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acute back pain

Back pain

Slipped Disc: What is it and how to fix it

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Slipped discs are very common, right? Well, to tell you the truth… they don’t actually happen! Find out what a slipped disc really is and how YOU can sort it out yourself.

Slipped disc, Herniated disc, disc bulge and sciatica are all interchangeable and often used to explain the same thing. Now I need to say first of all that intervertebral discs cannot actually “slip” as they are firmly attached to the vertebrae above and below vertebrae by very strong ligaments – Slipped disc is just a colloquial term which has bred a lot of fear over the years but really there is nothing to fear!

The two common sites for herniated discs are the lumbar spine (low back) and the Cervical spine (neck). Today we are going to cover the low back as this is the most common, but stay tuned for self-treatment of herniated discs in the neck!

Discs cannot actually “slip” as they are firmly attached to the vertebrae above and below vertebrae by very strong ligaments

Basic anatomy:

lumbar anatomy - slipped discs and herniation

The spine is made up of vertebrae stacked on top of each other, held together by ligament and muscle. in between each vertebra is an intervertebral disc. Now in the lumbar spine, there are 5 vertebrae and the most common level for disc herniations are L5/S1 – this is the Disc between your lowest lumbar vertebrae and your Sacrum. roughly 80% occur here with the second most at L4/5 above it.

The Lumbar discs are made up of a harder outer layer, holding in a gooey middle.

How does a Disc herniation occur?

When too much force is repeatedly put through the front of the disc (such as bending forward, slouching and lifting heavy objects) the gooey center of the disc is forced forward and eventually (after thousands of bends)it forces through the outer layer.

A lot of Discs are injured doing very simple things light, changing a light bulb or picking up a baby but it is not that action that does it, it is a build up over time and it can take any little thing to tip it over the edge!

Now there is different levels of disc damage as you can see in the picture below:

disc bulge levels herniation - how to fix slipped disc

Now, sequestrations are serious and often need surgery but the remaining levels can be and should be treated conservatively (non-surgically) first.

Depending on the level of disc herniation, they can cause symptoms in different places down the leg due to the nerve roots that get annoyed. Keep in mind though that Disc herniations often do not have pain or change on sensation into the legs – there is a very wide range of presentations.

Herniated disc symptoms: You can have some or all of these.

  • Pain worse in the morning and cold/bad weather
  • Sciatica – Common back and leg pain caused by irritation to one of the 5 Lumbar spinal nerves. The nerves are irritated by the disc compressing on it or inflammation from the disc herniation. This usually only occurs down one leg.
  • Back spasm – often people are given this as a diagnosis but muscle spasm DOES NOT HAPPEN FOR NO REASON – there is always something behind it. Muscles around your back tighten up and go into spasm to protect your back and try to stabilize it so that no more damage is done.This is called muscle guarding and is a natural mechanism initially but in the following days, it can lead to a lot of discomfort, pain, and limitation.
  • disc bulge, slipped disc, herniation - self treatment physiotherapyAggravated by sitting, prolonged standing, bending and twisting.

Recovery and healing time

Recovery: Up to 80 percent recover within 6 weeks

Healing time: 12-18 months due to poor blood flow into the discs.

When to go to the hospital or see your Doctor

  • Weakness in your legs
  • Change in bladder or bowel (toileting) function.
  • Constant unremitting pain or pain not improving

If in doubt see your local health professional as this information is not meant to replace the assessment and advice of a health professional.

“Slipped disc” Self-treatment

1. keep active: back in the day bed rest was the first port of call, now it is the opposite. keeping relatively active is the best thing for your back and you need to remember that the chances are your back will get better and that over 80% of the population get back pain just like yours!

2. Exercises: to get the right muscles firing again to stabilize your spine and to loosen off the tight muscles (so that you dont feel hunched over and shuffling!) follow this link: Must know exercises for acute low back pain

3. Stiffness in your upper spine puts a huge amount more stress though your low spine and gets worse when in back pain! Here is a great way to mobilise your own spine

4. The greatest exercise for Disc Herniations: this exercise was developed by a top Physiotherapist Robin McKenzie. Repeated Extensions In Lying (REIL) act to centralise the disc and gradually reduce the disc Herniation.

