Bulging discs and referred disc pain

[vladimir]

This one is for Andrew and i'm posting here as Rick suggested. I injured myself doing bent press, though the real reason was that i didn't train for 3 months and then decided to go back in guns blazing.

The result was 3 bulging discs - L2/3, L3/4, L5/S1 with one of them pressing on my nerve and causing a lot of referred pain. It took me 8 weeks to recover to the point of walking again and i started doing pilates twice a week and yoga once a week.

Last weekend i did something and the pain came back big time and physio has said that i will get one of these 48hr warnings every now and again. For the record, pilates was my idea, he advocates walking/movement and stretching to deal with this injury.

The only way i can get going in the morning is still a heat pack on for 20 minutes, before i can shave/stand up etc. I'd rather know some movements in the morning, cause i don't want to be reaching for microwave every day.

Just wanted to know your opinion.

Vlad

p.s. Through my own research I have found the following website on back pain www.backpain.com.au, just wandering if you've heard of it/comments ?

[VictorVondoomPhD]

My comments on the "backpain.com.au" site? Well, its typical of the uneducated person who set it up. "Come see me because only I hold secrets passed from master to master type bullshit. Snake oil has been around for centuries, there are no secret cures. Typical of the academic envy you get from some frustrated fellow who has never sat through anatomy exams or actually dissected a real human body or two. So, you know my thoughts now. So I consider the site to have some points of truth amongst a mountain of rubbish. I expect he may run a site of "and now the secrets to curing cancer" next.

Now to your problem
WTF are you doing Pilates for? There is NO study that has decent peer review that pilates will rehabilitate your back better than waving a dead fish over your head three times a day will. Infact I can clearly tell you the person Joseph Pilates himself was WRONG in his thoughts on the lumbar spine. It is fact he said to reduce your lumbar lordosis, it is fact he was wrong. He is now dead wrong. I just hope you don't wear lycra when you do the Pilates. I'm sure you set me up as a joke by putting Pilates in this question.

To have a disc bulge does not mean it causes pain. But you do tell me symptoms consistent with a symptomatic disc bulge. So lets consider that you do.

Go see a McKenzie educated physio to begin with. That will help you settle the acute phase. McKenzie is a science based method that treats discs better than anything else. After that you will need to see a Physio who understands Kettlebells or Powerlifting. It is that simple. If you played tennis, go see a tennis experienced physio. If you lift, then see a lifting Physio.

Fill me in on the next step.
Andrew

[Paul in Hobart]

Hi Andrew - a lot of people in the lifting game & MA have recommended these books by McGill & Sarno ; have you read them?

http://www.backfitpro.com/html/books.htm

http://www.healingbackpain.com/treatment.html

Of course , back problems often represent the tip of an iceberg of chronic postural and stress issues. I think once these acute issues have been appropriately resolved such books can reinforce preventative measures. As they say , the back forgives but never forgets. Cheers.

[VictorVondoomPhD]

I sure enjoy both books. McGill reigns supreme, no doubt. Real scientist. Relatively flawless in my estimation. Love the way he bags the Australian bullshit Transverse Abdominis isolation focused therapies that spawned the breeding ground for the Pilates fantasy. But he gives genuine pathways to assess and resolve low back pain. Just wonderful.

Sarno, well he thinks everybody has back pain in their head. It makes him money. I also find him VERY useful for right patient. That is, the patient who has a resolved injury but believes they are still injured. It is a rare problem. But i see components of it in lots of patients. I think Sarno stated 80% of patients are TMS, or behavioural. I'd say 2%. But he probably sees that style of patient often as they will be the ones who fail normal therapy and end up seeing him.

Both very useful, but McGill is more related to what we will see in daily practice.

Stay Big Paul!

[Paul in Hobart]

I like your attitude to Pilates. one which I have shared for quite some years. Imagine sucking your belly into your spine and lifting an Atlas stone ;)
Pilates does seem good for making friends over the post W/O capuccino , which seems de rigeur. Perhaps its main role is a social one?

[vladimir]

Thanks for the feedback Andrew. I must admit i am more confused because i am yet to get a similar opinion on back rehab from a physio. One thing i can confirm is that soe of the exercises i was prescribed by my physio were McKenzie exercises, so i guess that is common.

My gut feeling is that i have to listen to my body and see what will work in long term.

