Herniated disc

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Your spine is made up of vertebrae, each separated by intervertebral discs made of fibrocartilage.  The discs are made up of inner and outer parts - a soft gel like elastic inner core called the nucleus pulposus and the tough annulus fibrosus being the outer rim of cartilage. The nucleus pulposus is there to distribute the pressure of each disc when they are put under load, i.e. they are shock absorbers. They also enable each vertebrae to glide over the other, keeping movements smooth.

What is a herniated disc?
Also called a slipped, ruptured or prolapsed disc. What happens is the soft inner nucleus pulposus herniates - it bulges through a tear or distortion in the annulus fibrosus into the vertebral canal or intervertebral foramen. The damage to the annulus fibrosus can happen because the disc is compressed beyond its normal range.

Depending on which way the bulge protrudes will determine what symptoms are felt. The disc can compress the spinal cord or nerves which can lead to reduced, or loss of function to the areas of the body served by the nerves. To you, this will feel like mild to severe back ache with or without burning, tingling, numbness or other sensations. If really severe muscle function can be affected or even paralysis. It really depends how severe the injury is, and what structures are affected.

Why does it happen?
For a fit and healthy person it is usually caused by sudden trauma, generally because of strenuous exertion (e.g. lifting a heavy object) or exercise (e.g. improper technique when weight lifting). Trauma can occur because of the lightest of movements, e.g. picking up a small object, and this would point to an underlying cause, or with forceful trauma to the vertebral discs such as in a fall or car accident. Poor posture can also contribute to this condition. In the healthy/young population the herniation is generally sudden and acute.
For older people the herniation can occur because of wear and tear - bone disease or degeneration, and the onset can be more progressive and chronic. That said, the onset, i.e. when you feel the pain, is usually sudden and sharp.

Can it be prevented?
Obviously accidents and traumatic occurrences are difficult to prevent. You can however ensure you perform lifting with proper technique, and keep yourself generally fit and healthy. Avoiding repetitive twisting movements is generally a good idea as this can put extra pressure on the discs. In a gym ensure your trainer shows you correct posture and technique and continues to monitor you so that you continue to do the exercises correctly. This should minimise the risks.

How to treat it?
Immediate care is rest and application of ice initially, heat can be applied after the acute stage has passed. Seeing your GP or emergency doctor may be appropriate. With medical intervention anti-inflammatory and pain medication may be prescribed.  As the injury progresses bed rest may be applicable for a period but generally normal activity should be undertaken ('active rest') to prevent muscle guarding and keep the spine mobile. If there is pain then stop what you're doing. Longer term, you should be looking to undertake strengthening and flexibility exercises with a sufficient warm up. It should go without saying that sudden or excessive heavy lifting is to be avoided to prevent re-injury. In severe cases surgery may be necessary but the majority of cases resolve with this being necessary.

Can Sports Massage help?
Yes, it can. Providing the therapist avoids treating on a day when symptoms are bad then there are no reason not to massage. Sports Massage will help to relieve muscle spasms, muscle guarding and tension which is your body's natural reaction to 'protect' the area. The intention of massage is to create space around the affected vertebrae, thereby allowing for the retreat of the herniated tissues.

Massage will also help to manage pain. A good therapist will look at the wider issues occurring in your body which might be contributing to, or a result of the disc injury. For example, postural imbalances, muscle functioning (what might be inhibited or short), firing pattern dysfunction and gait reflexes should be considered as part of the treatment. The aim is to look for the cause of the issue, as well as managing the acute area and muscles surrounding the injured disc. 


It is often appropriate with this condition for massage therapy and osteopathy treatments to be included in the overall treatment plan. This is to allow the soft tissues and bony structures to be worked in tandem, since both are involved.

Thoughts on movement for postural information. Squatting.

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Quite a mouthful of a title, however, I hope that this will become slightly more clear as I ramble on.
We were over at Strength and Performance gym yesterday and I was beginning a new programme which is going to be going on for the next 4 weeks. One of the exercises here is the Front Squat, not a massively technical lift like some of the Olympic lifts, but technical enough to do you a fair amount of damage should you do it wrong.