Prone extensions in lying McKenzie exercise for disc low back pain

Position: Lying on your Front with your hands in front of you like you are going to do a push up.

Action: Keeping your hips and back relaxed, push your shoulders up. Do not push into pain, so stop when and if you feel pain and hold it for 10 seconds then relax down and repeat 10 times.

Initially start on you elbows as shown, then progress to straight arms.

Prone extensions in lying McKenzie exercise for disc low back pain physiotherapy

Reps and sets: 10 x 10 second holds 3 x daily


Remember: if pain worsens with this exercise do not push as far or as hard. If pain continues to worsen then consult a health professional.

These easy steps will help you so much, just remember that you WILL have good days and bad days but if you stick to the above 4 things, your Disc pain will get a lot better. Try and persevere with these exercises for 6 weeks at least!

Let me know how you get on and don’t forget to like, share and follow and remember, a slipped disc doesn’t exist!

For a more thorough rehab plan, download our Complete Low Back Self-Rehab Guide

Also see: progressed exercises for keeping back pain away


Back pain, Core strengthening

Acute Low Back Pain – Getting up and moving

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Low back pain is an incredibly common condition and is the single most common thing I see in practice every day. Luckily there are some great exercises to do early on to get you up and moving.

The following facts show just how seriously we should take back pain!

The bad

  • Low back pain affects 84% of the population at some point in their lives (1,2)
  •  38% of people have back pain each year (3)
  • Close links with low back pain and neck pain (15 fold increased the risk of neck pain)

The Good

  • 50-80% recover within 4-6 weeks
  • This is not uncommon

It may feel really sore and at times disabling but as long as you follow my recommendations below you have a good chance of recovering 100%

In most cases, the majority of low back pain is not serious. What a lot of health professionals do not tell their patients is that 85% of low back pain is categorized as “Non-specific low back pain”. This means that the pain and disability do not have a definitive cause or diagnosis. This non-specific low back pain is what we will be talking about today and I will be giving you the information and exercises to get you walking right and up straight again.

Because 50-80% of people recover in 6 weeks the usual advice is to take painkillers and keep active – but the thing is there is more you can do to speed it along!

First I need to say, yes there is the remaining 15% of back pain that is specific and does have a diagnosis so it is important to have these ruled out and see your doctor – especially if the pain is not improving.

Below I am going to outline a guideline for getting your back to the best it can be when you experience acute low back pain.

Phase 1. Initial inflammatory phase:

This is the stage where most likely it is uncomfortable to walk, bend over etc and you just want to curl up in a ball and stay there (that will not help!). In this phase you need to abide by the Tips below:

  • Number one rule is to keep moving, within reason. This prevents the structures around the spine such as the muscles in spasm from stiffening up too much. This is also very important in order to decrease the loss of stabilizing muscle activity. Now you don’t need to continuously keep moving – just don’t stay in one position for a long period (more than 20 minutes).

Bed rest is one of the worst things for back pain

  • Gentle range of motion exercise: knee rocker – Lying on your back with your knees bent up and feet on the ground – slowly let your knees drop to one side, and then the other. This is a gentle exercise and not to be forced or pushed into pain. Little and often throughout the day.
  • Safe sleeping positions: The best position is in side-lying with your knees bent up a little and a pillow between the knees. This position decreases the forces on the spine and allows muscles to relax.
  • If you must sleep on your back then have a pillow under your knees to unload the spine.
  • Stretch to straighten up: when in back pain your hip flexors tighten up and put a shear force through your spine and cause you to have a bent over, shuffling posture.

hip flex 1hip flex 2

Tip: to get a good stretch “tuck your bum in” or draw your front hip bones towards the roof. You should feel it in the front of your thigh or hip.

Hold for 1 minute.

Phase 2. Recovery:

In this phase, the main things causing stiffness and pain are muscles that are tight and in spasm in your hips, glutes and low back.