Thanks again,

Vlad

[VictorVondoomPhD]

I'm guessing the physio supports pilates as a back rehabilitation method? Look Vlad it's simple you just ask the physio to show you a Peer Reviewed journal article that demonstrated how pilates has any benefit for low back pain. They don't exist. Pilates has no scientific evidence to demonstrate that it improves low back pain.

My personal opinion, based upon the fact that I am very experience on the subject matter, is that ANY Physio/Chiro/Osteo/whatever who has a "fitball" or "Pilates reformer" or Pilates classes loses all credability as a an unbiased and up-to-date professional. My opinion is that most places that advertise "Pilates" in their clinics do it for finance purposes. I think Ultrasound machines are ineffective ways to treat as well. So I place Ultrasound machines, fitballs and Pilates as a waste of time and money about 99% of the time.

You might say that "I believe that Pilates will work" lots of people say that. But belief is no substitute for reality.

Pilates Vs Weight-rehab is like Astrology Vs Astronomy. One is faith, one is fact.

I can understand your confusion. There is a whole industry of misinformation out there. I'm lucky this is what I know about. Now ask me about Plasma Vs LCD TV and I have no idea, or how to change a light bulb (I tell my wife I have no idea how to anyway).

Andrew

[vladimir]

Hi Andrew,

In defense of my physio, he never recommended i do Pilates. It was my idea, based on what i thought i knew. His recommendation is to walk every morning as much as i can. Incidently, i downloaded the free e-book from that website i asked you about and one of the things he says is that pilates WILL NOT help with back rehab.

We can agree Pilates is not the way, except i feel guilty now that i have paid for 11 weeks course and don't want to just quit.

My question then is, where and/or how to find a physio that knows about kettlebells in Sydney ? Any recommendations ?

Vlad

[mick valentine]

Vlad,

Just sent you a PM, hope this can help.

Mick

[jordan]

Andrew,
Just a few comments to make regarding your various comments on Pilates in this forum.
A recent convert to kettlebells I am already convinced of the effectiveness of the technique. But to state that kettlebell training or weightlifting is the best option for all athletes in all situations is somewhat misguided I believe.

Having seen numerous Athletes with strong global musculature yet recruiting poorly with the inner unit and pelvic stabilisers, dependant on the injury, the very last thing I would be suggesting is what you seem to advocate in all cases on this forum.

Firstly having studied and worked in the health and fitness industry for almost 30 years I have tried most forms of strength and conditioning training, as well as the various forms of Yoga, Pilates etc.
I have also worked at one of Australias leading Sports Medicine Clinics so have quite a bit of clinical experience myself in terms of what works and what doesn’t for athletes and the general public alike.

If your only experience with Pilates is the “Marketing Creation” of “Clinical Pilates” then I probably agree with your comments. You can blame one of your colleagues for converting every second Physio in Melbourne into a Pilates wanabee who armed with 30 or so exercises (out of a reppertoire of 600 plus exercises) over a 2-4 day course tries to convince the public they should be the only people entitled or qualified to teach Pilates. Hang on Im starting to sound like an overly pompous moderater so Ill check myself there :)

To correct some of your statements. No research at all to back up the effectiveness of Pilates? I suggest you take a look at the “journal of bodywork and movement therapies” over the last couple of years and you will see a number of clinical studies confirming what true Pilates professionals see in our practices every day.

I have 3 comprehensive certifications in Pilates from Rehab based approach to Traditional repertoire. I know Pilates works because I see it work everyday but Im certainly open to all the latest developments in strength and conditioning and implement them into the way I train clients.

The common criticism of Pilates is that it is not functional. With an experienced practitioner you can make Pilates highly functional to ADL or sports specific. It has its limitations, don’t get me wrong but it cured my back pain of 20 years caused by pelvic instability that no amount of Physio, chiro, weightlifting, swimming, yoga etc had managed to do.

In my daily practice I fix people who have not been fixed elsewhere often having seen a procession of more learned practitioners like yourself.
I have taught an ex AFL footballer who was so amazed with the results in his injury wracked 40 year old body that he felt he would have played at least 100 more games if he had done Pilates during his career.

One of the greatest outcomes as far as my expreience goes is its improvement in body awareness and control which translates directly to postural awareness and correction.
How do you test for that and the implications it has in preventing injury and reducing wear and tear on the body including the spine? I guess from your point of view if it doesn’t exist in a journal then it doesn’t exist.

