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.
Lie facedown on the floor with your legs straight and your arms next to your sides, palms down. Contract your glutes and the muscles of your lower back, and raise your head, chest, arms and legs off the floor. Simultaneously rotate your arms so that your thumbs point toward the ceiling. At this time, your hips should be the only parts of your body touching the floor. Hold this position for the prescribed time. (Note: If you can’t hold it for the entire time, hold for 5 to 10 seconds, rest for 5, and repeat as many times as needed. If the exercise is too easy, you can hold light dumbbells in your hands while you do it.)
Position yourself in the back extension station and hook your feet under the leg anchors. Keeping your back naturally arched, place your hands behind your head and lower your upper body as far as you comfortably can. Squeeze your glutes and raise your torso until it’s in line with your lower body. Pause, then slowly lower your torso back to the starting position.
Assume a push-up position with your arms completely straight. Position your hands slightly wider than and in line with your shoulders. Rest your shins on a Swiss ball. Your body should form a straight line from your head to your ankles. Without bending your knees, roll the Swiss ball toward your body by raising your hips as high as you can (push them toward the ceiling). Pause, then return the ball to the starting position by lowering your hips and rolling the ball backward.
Lie face-up on the floor with your knees bent and your feet flat on the floor. Place your arms out to your sides at 45-degree angles, your palms facing up. Raise your hips so your body forms a straight line from your shoulders to your knees. Squeeze your glutes as you raise your hips. Make sure you’re pushing with your heels. To make it easier, you can position your feet so that your toes rise off the floor. Pause for 5 seconds in the up position, then lower your body back to the starting position.
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.