Disc Bulge - Will you lift again?
Short answer – Hell Yes
First off, if you have back pain go see a physician or physical therapist and be evaluated.
Secondly, if you are diagnosed with a disc herniation (bulge, slipped disc, etc), find someone to treat you that understands that you do not want to give up lifting.
I would suggest checking out ClinicalAthlete and finding a provider who is experienced with working with athletic populations - http://www.clinicalathlete.com/for-athlete/
While this article is not going to get into pain science or the nitty gritty of disc issues, it is going to address that a disc bulge by no means is the end of a lifting career. I am going to outline a few important points advocating why you SHOULD continue to lift, including strategies to train while dealing with it and how to help manage it.
As a strength coach and physical therapy student, I get told about injury histories from a wide variety of people. One of the most reoccurring injuries I hear about are back injuries. Of particular interest to me is disc herniations.
If you’ve been going to the gym long enough, you’ve probably had a back issue and you’ve likely got some friends who have irritated their back some how too. In some lifting circles its like a badge of honor – you aren’t a real lifter until you’ve been stuck laying on the floor because your back is “locked up.”
Back pain is the most common pain reported among adults in the united states, with up to an estimated one third of the population currently experiencing back pain.(1)
At some point, the back injury is bad enough that these people decide to see a doctor. In a lot of cases a disc bulge/herniation is diagnosed and the exercise that was being done is given blame for the pain. For a great deal of these people, they deem lifting no longer an option. However, disc herniations are rarely due to one specific event and are usually due to a history of not moving well.
When dealing with a herniated disc it is important to know that many herniated lumbar discs will resolve with enough time.(2) In the past it was more common for surgical intervention to be done quickly following a lumbar disc herniation diagnosis.(3) When treated surgically, patients had experienced a great relief of pain within the first year after surgery, unfortunately, following that first year had the same results as people who did not have surgery.(3)
There are a number of complications associated with surgery that can make it ideal to avoid when possible and to at least try the non-operative option.(2)
Due to the growing understanding of both pain and lumbar discs, we are much better able to manage disc herniation’s. In a study looking at what was classified as “massive lumbar disc herniations” 14 out of 15 subjects were able to be treated non-operatively.(2) This provides a strong backing that most people experiencing a disc herniation should at least try to manage it through a non-operative route.
Hopefully by now I’ve convinced you that you can alleviate your disc herniation. During your treatment of your disc herniation (under the watchful eye of a PT), it can be very valuable to continue to train. By maintaining a good level of fitness and retaining your muscle mass, we can encourage a faster recovery. When I say continue to train though, I don’t mean to keep doing everything you did before. Training will need to be modified to prevent further injury – avoiding any activities that cause increased pain.
Depending upon the severity of your pain and the positions in which you feel symptoms, this can range very drastically – some people can do a wide range of activities, whereas for other this may start out very limited. Training may consist of walking initially and progress to including light extremity work (think bodybuilding work for arms, calves, etc.). For others, we may just need to transition to activities like unilateral lower extremity work (lunges, split squats, step ups) with minimal spinal loading and put a huge focus on upper body training. Over time we can progressively add more, but this is where having a good therapist comes in to guide you in these decisions.
During the time that you train and still have issues with your back, it is critical that we avoid anything that either does cause pain or may cause pain.
From my experience, it is far smarter to err on the side of being over safe than increase the duration of your issues.
For example, if you have a disc herniation it is safe to say you should stop doing most movements where your spine has a lot of shear stress (deadlifting, squatting, most things where you have your hips behind your shoulders) and also movements that put your into end ranges of flexion (sit ups and other movements where you bend forward through your spine) until your pain has gone away.
Additionally, if you find any movements cause increased symptoms/pain then avoid those for a while.
Doing things that don’t increase symptoms or pain can help get better faster through a host of mechanisms. Charlie Weingroff has discussed this thought process previously in regards to having people do pull ups while rehabbing their ACL because “feeding the nervous system inputs that tell the brain, “we are fine. We are ready to go.” That message translates to the knee and the knee isn’t even loaded.”
Once you get into a stage of symptom relief and are wanting to get back to “normal” training, the smartest thing you can do is be slow and progressive in your come back. This is the stage where a lot of people screw things up: “I’m pain free, I should jump back into the program I was doing.” This often leads to re-injury and a longer recovery process.
In contrast, what I’d recommend is to start very light, very very light, so light that you don’t feel challenged. During this time, focus on refining your technique and practice better positioning to reduce your chance of re-injury. Each session that you completed without any issues, add a bit of weight and repeat. This can take a longer time to get back to “true weights” but during this time you are providing a good stress to keep healing. You can also start to push your other exercises (unilateral work, upper body work) harder to keep motivation up. Over time you’ll get back to your weights you used prior and stay injury free due to your improved technique, weak point development, and healed body.
In summary: get evaluated by a doctor and good physical therapist; do what you can without irritating it and focus on that stuff; slowly add weight to your movements, it is always better to add less weight and not have pain than add more weight and have pain.
General suggestions to reduce disc injuries from occurring:
Disc injuries are more likely right after waking, so provide yourself some time between waking and lifting.4
Disc injuries are more likely when dehydrated so stay well hydrated.5
Explore the ranges of your spine in an unloaded environment to not only maintain movement in those ranges, but also provide some good stress to encourage adaptive strengthening.
https://youtu.be/ibD4gzy4Fec is a good starting exercise
Maintain as “neutral” of a spine as possible while lifting heavy loads.
This can be aided by improving mobility through the other joints of the body – ankles, knees, hips, shoulders, etc.
If you’ve had a disc injury in the past, you need to figure out what movements can be improved and work on them to not allow it to occur again (squats hurt your back, practice squatting better; deadlifts hurt your back, practice deadlifting better)
Interestingly, there is not a good correlation between MRI’s and individual’s pain:
“Despite a thorough analysis of the data were not able to prove any correlation between radiological findings (MRI) and the severity of pain.” – Burgstaller et al.
So just because your MRI shows up as having a disc herniation, it doesn’t mean you’re screwed.
Move well, lift heavy, stay healthy,
The Strength Therapist Crew
Deyo RA, Mirza SK, Martin BI. Back Pain Prevalence and Visit Rates. Spine. 2006;31(23):2724-2727.
Cribb GL, Jaffray DC, Cassar-Pullicino VN. Observations on the natural history of massive lumbar disc herniations. J Bone Joine Surg Br. 2007;89:782-784
Weber H. Lumbar disc Herniation. A controlled, prospective study with ten years of observation. Spine. 1983;8(2):131-140.
Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 4th ed. St. Louis, MO: Elsevier Saunders;2015
Urban JPG, Roberts S. Degeneration of the intervertebral disc. Arthritis Res Ther. 2003;5(3):120-130.