Prolapse in L4 / L5 after heavy lifting

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woman with back pain

Prolapse in L4 / L5 after heavy lifting

Events: 39-year-old woman with proven prolapse in L4 / L5 after heavy lifting. The pain is localized to the lower back, buttocks, calves and feet - and has not improved since the pain first started. She has tried several therapists in conservative treatment and has now decided to try a private back operation at Volvat. It should be mentioned that a public orthopedic surgeon would not perform the procedure.

 

Also read: - Prolapse in the back? Read more about it here!

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Age / Gender: 39 year old woman

Current - your pain situation (supplementary about your problem, your everyday situation, disabilities and where you hurt): Have had prolapse L4 / L5 (ie between fourth and fifth lower back vertebrae) since October 2015 when I bent down and lifted some boxes.

 

Was on MRI in January 2016 where it was first detected, then by a surgeon in March 2016, they would rather not operate due to fear of "post-prolapse" (they say in the disc below). Was treated by a chiropractor, physiotherapist etc., and then took a new MRI in May 2016 - just like in January.

 

Then I walked like that, with pain in the buttocks and calves, as well as a foot that aches only I walk a few steps, and start to limp. Was on MRI again this May - and the prolapse was the same as last year, but there was a narrow passage in the spinal canal due to fluid, so Dr. Sjur Bråthen at Volvat recommended surgery by filing away some bone so that there was more passage and possibly take remove the prolapse if it has dried out.

 

This was now in June - and I got an appointment with a surgeon in November. Have done all the exercises I have been given but do not work. I have received the TENS device, it works there and then when I use it, but not afterwards. Now the pain has picked up again, and there is lightning, pulsating pain down the leg .. I respond very well to all new treatments / exercises, but after 2 times there is no effect anymore. It is said that a prolapse usually disappears after 2 years, so you can cross your fingers. Now I have reached the stage where I want to operate because I can no longer bear it like that. Do you have any good advice and measures?

 

Topical - pain location (where is the pain): Lower back, lower part, and down in the buttocks, calves and feet.

Topical - pain character (how would you describe the pain): Toothache. Lightning and pulsating pain that "shoots" down the leg.

How do you stay active / in training: Exercises from chiropractor and physiotherapist - no long-term effect.

Previous imaging diagnostics (X-ray, MRI, CT and / or diagnostic ultrasound) - if yes, where / what / when / result: MRI examination January 2016 and MRI May 2016. MRI May 2017.

Previous injuries / trauma / accidents - if so, where / what / when: When I lifted the heavy boxes.

Previous surgery / surgery - if yes, where / what / when: Going for an orthopedic assessment in November 2017 at Volvat.

Previous investigations / blood tests - if yes, where / what / when / result: Yes, with orthopedic surgeon and doctor.

Previous treatment - if so, what kind of treatment methods and results: See above.

 

SVAR

Hello and thank you for your inquiry.

 

Rating: It seems as if you have tried most of the treatment, exercises and training - at least to the extent that you have had the energy for it. Exercising the muscles sufficiently to relieve the intervertebral discs and lower joints is an almost inhuman task without the right support system around them - especially as it can cause aggravated pain in the beginning - and here it may seem as if you have failed a little in my eyes. Holistic treatment where factors such as nutrition, exercise, exercises and other variable factors are the only way to get out of the "prolapse ditch" for many.

 

Damage process and cause: A prolapse (protrusion of the nucleus pulposus through the annulus fibrosus) can occur due to prolonged misload or by sudden overload (as in your case) - it is believed that many may have a genetically weaker structure in the intervertebral discs than others and that these are more prone to prolapse . Many people have asymptomatic prolapse where the soft mass that has passed through the wall does not press on any nearby nerve root - while others (like you), have prolapse with affected nerve root and associated pain and impairments associated with the affected nerve root (different nerves go to different muscles and areas on the skin among others).

 

Further measures: Of further measures, it appears that you have already been thoroughly examined within the imaging diagnostic examination - especially MRI examination. A good clinician should be able to determine with almost 100% certainty which structure is affected by orthopedic tests and neurological tests - without the use of MRI.

 

It also seems like you are looking at an operation as the 'ultimate relief' from all your pain. Unfortunately, this is not always the case and more and more research shows that structured training over time outperforms the scalpel in the form of better results and effect. An honest question you need to ask yourself before going under the - private - scalpel is whether you have really given physical exercise a real chance? Especially in light of the fact that - presumably - a public orthopedic surgeon would not operate on you based on his examination. An operation will always leave scar tissue - which can potentially give you the same ailments you are experiencing now. It should also be mentioned that there are other differential diagnoses (myofascial pain syndrome etc.) that are possible adjacent causes for parts of your pain picture.

 

Exercises and actions: Sitting still and lack of exercise leads to weaker muscles and often more pain-sensitive muscle fibers. Regular exercise increases blood circulation to the injured area and then takes nutrients to the intervertebral disc and soft tissue. If you have been weak for a long time, it may be beneficial to set up an exercise program with the help of a physiotherapist or other publicly authorized clinician - a program that is personally tailored for you. If the pain is too strong to exercise, then symptom-relieving treatment should be combined with exercise until you have "upstairs" again and can exercise without major pain.

 

But when exercising for those with prolapse one recommends low abdominal exercises (ref: McGill, Liebenson). You can see a selection of these here:

Folding knife abdominal exercise on therapy ball

Read more: Make intra-abdominal pressure exercises for you with disc injury

 

Wishing you good recovery and good luck for the future. Feel free to contact me again for more information or other advice.