So I do have a laugh when I read uninformed opinions from practitioners such as yourself.
In terms of Joe Pilates himself it is true he wrote and was quoted as stating that you should be able to flatten out your Lumbar spine using your abdominals(not by tucking the pelvis which is the common misconception)

Having been taught by somebody who worked personally with Joe himself for over 20 years, what you don’t hear is that Joe Pilates also thought that an articulate spine should be able to flex,extend,side bend and rotate as required.
The full range of spinal mechanics and not just with a straight back.

Even if Joe was somewhat misguided in this area based on developments in biomechanics and sports science, like all techniques and Methods, Pilates has evolved.

Do you suppose Kettlebell lifting techniques and conditioning methods may have developed more than just a little since Russian wheat farmers started tossing them around over 100 years ago?

To use an argument as you have based on an outdated interpretation of spinal mechanics by Joe when the method as a whole has evolved shows you are rather uniformed.

So as a practitioner who has many strings to his bow I say its an individual approach.
With some Athletes certainly weightlifting or Kettlebells would be more functional and beneficial. With others I would be taking a more stability/core control approach FIRST with Pilates based exercises.It depends on the injury,the individual,the demands of the sport.
But Andrew if you only have one thing up your sleave keep your blinkers on and keep using it:)

[Andrew Dixon]

I went with the McGill approach for a while and that kept me pretty much fused with pain in my lumbar spine. I was struggling to put my shoes on and worried a little girl would try to mug me and succeed.

I then found the Sarno approach and adopted the 'fuck it' approach and now I can swing a kettlebell again.

Still not 100%, but a huge improvement from focusing on rehab and limited movement.

[VictorVondoomPhD]

Sweet Jesus Jordan,
You must think I have as much time on my hands, as you obviously do, to think I'd have time to read your BLOG. No way. I'm too busy, so I didn't.
Mate, The "journal of bodywork..." I have been told has about as much academic impact as "Flex" or "Ironman". I think you mistake an "industry publication" as academic excellence. It's O.K., you may want to try "Journal of Bone and Joint Surgery", "Nature", Journal of American Medical Association", "Clinical Orthopedics". Then again maybe you won't.
Keep up the reformer work my dear, I'll be in the weights-room with the big boys.
Valhalla is not populated by rabbits.
Andrew.

P.S.
I'd suggest you might find Pilates fits well into the Placebo Effect.
Please enjoy

http://www.youtube.com/watch?v=MzjoKhBklYg

Should have called the coats "Pilates coats"

[jordan]

As far as moderators go you have missed your calling I think. Your style would be much better for the fitness section in Ralph magazine.

I have to admit i am flattered. For a man so busy as yourself and who says he didn't read my post it seems you did and only managed to comment on my choice of journal. I will take your advice and dust off my old copies of The journal of bone and joint surgery. While looking for the research you believe doesn't exist I will be happy to forward all of the peer reviewed research on the effectiveness of kettlebell training for rehabilitation compared to other modalities. If you can find a single one yourself I would be happy to read it.

But as I have already said- I know kettlebells work. So do you. Do you really need peer reviewed research to convince yourself that what you do everyday works and has validity? I'm guessing not. Neither do I.

I would add some witty put down quote here at the bottom but I'm not nearly as clever as the good doctor. Enjoy your journal reading doc.

[Antoni]

So how does pilates teach body awareness or control when its performed lying down or on a reformer?

[Paul in Hobart]

Written in 2002 , the same time KBs were introduced from "Russia"...

http://www.russiajournal.com/node/14511


Want to burn 350 calories in just 40 minutes without getting tired? Try Moscow's new fitness trend, Pilates. Both a workout and a philosophy, Hollywood celebrities have been practicing Pilates for years, even though at first it was an underground thing. Originally developed by Joseph Pilates nearly a century ago, Pilates is still regarded as a unique fitness phenomenon.