1. Glute stretch: To get into the below stretch, start in four-point kneeling and bring one knee forward between your hands. then extend you

To get into the below stretch, start in four-point kneeling and bring one knee forward between your hands. Then, extend your other leg out behind you and across to the other side. Lean forward in this until you feel a stretch in your glute region. To add more of a stretch, walk your hands out in front of you. Hold for 1 minute each side

glut and Lat stretch - Hip flexibility glut and Lat stretch - Hip flexibility

2. Hip flexor stretch: as above in phase 1

3. Bird-dog exercise:

In four-point kneeling slowly raise one arm and leg on opposite sides, making sure to keep your back straight (imagine your dinner is sitting on your hips – it is all about control). Lower down in control and repeat, 10 times each side twice.

Beginners: Start by raising one leg only.

birddog 1birddog 2

4. Bridge, level one:

START POSITION: Lying on your back with your knees bent.
Stabilization: Tighten abdominals.
Squeeze your buttocks together and lift buttocks off the floor until your body is aligned. Hold for 5 seconds and then lower down. repeat 10 times twice.

Brideg - up Brideg 1 legges - up

Phase 3: Strengthening and back stability – and maintain!

To do this make it a routine to do my top five Low back pain exercises daily.

Maintaining core stability is important in preventing flare-ups and ensuring you at your best if flare-ups do happen, to speed up recovery.

Thanks for reading and remember looking after your back is ALWAYS important, not just when it is sore.

Looking for a more detailed self-rehab plan? Download our Complete Low Back Self-Rehab Guide


Core strengthening, running, Spine

The importance of Core Stability on injury

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core strength minimizes lower limb injuryHaving a stable core and pelvis has huge benefits through-out the body, including laying a stable base for your legs to work off. This means more bio-mechanical efficiency, less injury AND less pain.

In order to do any lower limb exercise well, including running, squat, weight lifting, tennis etc, you need to be in control of your core. If you don’t have a stable base, everything working off it is going to struggle and compensate. This can lead to tight hip flexors, ITB syndrome, patellofemoral pain, ankle sprains, niggles and more.

Imagine a tennis shot, for example. Your are stepping forward and driving off your back foot while at the same time swinging your raquet forward to strike the ball. If you core isn’t in control then you are losing force between your legs and arms – losing that strength of the drive from your legs.

Core strength makes your body stronger, not just your abs, by conserving and transmitting energy.

Just for clarification, as “core” can mean different things to different people. Core for me is your Lumbo-Pelvic stability. The combined control and strength of your spine and pelvic muscles.

Quick self test: A great way to test and see how good your Lumbo-pelvic stability is yourself is to do the Single Leg Squat Test. If you see your hip dropping or knee tracking inwards, then you are at risk or injury and need to get started strengthening ASAP.

 

Poor core stability can also lead to and contribute to all sorts of injuries and pain, including in your:

  • Low back
  • Shoulder and neck
  • Knee and hip

 

So how do we sort this problem you ask?

Below is an exercise program to get started on that will really make a difference if you stick to it. I also fully recommend finding a good Physio in your area to have your specific deficits assessed to get some manual therapy to speed things up.

Exercises to improve Core stability:


1. Single leg Bridge:Bridge 1 leg - glute activation, leg strength and core stability. the best exercise for hip stabiltiy, great for runners

Position: lying on your back, bend one knee so that your heel is close to your backside and straighten the other leg as above so that your thighs are horizontal. Your arms can be crossed over your chest or down by your side to make it easier.

Action: Pushing through your grounded heel, lift your bum off the ground as above, straighten your back and hold for 30 seconds then lower and repeat on both sides.

 

2. Clam Plus: (Do them right and they are surprisingly hard!)Clam exercise plus - gluteus medius strengthening, pelvic stability, leg strength

Position: Side lying  with top elbow on the ground, knees bent, ankles together and importantly the top knee sticking out 1-2 inches further that the bottom knee.

Action: Making sure not to let your pelvis rotate backwards and keeping your ankles together – lift your top knee up roughly 20cm and lower down in control. Reps: Build up to 50 reps on each side.

