Slipped disk treatment, prevention, and exercises.
Discogenic back pain, aka a slipped or herniated disk, is a more complex issue than simple muscular back pain. The intervertebral disks, which are made of cartilage, are built like marshmallows and sit between the vertebrae for cushioning. When an athlete “slips” a disk—most commonly as the result of a direct impact, a wrenching movement or degeneration—it means that part of the disk lining tears and the disk material inside bulges out, pinching the nerves of the spinal cord that lie just behind it.
Discogenic back pain can include muscular lower-back pain if the nearby muscles spasm, but a clear signal that the problem’s origin is in a disk is pain that shoots down the back of one or both legs. This comes from the irritation of spinal nerves.
Employ dynamic rest. You’ll want to lie down, but minimize the amount of time you spend on your back. Stay mobile, even if it means taking little shuffle steps around the house. Bed rest during spells of back pain only deconditions your muscles, which is the opposite of what you want to happen. During the acute stage, avoid straining your back, but do simple stretches to loosen your hamstrings, hip flexors and glutes. All of these can help alleviate the spasms.
Ice it, then heat it. Apply ice for 15 minutes 4–6 times a day for the first two days. After two days, using a heating pad at the same time intervals can help relieve the spasms.
Try an NSAID. An anti-inflammatory like ibuprofen or naproxen can help with pain and inflammation.
Vary your therapies. Effective pain relief therapies are very individualized. For example, some of my patients respond well to massage therapy. Others swear by acupuncture, though in my experience it works better for muscular, non-discogenic back pain. My point: Try different therapies until you get results. Everyone responds differently to different things.
Stretch and strengthen your kinetic chain. As the pain subsides, start the reconditioning process with basic core strengthening and stretching exercises. Go slow. Stretch your hamstrings, hip flexors, glutes and core. Do glute bridges and planks, adding reps and intensity as you improve. Once you’re pain free, up your kinetic chain conditioning.
Commit to your kinetic chain. The more muscles you have supporting your back, the better off your back will be. Therefore, back pain prevention isn’t just about strengthening your back muscles. Your back is working in combination with the rest of your core and your glutes, hips, hamstrings and quads for optimal performance.
Your fitness program must include dynamic, compound exercises that target as many of these areas as possible. Workout staples should include multidirectional lunges, core exercises with trunk rotation, squats, squat jumps, burpees, planks, mountain climbers and more (see some ideas at right). Plyometric total-body boot-camp-style workouts are terrific. I also recommend regularly attending Pilates classes. All of these things focus on strength and flexibility throughout your kinetic chain.
When to See a Doctor
If you have pain radiating down the backs of your legs, see a doctor. This is a clear symptom of discogenic back pain and you need to have an MRI to determine the size of the disk herniation and X-rays to reveal any other underlying bone problems.
Once you have this diagnosis, a doctor can give you a cortisone or anesthetic injection to help with the pain.
Physical therapy is also a good idea in these cases, both to reduce the acute muscular pain that often goes along with this problem and to begin reconditioning your kinetic chain to bring muscular stability to the spine. The exercise and stretching ideas I offer here help, but a physical therapist can direct your care and teach you correct form and how many repetitions to do based on your individual case.
Build a Better Back
Now you know that fixing back pain requires a holistic approach—integrating exercises that work your core, glutes, hip flexors, hamstrings and quads—because if you’re weak or imbalanced in any one of those areas, it can throw off your whole system and become a back issue. Therefore, the best pain-proofing plan is to target all of those areas. Add these dynamic stretches and exercises to any workout for a stronger back.
New York City sports medicine specialist Jordan D. Metzl, M.D. is a 33-time marathon finisher and 13-time Ironman. His book, The Athlete’s Book of Home Remedies, has more than 1,000 tips to fix all types of injuries and medical conditions.