Low Back Pain, Disc Herniation, Sciatica Treatment Bellingham
It’s been 10 years since I had my bad back injury. For me it was having my back slammed on the concrete playing basketball with very large humans. My left leg immediately started giving out on me. I had been active with weightlifting doing CrossFit and Olympic lifts the 3 years leading up to this event. I was unable to return to weightlifting without intense low back pain at the time. As a 22-year-old, I didn’t know anything about navigating back pain. I was at the mercy of the healthcare providers I was referred to. Doctors told me I had to stop lifting altogether. The first two physical therapists I saw just gave me repeated lumbar extensions or the McKenzie method. The next PT clinic I went to had more of a shotgun / cookie cutter approach where nothing was specific. I was steered away from manipulation therapy. One thing in hindsight I was grateful for was that I was also steered away from unnecessary advanced imaging and surgical intervention. There are times when a disc actually compresses a nerveroot and those individuals will have progressive weakness, reflex loss, and numbness. Those individuals do better with a microdiscectomy surgery according to the current research. That small population of patients aside, most disc related issues are simply weaknesses about a segment in the spine with inflammatory driven, noxious chemicals around nerve roots causing radiating symptoms. I thought I had exhausted what physical therapy had to offer.
I thought I had failed PT, I had seen 3 different PTs after all. While each helped a little, none were super effective at actually resolving the issue. Healthcare workers mean well, it’s why we get into the business. Not all healthcare providers know what it’s like to personally navigate rehabilitating significant injuries. As a young 22 year old, I listened to my healthcare providers. I lost a bunch of muscle, I avoided activity that might have elicited pain, and I became another statistic of the system dealing with chronic low back pain. I didn’t fail physical therapy, physical therapy failed me.
Fast forward a few years and I’m a physical therapist with low back pain still with radiating symptoms into the left leg. I devoted my early career to solving this problem and getting really good at treating low back pain. I studied Stuart McGill’s work (the leading researcher for disc related pain), listened to every podcast I could on my work commutes, invested thousands into continuing education classes, and I learned what the research actually has to say. Some things that stuck with me:
Strength levels are the #1 predictor of back pain episodes with workplace injuries.
Weight lifters with low back pain who continue to lift the same amount of weight have less pain than those who reduce their weights, and those who reduce weights have less pain than those who stop altogether - it’s about muscle engagement around the spine.
Brian Carroll, the world record holder for squat weight suffered a bad disc herniation when he was capable of squatting <800lbs, at the time he didn’t know if he’d ever be able to lift competitively again. He changed his habits, worked with Dr. McGill, focused on static core stability of all planes, especially with lateral, rotational, and diagonal forces, and eventually returned to progressive loading. He went on to shatter the world record for squats at 1306lbs. The body is resilient, adapts, and will heal if you consistently apply positive stress over time.
Spinal Manipulation can be a game changer.
Nerves are far more sensitive to chemicals from inflammation than they are to mechanical compression. Nerve pain does not equal nerve compression or a pinched nerve. If prednisone works, your pain is inflammatory and an MRI will just show you what was already there.
Disc Herniations are a normal part of the aging process and they don’t equal pain. A significant portion of pain free individuals have disc “pathology” on imaging. Most of us are walking around with disc herniations without pain. What matters is if there’s physical compression or chemical irritation of a nerve root.
Strength training vs traditional therapeutic exercise showed no difference in efficacy of treating low back pain. So, no, you don’t have to do the testicle clenchers (kegels) and hope your back pain goes away. You could just do deadlifts instead. In all seriousness there’s a time and a place for both therapeutic exercise and weight training. Both are important. You need a coach that understands when and how to do what your body needs to get you the best results.
I put in the work strength training but still had some lingering low back pain. I found myself in a manipulation course and one low back manipulation cleared up a lingering pain with bending backward that had been ongoing for 5 years. All the prior PT mobilizations just made it more painful. I see this a lot in my military clientele who were effectively trained to live with the pain so they didn’t get treatment for years but stayed active. One manipulation can have a dramatic effect on their pain. In that class, I personally experienced the immense benefit of the right manipulation for the problem I had, and just once was enough to get me addicted to the crack.
Should you have your low back manipulated? There’s a group of patients who definitely should: recent onset of pain <16 days, no symptoms past the knee, low fear of movement / manipulation, hip internal rotation mobility of at least 35deg in one hip, and stiffness of at least one segment in the low back. Those who meet that criteria and do not receive spinal manipulation therapy are 8x more likely to experience worsening disability at 1 week and 4x more likely to experience worsening disability at 1 month. That was me. What I needed was a performance physical therapist who understood weightlifting AND who was skilled in spinal manipulation therapy, so it’s what I’ve become that I might help others not become a product of mismanaged healthcare.
So is manipulation only good for people that check those boxes? Nope! About 50% of the people in these studies who didn’t meet the criteria still benefited from manipulation, it just wasn’t a home run treatment intervention. So, the majority benefit from manipulative therapy and if it’s not part of the recipe to get past your back pain, you’re likely not giving yourself your best chance. Sadly less than 15% of physical therapists in Washington state hold a spinal manipulation endorsement allowing them to legally manipulate the spine.
Minus a few short term flare ups, I’ve been free of low back pain for 3 years now. The ability to maintain a neutral spine with dynamic stress to the core in all planes of motion from different angles bulletproofs the back. Disc Herniations are not a death sentence. They require proper dosing of load over time. They require trusting the process and putting in hard work. While there’s always the risk of a training related flare up, being weak is the real threat. At the end of the day, would you rather injure your back lifting heavy, or frequently break down from simple things like picking up your child or bending over?
If you’re interested in giving yourself your best chance to get past low back pain, schedule a free discovery call and we’ll get you going in the right direction.