If you have found in the past that normal clams don’t do much for you, try it this way with your hip s rolled forward more to isolate Glute Med better and get less Tensor Fasciae latae activation.

 

3. Double or single leg squatSingle leg Squat, Glut Med activation - hip stability and strength:DL squat
Try performing the Single leg squat, but if you are too unstable (cannot stop your knee going inwards) then start with the double leg squats.

Single leg: 2 sets of 12 reps

Double leg: 3 sets of 12 reps

Tips: stick your bottom out like you are going to sit down and keep your knees out!

 

4. Front Plank: 
plank

Hold this for 60  seconds (if you can, otherwise build up to this).

Tip: do not hang on your hip flexors, tuck your bottom in and bring your hip bones up towards your head.

 

 

 

 

5. Side plank: side plank

Again aim for 60 seconds here, keeping your body straight!

 

Too easy? Add in leg raises to this – Raising the top leg straight up and down, building up to 50.

 

 

Do this short program  DAILY and stick to it for at least 6 weeks -Let me know how you go!

 

You may also be interested in:

Iron out your running – What you never got taught

Get your spine moving

Smash your Glutes


Back pain, Core strengthening, Health, running

Glute activation, the missing link

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Glute activation, building a good squat pattern and reaching your Peak.

A strong, healthy back (not to mention your knees!) needs the areas above and below it to work optimally to avoid overload injuries and pain. Whether it is running, lifting up your child or building the perfect squat, good glut activation is essential to all body movement and is one of three aspects essential for a healthy low back and lower limb.

  1. A mobile thoracic spine to unload the low back.
  2. Good muscle length in Gluts, hip Flexors and Lats.
  3. Normal Glut muscle activation.

Today we are going to cover glut muscle activation and the best ways to optimize this as this is the hidden cause behind many injuries such as low back pain, sciatica, patellofemoral pain, meniscal injuries and groin pain.

Here is a quick Test to see how strong your glutes are.

You might ask why bother with increasing your glut activation – your gluts work right? well you could be wrong! The main reasons why glut activation may be missing are:

  • Past back pain or injury. The Lower crossed syndrome is very common in anyone with a history of low back pain of any kind: A syndrome developed by Dr Janda proposed that those with a history of low back pain and troubles all had a characteristic pattern of weak and tight muscles. Weak: Gluteals and abdominals. Tight: Hip flexors and Erector Spinae. It is very common to have people arrive at the clinic with history of low back pain or tightness showing this pattern.
  • Poor technique and lack of body conditioning.

What happens if you have poor gluteal activation:

  • With poor activation in a squat, you cannot protect your back as you use the hamstring and erector spinae (back muscles) to push your body into extension – This leads to Erector spinae increasing the load and compression on the Lumbar spine. So healthy glut function is needed to unload the spine and decrease low back pain.
  • Poor glute activation leading to you hanging on your hamstrings also leads to over extension of the spine – leading to much-increased risk of injuries such as spondylolisthesis (stress fractures) and muscle spasm.
  • Lack of gluteus medius activation causes internal rotation of the legs (knee dropping inwards) leading to increase force on the knee and higher chance of injury.

Now one thing to mention here is that it is impossible to rebuild proper Glute function without a good hip extensor pattern and certainly not with traditional squat exercises utilizing barbells and free-weights (don’t even get me started on leg press machines).

Below is your pathway to achieving optimal glute activation, reaching your goals and decreasing lower limb and back injuries:

Gluteal Muscles - building the best squat pattern.

 Before you get to the exercises, above are the three gluteal muscle and here their function:

  • Gluteus Maximus: External rotation and extension of the hip.
  • Gluteus Minimus and Medius: Abduction of the Hip (pulls your thigh out to the side and stops your hip dropping.)

Must-know exercises for glute function:

1. Clams: This exercise has been shown to be the best for isolating glut Med and Min and really gets the legs shaking if done right!

Clam exercise plus - gluteus medius strengthening, pelvic stability

Position: Side-lying with top elbow on the ground, knees bent, ankles together and importantly the top knee sticking out 1-2 inches further that the bottom knee.

