Back injuries – an athlete’s worst nightmare. So much of human movement relies on the ability to both stabilize and fluidly move your spine. What happens if you herniate a disc? You might be wondering, can I ever lift weights again? The short answer is yes, but first let’s discuss what a herniated disc is, and then address how you can safely incorporate strength training back into your workout program.
Disc herniations of the lumbar spine (L3-L4, L4-L5, L5-S1) are one of the more common back injuries. Between each vertebra in your spine is a vertebral disc. These vertebral discs serve as cushions between the vertebrae, and they help to absorb impact while also assisting the spinal facet joints to guide movement in the spine. Unfortunately, these discs can rupture and herniate. In some cases this can lead to pain and pressure on your nerves, and also cause symptoms in your back that can radiate down into your legs.
While symptoms can come on suddenly and acutely, disc pathology is usually considered a long-term chronic condition. The last aggravating motion that caused the acute bout of pain is often just the final movement of several times your back was stressed by poor movement mechanics. This is why lifting weights with proper form during all exercises is essential. Poor movement mechanics themselves are often not painful, but the repetition of poor movement (especially with heavy weights) can lead to micro-trauma in the spine that cumulatively adds up and result in injury.
Degenerative disc disease and herniations are associated with increased lumbar spine mobility, particularly excessive flexion and rotation. In other words, the more your spine moves out of its neutral position during exercise, the greater risk you’re at for experiencing a disc problem 12.
Symptoms may vary slightly, but generally consist of pain or decreased sensation in the back, buttocks, thigh, and calf. People may also have some numbness or tingling, in addition to muscle weakness, in the body part served by the affected nerves.
If you do experience weakness, it is generally recommended that you see a health practitioner. Your health practitioner should be able to tell which segment of your spine is most likely affected based on the exact location of your symptoms.
In addition to noting where your symptoms are, your health practitioner should also perform:
1. A full neurological examination, which includes a screen of isolated muscles, sensations, and reflexes.
2. Nerve tension tests, usually a straight leg raise test or the crossed straight leg raise test.
Only if your health practitioner is not able to identify what is going on, would I recommend imaging tests such as MRI. While MRIs can be helpful, keep in mind that they are expensive, and often unnecessary in treating disc herniations.
Fortunately, the best thing you can do to improve your herniated disc is to exercise!
The exercises you perform will depend on how you feel and how long it’s been since you’ve injured your back. Here’s a 3-phase breakdown of how to reincorporate strength training after herniating a disc.
Prior to exercising, you’ll want to minimize the pain that you experience. For most people with herniated discs, lightly extending the back can help to reposition the discs anteriorly.
Try laying prone on your elbows to see if it alleviates your pain (like sphinx pose in yoga). It’s important to relax and breathe normally. If this position feels good, you can even straighten your arms into the prone press up (arms straight, back relaxed and curved).
At this stage, consider modalities (such as electrical stimulation) and only very light movements to maintain blood flow and to control pain. Returning to light activity can actually speed up your recovery, since light loads can speed up the early healing process. That being said, you must be careful not to push yourself to hard too soon. Heavy loads have been shown to have the opposite effect, decreasing blood flow in the spine and possibly impairing proteoglycan synthesis, which is critical for the normal function of your discs.
Start with walking, and gradually incorporate the following exercises in phase order.
This phase is usually started in the first 2 weeks, after local back pain is controlled and minimized. At this point, your pain should not get worse with any of these exercises. The focus here is to begin reloading your spine with light activity, and to relearn how to move properly. When your body experiences pain, your proprioceptive abilities are decreased (meaning you have less control of your body position than normal).
The following exercises focus on keeping your spine in a neutral position at all times. The focus is movement reeducation and core stability.
Keep the small, neutral curve of your back (you may place a small folded towel underneath your low-back to help you feel and maintain this position). Practice lifting your legs off the floor while maintaining complete stability of your spine. Your low-back especially should not lift away from the towel. You should feel your abdominals engage and tighten to prevent your pelvis from moving. Progress to the full movement, extending one arm and the opposite leg.