Pilates consists of sustained movements, diaphragmatic breathing and mental concentration. Popular as an alternative form of low-impact exercise and meditation, it's been linked to lower blood pressure and gastrointestinal improvements. No one is born with a perfect body or a perfect set of abs - the key lies in the correct technique. Each movement in Pilates is designed to strengthen your muscles so that they function more efficiently in everyday life, leading to better posture and fewer aches and pains, not to mention a more toned physique.
"As you go through the variety of exercise movements, you visualize yourself swimming across a river," explained Oksana Marchenko, a fitness trainer whose stated goal is "to help people find the champion within."

"The river is Zen. It doesn't really exist but, with the right mental tools, you can get through a harder workout," Marchenko added. Pilates is more about building up resistance to injury and illness and supplying the energy to enjoy life to the fullest. One Pilates lesson costs 250 rubles in the Fit Olympics sport club. "I've noticed that I get much more motivated after a session," said Marina Petrova, 27, an HR manager who works out at Planeta Fitness. "While I'm doing Pilates, I don't think about anything else, and I come out really focused. Physically, it's an unbelievable workout that has increased my metabolism, and I've slimmed down all over."

Alla Potovina, a fit television producer in her 30s, has been doing Pilates for nearly two years in the Dr. Loder club. "I used to be so moody. But there's something very peaceful about Pilates that makes you feel happy and relaxed. Pilates is similar to yoga because it involves plenty of stretching and slow movements and is usually done to relaxing music," she said. Instructors stress that you can come into Pilates at any point in life and get something out of it.

Even for beginners, Pilates increases strength, flexibility and endurance. Don't be discouraged if you're not sweating. Your mind, muscles, posture and breathing are all getting a workout. Although Moscow is slow to pick up on fitness novelties, Pilates instructors admit that, far from being a mere exercise fad, Pilates is here to stay. There has been an amazing rise in people seeking Pilates programs in Moscow. And not just foreigners who have been doing it for years, but fitness-oriented Muscovites in search of physical perfection. It attracts people of all ages (and not just women), though most people come along either out of curiosity or fueled by skepticism, wondering how Pilates can help in their quest for fitness. But they leave feeling they have worked their muscles harder than before, and the fact that nearly everyone returns is an indicator of the workout's effectiveness.<link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CALEXTU%7E1%5CLOCALS%7E1%5CTemp%5 Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com<img src=" images="" smilies="" icon_surprised.gif="" border="0" alt="" title="" smilieid="2" class="inlineimg"></o:smarttagtype>
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[VictorVondoomPhD]

I am, infact, working as a ghost writer for a series of articles for the "Blokes" mags at the moment, and for the next year. Good to know the style is ON!
I'll put yer request on my list, just don't go holding yer breath, it's a long list.

How funny was that Russiajournal article? Absolute pissa. I can see the melt from their goats milk popsicles dribbling down their bioorganic borgoise beards right now. Seems the revolution missed a few people after all! Send them to the coal mines to do their "Pilates". Lycra won't last too long in Siberia! Power to the People.

[Paul in Hobart]

GS consists of sustained movements, diaphragmatic breathing and mental concentration. Unpopular as an alternative form of low-impact exercise and meditation, it's been linked to lower blood pressure and gastrointestinal improvements , including fortitude. No one is born with a perfect body or a perfect set of abs - the key lies in the correct technique. Each movement in GS is designed to strengthen your muscles so that they function more efficiently in everyday life, leading to better posture and fewer aches and pains, not to mention a more toned physique.I made up my own version of the Russia journal article.

[jeanlee411]

I like your attitude to Pilates. one which I have shared for quite some years. Imagine sucking your belly into your spine and lifting an Atlas stone
Pilates does seem good for making friends over the post W/O capuccino , which seems de rigeur. Perhaps its main role is a social one?

[dorramide7]

I sure enjoy both books. McGill reigns supreme, no doubt. Real scientist. Relatively flawless in my estimation. Love the way he bags the Australian bullshit Transverse Abdominis isolation focused therapies that spawned the breeding ground for the Pilates fantasy. But he gives genuine pathways to assess and resolve low back pain. Just wonderful.

Sarno, well he thinks everybody has back pain in their head. It makes him money. I also find him VERY useful for right patient. That is, the patient who has a resolved injury but believes they are still injured. It is a rare problem. But i see components of it in lots of patients. I think Sarno stated 80% of patients are TMS, or behavioural. I'd say 2%. But he probably sees that style of patient often as they will be the ones who fail normal therapy and end up seeing him.

Both very useful, but McGill is more related to what we will see in daily practice.