If you ARE doing it wrong, and persist in doing it wrong, upping the weight because you think you can, eventually something is going to give. If your biomechanics are not very good, its probably not going to be your legs (the main bit that is doing the lifting) that are going to blow. Most likely its going to be your back.
So.
Its probably quite a good idea to get the action right before you start piling on the weight and potentially doing yourself a mischief.
One of the reasons why I'm looking to squat with Sean and Z from S&P is because they have a perspective I do not. They are Strength coaches and can see a million different things about how I am moving and how I should be moving, and what I need to do to move correctly. Standing still, in a static position I don't seem to be particularly wonky, nor do I seem to be particularly prone to odd movements. If I Goblet Squat with a dumbbell, even with the movement, I appear to be quite well balanced and move quite well.

We started with a bare olympic bar, 20kg and some interesting things started happening. As you can see from the standing still with the bar relaxed across me, its dipping down to the left without me doing anything.

At the top there is a slight imbalance, left being lower than the right

During the actual squat, my hip flexors don't appear to be moving properly. The right side seems to move fine, and drops down into position, but the left side is doing something odd. The way I am moving appears to suggest that the Glutes or the Hamstrings are too tight and are preventing me from getting down into a decent squat properly. Because of this inhibition, I sink lower on the right, the left leg is slightly abducted, and my entire trunk sways to the right, but the shoulders dip to the left.
Double trouble.

during the squat, there is a continuing left/right balance problem

At the bottom of the squat, my body is swaying off to the right, bar leaning to the left, right ischial tuberosity lower than the left, left leg abducting out to the left.

Looking at the photos I decided to do a bit of stretching. Looking at my glute stretch, on the right I can get my knee to my chest easily, not an issue in the slightest. The left is a different story, but in an interesting way. I can't get my knee to the chest, but I don't feel like there is a stretch coming on in my glutes or in the hamstrings. It feels like my hip flexor area is "blocked", as if there is something in the joint that is not allowing full flexion of the hip. It's almost like the tissues are approximating because there is not enough space in the joint capsule. Because of this, the squat doesn't sit down as far as it should, and if I decided to ignore this, and carry on sticking weight on the bar, at some point, the compromised back would decide not to work and I'd end up in a pretty rubbish situation.

We have decided that for the moment, its worth looking at improving the flexibility of the hip flexors, which includes working on the lift pattern - movement will help improve hip flexibility, but not to increase the weight until I am closer to a more optimal squat pattern. I know a number of people that would have said - ah, we are close enough, I want to get my lift up, lets rack on the heavies... Not a good plan. I'm in this life for the long shot and want to keep my body performing optimally for as long as I can.
Look long term, think big picture.

(though sometimes, that has to be replaced with the "go big or go home" mantra...!)

Lower Back Pain Trigger points from the QL

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Now Lower Back Pain is quite a big subject, (minor understatement), and for the sake of not sitting here and writing an entire book, I'm going to limit this to a client I was treating last night.

Whilst driving, he was getting significant pain in the far lower back, right down where the back meets the bum- the lower lumbar area going into sacral area (L5-S1). He has had no history of spinal problems, no slipped discs, hernias or anything like that, and has to stretch the area out when driving because it hurts.

Now, originally you would assume that there is something wrong with the Glutes and surrounding muscles, for something to be hurting there, and you may well be correct. Weakness in the Glute area has been shown to be a major issue in terms of Lower Back Pain. As we walk around and sit at desks all day, the glutes barely get a look in and slowly waste away- getting overly tense when they are forced to be used.
In this case it is the case, however, it is not where the pain is originating from.

After palpation it was clear that there was pain in the glutes, and around the sacral area, but there was also referred pain into the glutes from the quadratus lumborum- and this was the main issue- I keep blabbing on about it, this is the fire and although there is pain in the glutes from lack of use and tension, this pain is the smoke.

So, in THIS particular case, it was a referring triggerpoint pain from the QL, (my model is unfortunately not available to draw on at the moment so you'll just have to google Quadratus Lumborum) which was antagonising the glutes, which was causing the pain. Had I treated JUST the pain in the butt (as it were), the client may have gone away happy that I had been treating the "right" area, but the pain would have come back quickly.
With a decent explanation of what I was doing and why, the client could understand- and indeed feel- why I was treating somewhere that wasn't initially painful- that is- didnt feel like the origination of the pain.

Lower Back Pain can be created from a variety of places- this time it happened to be in the QL, it could be coming from almost ANYWHERE in the body. Look at imbalances, look at other issues in the body, not just at the back.
Look for the FIRE not the SMOKE.