Hold for 5 seconds, and then switch sides. Start with 3 sets of 30s. Work up to performing deadbug for 2 minutes straight.
Similar to the deadbug exercise, bird dog involves extending one arm and the opposite leg without moving your spine or rotating your hips. Lifting opposite arm and leg off the ground while maintaining your balance will challenge and stimulate the diagonally-oriented muscles (multifidus, rotatores), which is exactly what you want when recovering from a herniated disc.
You should be able to perform this exercise without any movement of your spine. Try this with a foam roller (or rolled up towel) balanced on your back. You’ll know you’ve “cheated” if the roller or towel falls off your back. Try to hold your balance on each side for 5 seconds before switching, and perform for 2 min straight.
Especially if you want to return to weight lifting, it’s imperative that you practice moving and bending from your hips without movement in your lumbar spine. If you’re not sure if you’re keeping your spine neutral, try putting a piece of tape along your low back or holding a dowel against your head, upper back, and tailbone.
When standing straight up, you should have a slight curve in your low-back. If you bend your back at all while doing the hip hinge, you’ll either feel the tape pull or lose the dowel from one of these three points of contact. Your goal, especially when you lift weights, is to move from your hips, and not from your spine.
First, perform the hip hinge in the quadruped position. Once you’ve mastered that, do a standing hip hinge.
It’s critical that you understand how to move from your hips while stabilizing your spine before returning to bodyweight (or loaded) squats, deadlifts, and rows.
This phase will last about 2 to 4 weeks, and your focus in on movement control and spinal stability using anti-rotation exercises.
At this point, your body is in what we call the “repair phase”. As it’s healing, you’ll want to increase the challenge to the diagonally-oriented muscles in your spine (external & internal obliques and multifidus, all in combination with the transverse abdominus). Here, you will start to add weight to challenge your stability.
This is a great core exercise to incorporate early on as it challenges your obliques without excessively compressing the spine.
First, perform side plank with your knees bent prior. Progress to straight legs. Hold side plank for 10 seconds, with only 3 seconds of rest, for a total of 10 reps. As you get stronger, start combining the holds until you can do this for 100 seconds straight on each side.
This helps to challenge the rotational stability of your spine. You’ll need a cable or elastic tubing for resistance.
Start with holding the cable at your stomach. Stand tall with your core tight. As you push your arms straight out in front of you, you’ll feel the resistance try to pull you sideways. Maintain control and resist the side pull, keeping your hips and shoulders square. Hold for 5 seconds, and then slowly bring your hands back towards your stomach. Repeat 10x. Once this gets easier, increase the tension by standing farther away, using a stronger resistance band, or increasing the weight.
Bonus Tip: You can change the height of the anchor point to emphasize the challenge on your anterior muscles (abdominals), or your back muscles. If you want to challenge the abdominals more, place the anchor point around shoulder-height. If you want to challenge your back more, place the anchor height below your pelvis.
The second half of this phase involves performing many of your normal exercises, but on one side at a time. Perform lighter loads of your traditional exercise routine, and modify to do them unilaterally.
Incorporate these two common exercises, but perform them on one hand at a time. You should feel parts of your trunk (your core and spinal stabilizers) engage differently (and more) than if you were to do these exercises with both arms simultaneously.
At this point, there should be no pain. You’ve spent the last few weeks strengthening your core so that your trunk can maintain stability and resist rotation and flexion under load. The last step before returning to sports training and higher-level movements is to train your spine to rotate without flexing or extending.
Now you’re going to rotate your spine while maintaining core control. First, perform chops and lifts focusing only on rotation through your spine. Then, make these exercises more full-body by pivoting and rotating your feet and hips as well. Just as in the push-pull exercise, you can change the anchor point to challenge different parts of your core. Make sure to not flex or extend your spine.
If you follow this 3-phase approach, you’ll train your body to be stronger, more stable, and more injury-resistant. You’ll allow the disc to heal and retrain the surrounding muscles to protect it. A disc herniation doesn’t have derail your strength and fitness goals. With strategic training, you can return to weight lifting like deadlifts, squats, and kettlebell swings, probably with better form and control than before.