bulges it backwards. Sit-ups will only aggravate the symptoms and slow down the healing process.
Instead: Kneeling Fallbacks
Get into a kneeling position with both knees on a yoga mat or soft surface with the tops of your feet touching the floor. Your body should be straight from the knees to the shoulders (Imagine a yardstick with one end taped to your knees and the other end to your shoulders). Without ANY movement of the spine; keep your spine straight and your core braced, slowly bend at the knees and allow the rest of your body to be lowered in a straight line towards your feet. When you reach the point at which you can go no further without arching your back, slowly return to the upright position. Be sure that you don’t arch your back by going too far!
This exercise keeps the spine in a neutral position while strengthening the muscles responsible for stabilizing your spinal cord. If you can only lean a small amount at first that’s fine! Start off easy, build up the strength, and push yourself more as you feel stronger. Even small “fallbacks” are effective.
2. Twisting Exercises
Twisting an aged or damaged disc is another good way to aggravate your symptoms and worsen the herniation. Be weary of exercises that encourage twisting motions like russian twists or lunges with rotations. Wait for the herniation to heal more before continuing these types of movements.
Instead: Band Anti-Rotations
Wrap a band around a power rack or similar stable vertical bar. The bands with built in handles are preferable. Put both handles in your hands and interlock your fingers around them. Straighten your arms, stand up tall and squeeze your shoulder blades down and back. The pole should be to your right or left. Now step away from the pole until there is tension in the band. Get into a slight squat position and brace your core. Now take a controlled step away from the pole with each leg, pause, then a controlled step back to it. Do this without any spinal twisting.
This exercise places rotational forces on your core to which you must overcome in order to keep from twisting towards the pole. Start off with a thin band then work your way up to a thicker one as you develop proper technique and strength. If this is too difficult to do without twisting the spine, or you have a lower body injury preventing you from side stepping, try it without the side steps!
As great as these exercises are for building lower body and core strength, they have no place in your routine if they are causing you pain! That being said, you can get back to these exercises as soon as possible after you build up stability and don’t feel discomfort or pain during them. The act of leaning forward with weight places a tremendous amount of stress on the lower back. Even with proper form this leaves your back at a mechanical disadvantage, due to the longer lever arm. Instead, focus on exercises that encourage core “bracing” with little to no movement of the spine while under stress.
Instead: Bridges, Nordic Hamstring Curls
Lie flat on your back with your knees bent at a 90 degree angle and your feet on the floor. Push through your heels and squeeze your glutes, getting your hips as high as possible. Do this with a braced core to reduce spinal flexion or extension. These are great glute workouts without even using any weight at all. As you feel stronger place a dumbbell the on top of your hips for added resistance. Make sure you don’t arch your back at the top!
Nordic hamstring curls are a great way to get a good hamstring workout with a partner. Get into the same position as kneeling fallbacks (refer to #1), except this time, your partner stands behind you on the backs of your feet and you brace the core while falling forward. If done correctly, and with no bending of the spine, they are a healthy way to strengthen the stabilizing muscles in your back as well as your hamstrings. Put your hands out in front of you to catch yourself if you fall forwards. As with the kneeling fallbacks, start off with small falls and work yourself up to larger ones. Challenge yourself but know your body and your limits! Once again, back straight, don’t bend it if you go too far!
Once the acute pain of the disc is improving, learning how to hip hinge is next. The hip hinge is key for a squat and any lower body movement. Too many people can’t bend from their hips alone and begin recruiting their low back! Start with small motion, using a mirror or wall for external cueing.
Once the disc is feeling better, you can start with some basic squats working on hip hinging.
4. Overhead Weight Lifting
As with squats and deadlifts, overhead weightlifting puts your back at a mechanical disadvantage. That means that lifting 10 lbs of weight at arm’s length from your waist to above your head translates to around 100 lbs of stress on the lower back. Do that while leaning over and it translates to over 1,000 lbs! This is fine with a healthy back and good technique, but we don’t want to take any chances with a herniated disc.
Instead: DB Bench Rows
Get into a bent over position with your left knee on one end of a bench and left hand on the other. Your right foot should be off to the side of the bench, not right up against it. Keep your back flat, core braced and shoulders down and back. In this position, pick up a dumbbell with your right hand and pull it in a straight line up towards the ceiling, keeping the elbow and arm close to your body and squeezing the shoulder blades together at the top.
DB Rows keep your spine in a neutral position with little stress while allowing you to work your shoulders and arms. You can increase the weight to get a greater workout as long as you keep a stable spine and don’t drop the shoulder on the downward phase.
As your discs age, not only do they become more stiff and less pliable, they become flattened. Less shock absorption takes place and more jarring occurs between the vertebrae, which increasingly aggravates a herniation, thus increasing the healing time. Avoid running early on in your rehab program, especially if the heel drop self-test showed positive signs for a compression trigger.
Instead: Walking or Light Jogging
Walking puts very little stress on the vertebrae, making it a great alternative to running. Start off easy and increase your speed as you feel more comfortable. As you heal, the next step is to increase your speed to a very light jog. The focus here is on the shock that you place on your spine, so take it easy! If jogging feels good on your spine but running gives you pain, it is okay to stick to jogging and not push yourself too quickly.
Ask any medical professional what the purpose of intervention or rehabilitation is and you will get some version of the same answer: participation. Whether it’s in your favorite hobby, everyday activities like tying your shoelaces, or being able to lift up your child without fear of injury; pain-free participation should always be the goal. Although exercising with a herniated disc certainly poses some challenges for those seeking to stay in shape, with a little creativity and adjustment, you can safely continue your workout routine. You just have to put effort into having a purposeful rehabilitation program that will heal you effectively and quickly, allowing you to participate fully in the activities that make you who you are.