Action: Making sure not to let your pelvis rotate backwards – lift your top knee up roughly 20cm and lower down in control. Reps: Build up to 30 reps on each side.

2. Single leg squats: Now don’t get daunted! these will really get your gluts firing functionally and are far superior to double legs squats.

Single leg Squat, Glut Med activation - hip stability and strengthSingle leg Squat, hip stability and strength

Position: standing on one leg with your arms straight out in front, chest up and looking straight ahead and the other leg directly out to the side.

Action (1st image above): Squat down, like you are going to sit down in a chair(stick your bum out). Only go down as far as your body allow (come back up before you fall over!) and don’t leg your free foot touch the ground. come back up and repeat, no hold needed.

Reps: build up to 2 sets of 12 reps on each leg.

Too hard? – try it with the leg out in front or bent as you can see in the second picture above.

Single leg bridges: The third and final Glut blasting exercise:

Single leg bridge - glut medius activation for hip stabilitysingle leg bridge for hip stability

Position: lying on your back, bend one knee so that your heel is close to your backside and straighten the other leg as above so that your thighs are horizontal. your arms can be crossed over your chest or down by your side to make it easier.

Action: Pushing through your grounded heel, lift your bum off the ground as above, hold for 5 seconds then lower and repeat.

Tip: make sure to keep your pelvis level.

Reps and sets: Build up to 2 sets of 12 reps on each leg with the 5-second holds.

Go hard at these exercises – Twice a day ideally and you will notice a huge difference in everything from running, squatting and weightlifting to low back and knee pain.

You might even like to give The Best Glute Stretch a try as with poor muscle activation, you also often end up with tight muscles!


Back pain, Core strengthening, Health

Sciatica and low back pain – All you need to know to sort it out

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You may have heard of Sciatica or Low Back Pain, or been told that you have it. BUT do you really know what the sciatic nerve is or how it gets sore?

In this post I we will go over, common causes, misperceptions and finally, self-treatment techniques.

Sciatica is a buzz word used by a huge amount of back pain sufferers and medical professionals but is really an umbrella term and can be caused by a number of things:

– Tension on the sciatic nerve as it passes through the gluts by your Piriformis muscle.

– Compression on nerve roots as the exit the spinal cord by disc herniation.

– Compression or irritation by rough surfaces and extra bone growth (spondylosis or arthritis of the spine).

The symptoms of sciatica range from radiating pain down the buttock and leg to altered sensation in the leg and foot. Back pain may or may not be present.

Physio exercises and information on low back pain

It is very important that you see a good physiotherapist who can diagnose what is causing your low back pain and/or sciatica as this gives a better picture and leads to a more specific treatment approach.

A large proportion of “sciatica” pain is caused by Lumbar disc herniations which is where the disc bulges backwards into a spinal nerve due repetitive flexion (bending forward or slouching), compressing it and restricting movement and sliding of the nerve.

Self-treatment technique #1: Extensions in lying. In order to know whether it is a disc contributing to your pain, lie on your front with your hands under your shoulders like you are going to do a push-up.

In order to know whether it is a disc contributing to your pain, lie on your front with your hands under your shoulders like you are going to do a push-up. (Now remember not to push into too much pain here)
What I want you to do now is push your shoulders up, keeping your hips relaxed a hanging down. Hold this for 10 seconds 10 times and if this either decreases your pain, or decrease your leg pain and causes pain more centrally in the back then, most likely this is a disc problem which is helped greatly by doing this McKenzie exercise twice daily.

Tip: as in the picture above it is best to slowly progress this exercise, so begin only pushing up into the middle position if you have moderate to severe back pain and then progressing up over the next fortnight.

For more information on how this exercise was developed check out Physiopedia.

Self treatment technique #2: The exercises in this great post lay a great foundation to start rehabilitating your back and is an excellent place to start. They are also fantastic for all common causes of back pain!

Make sure to share, comment and subscribe to future posts for more information on Disc pain.

Looking for more? We have compiled all the best info in one, evidence based rehab guide

Disclaimer: It is important to stop this exercise if it increases back pain and seek medical attention if symptoms worsen or you lose strength in your legs


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