I am 33 yr old male, 6’4 and 240 lbs. I am recovering from a back injury and trying to rehab and rebuild a strong core and add mass and loose fat. I have a bulging disk around L4/L5 that is pushing on my sciatic nerve. I have received 2 of 3 steroid epidurals to relieve the pain. My understanding is that a strong core will relieve the pressure from my back in the future…
I’m looking for advice to help me find a routine to build a strong core without furthering the injury to my back.
Any help will be greatly appreciated.
THANKS
jguy,
Your understanding is, I’m sorry to say, not how it works. MD’s think this is true, but they have about 17 total minutes of musculoskeletal training in medical school (this is based off a true education from qualified musculoskeletal physicians.)
I would encourage you to follow stuart mcgill’s exercises to allow you to continue to train your lumbopelvic region and change movement patterns to decrease stress on certain tissues within the low back region allowing for continued exercise.
Keep in mind this ‘core strength’ mantra is not what helps back pain. If it did, then why have low back pain visits, cost, lost days at work, medications, injections and surgery increased by billions over the last ten years. Everyone trains the core, yet it continues to grow.
The improvements in pain are most likely a regression to the mean (time) and most likely a cognitive behavioral component. Have a look at this reference…
Steiger, F., Wirth, B., de Bruin, E. D., & Mannion, A. F. (2011). Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. doi:10.1007/s00586-011-2045-6
[quote]olifter1 wrote:
jguy,
Your understanding is, I’m sorry to say, not how it works. MD’s think this is true, but they have about 17 total minutes of musculoskeletal training in medical school (this is based off a true education from qualified musculoskeletal physicians.)
I would encourage you to follow stuart mcgill’s exercises to allow you to continue to train your lumbopelvic region and change movement patterns to decrease stress on certain tissues within the low back region allowing for continued exercise.
Keep in mind this ‘core strength’ mantra is not what helps back pain. If it did, then why have low back pain visits, cost, lost days at work, medications, injections and surgery increased by billions over the last ten years. Everyone trains the core, yet it continues to grow.
The improvements in pain are most likely a regression to the mean (time) and most likely a cognitive behavioral component. Have a look at this reference…
Steiger, F., Wirth, B., de Bruin, E. D., & Mannion, A. F. (2011). Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. doi:10.1007/s00586-011-2045-6
[/quote]
Your statement about physicians education is flat wrong. It seems like the “cool” thing to do is to bash medical professionals.
McGill’s exercises do actually address so called “core strength”.
For the OP improving abdominal strength doesn’t heal the disc. What it (combined with hip mobility etc) does do is help take the pressure off your low back and hopefully the disc.
[quote]jguy wrote:
I am 33 yr old male, 6’4 and 240 lbs. I am recovering from a back injury and trying to rehab and rebuild a strong core and add mass and loose fat. I have a bulging disk around L4/L5 that is pushing on my sciatic nerve. I have received 2 of 3 steroid epidurals to relieve the pain. My understanding is that a strong core will relieve the pressure from my back in the future…
I’m looking for advice to help me find a routine to build a strong core without furthering the injury to my back.
Any help will be greatly appreciated.
THANKS [/quote]
First rule of coming back from a disc injury is don’t do anything that causes pain now or later.
When I herniated a disc 6 or 7 years ago I worked with a PT and didn’t touch a heavy weight for around 5 months.
Realize that coming back from these thing is very individual and you have to be smart about progression. Stuart MCGills work is well worth reading and then you have to find your own progression that allows you to get to your goals.
Also cleaning up your diet in the mean time can help and losing extra fat mass certainly helps the back.
Mdgray,
flat wrong???
I could go on but I think this covers it…
Once again I ask olifter1 are you a chiropractic school drop out?
[quote]olifter1 wrote:
Mdgray,
flat wrong???
I could go on but I think this covers it…[/quote]
Flat wrong may have been over board. How about a broad generalization? These studies certainly support the idea that a fair number of medical students and non-ortho residents need more education on evaluation and treatment of the musculoskeletal system. The problem is that none of these studies find fault with the education of sports medicine and orthopedic MDs which are the groups people go to for musculoskeletal injuries such as a disk herniation.
First let me qualify myself, I have a BS in biomedical engineering. I am both an MD and a PhD. I have a PhD in Neuroscience, where my dissertation work pertained to central neuropathic pain and spinal cord injury. I also completed a residency in Physical Medicine and Rehabilitation, and an ACGME accredited Pain Medicine fellowship, in an anesthesia department. I also have competed in powerlifting since 1996.
So, if core strength is not the mantra, then what exactly is Dr. McGill’s exercise prescription?
Also, one must also distinguish between medical school and residency. In medical school the curriculum is already very full. The type of information ranges from very basic science (molecular level) to the clinical realm. Naturally, the knowledge base should be divided between, that which a medical student should be requried to know versus a resident. One cannot expect all facets of medicine to be adequately instilled in a medical student. Otherwise, what is the point of doing residency training?
In the realm of pain medicine, certainly there is a cognitive/behavioral component with some patients. Some patients do great with good quality PT alone, some do well with medicines with PT, some do well with an injection and PT, some do require an intense interdisciplinary pain medicine program focused on functional restoration. Of course there are also times, when surgery is the most appropriate course of action.
With regards to the 1st article (I have not pulled the entire article), but in reading the abstract:
“The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest.” Chronic non-specific low back pain is not the same as lumbar radiculopathy, lumbar spondylosis, SI joint mediated pain. It would appear the article does not differentiate between the causes of back pain. Does the patient population actually have organic pathology that correlates with their complaint? Are the patients from a pain clinic, complaining of back pain, but are actually looking for narcotics? Do the patients have poorly controlled psychiatric comorbidity? This would be like me writing an article on the effectiveness on antibiotics on coughing, without delineating if the cough was secondary to a bacterial infection, viral infection, gastroesophageal reflux, etc.
As MDGray has already pointed out, Olifter, your arguments are overgeneralized.
Beef
Please get assessed by a qualified person who will provide you a personalized program, rehabbing from YOUR starting point. The only place I’d even consider looking is here: http://robertsontrainingsystems.com/trainingnetwork/
If there’s nobody on the list in your area, search diligently until you find someone like them!
(Don’t take a chance with just anybody. The odds are not in your favor)
P.S. I’m only a 35 y.o. guy who kissed sciatica goodbye.
Mcgill suggests that the most important things, in general, are strength endurance and proper movement patterns rather than core strength. He prescribes individualized programs based on his assessment, but they usually focus on first resolving or avoiding symptoms and then moving on to developing proper movement patterns and strength endurance. There are a few good interviews with him on this site. His books are also definitely worth reading, especially for anyone who works in a related field.