 

Sincerely,

Alexander Andorff, off. authorized chiropractor, M.sc. Chiro, B.sc. Health, MNKF

 

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5 exercises for scoliosis

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scoliosis-2

Scoliosis: 5 recommended exercises (scoliosis training)

5 exercises against scoliosis (crooked back), from our physiotherapists, which can strengthen the right muscles and help prevent the development of scoliosis. Correct scoliosis training can play a particularly important role during periods of growth (childhood scoliosis).

Scoliosis is a medical condition in which the curvature of the spine has a bend or deviation. Often scoliosis can give a characteristic S-curve or C curve on the spine compared to a normal, straight spine. Therefore, the condition is sometimes, in a more popular term, called for S-back. Exercises against scoliosis aim to strengthen relevant muscles which, among other things, relieve the spine and reduce the scoliosis curve.

- S-back: Scoliosis training is an investment for the future

In this article, we focus on strengthening muscles that can relieve and limit the development of the condition - with a strong focus on the core and back muscles. This is, of course, only a starting program, and gradually you will change or add exercises according to what the person's scoliosis actually is.

- Difference between childhood scoliosis and adult scoliosis

Studies have shown that both core training and Schroth exercises have a documented effect when it comes to preventing and correcting scoliosis (3 times a week).¹ By the time we are adults, the Cobbs angle (the extent of the curvature of the spine) is fully developed. But in earlier phases when we are still growing, as with childhood scoliosis, it is extra important to carry out corrective scoliosis training.

"The article has been written and quality checked by publicly authorized health personnel. This includes both physiotherapists and chiropractors at Pain clinics Interdisciplinary Health (see clinic overview here). We always recommend having your pain assessed by knowledgeable healthcare personnel."

Tips: Further down in the guide you will get good advice on knitwear training, use of foam roll and answer whether you should use it attitude vest.

What is Cobb's angle?

Cobb's angle is what is called the measurement of the extent of the scoliosis. This is measured in degrees and is based on a measurement carried out on X-rays. In the illustration above, you see a rather extreme version of 89 degrees.

Cobb's angle and severity

How extensive the scoliosis is in relation to Cobb's angle helps to determine how it is managed. For milder cases, it is often only training, but for larger cases (over 30 degrees) it may be appropriate to use a corset. Operations are only performed in the most serious cases (above 45 degrees).

  • Mild scoliosis: 10-30 degrees
  • Moderate scoliosis: 30-45 degrees
  • Severe scoliosis: >45 degrees

A larger Cobb's angle implies a larger failure load. Which in turn can lead to greater compensation mechanisms and pain. Again, we want to emphasize the importance of taking scoliosis seriously, as relatively simple measures can have major positive effects for the rest of your life. This applies particularly to children's scoliosis. But also in adult scoliosis. The curvature of the back can, among other things, lead to an increased incidence of pain in the chest og pain in the shoulder blade.

1. Side boards

Side plank is a very important exercise for stabilizing the spine. Here you will quickly notice which side is overactive and which side you are too weak on. The aim of doing this exercise is to correct this balance and thus ensure that your back has a more correct use of the core and back muscles. The exercise will be very difficult at the start, but you will most likely notice progress quickly if you do this exercise regularly. The exercise can be done dynamically or statically.

side plank

  • Position A: Support your elbow and make sure your body is in a straight line along the workout mat.
  • Position B: Lift yourself up slowly - then hold the position for 30-60 seconds.
  • reps: 3 repetitions where you hold 30 seconds each time. Gradually work your way up to 3 repetitions in 60 seconds.

2. Back lift

Back raises are one of the few exercises that have proven effective in producing hypertrophy (larger muscle mass) in the deep back muscles called the multifidus. The multifidus have become more and more recognized as some of the most important, injury-preventing back muscles we have. And especially with scoliosis. They are also called deep, paraspinal muscles, which reflects the fact that they sit deep inside the spine - and are thus very important when it comes to stabilizing the spine.

Back lift on therapy ballBack lift on ball

  • execution: Start with the upper body and abdomen supported against the therapy ball. Then slowly move upwards until your back is fully raised. You can choose whether you want your hands behind your head or bring them up along the side.
  • reps: 5 repetitions over 3 sets. Gradually work your way up to 10-12 repetitions over 3 sets.

3. "Monster walk" with elastic

A very good exercise for increased stability in the hip and pelvis. Both of which act as the foundation of the bent spine.

To do this exercise you need a minibands. This is fastened around both ankles. Then stand with your feet shoulder-width apart so that there is good resistance from the band against your ankles. Then you should walk, while working to keep your legs shoulder-width apart, a bit like Frankenstein or a mummy – hence the name. The exercise is performed for 30-60 seconds over 2-3 sets.

Our recommendation: Complete set of mini bands (5 strengths)

Mini band is a training band that is excellent for training the knees, hips, pelvis and back. In this set you get 5 different mini bands with different resistance. Press here to read more about them.

4. Yoga Exercise: Urdhvamukhasvanasana (scout dog position)

scouting dog position

Yoga can be an excellent way to increase body control and ensure a more correct use of the back muscles. This yoga position opens up the ribcage, thoracic spine, stretches the abdominal muscles and activates the back in a good way.

  • Starting position: Start by lying flat on the floor with your palms down on the floor approximately in the middle of your ribs.
  • execution: Then pull your legs together and press the tops of your feet against the floor - at the same time you use the strength from your back, not your hands, to lift your chest off the floor - you should feel a slight stretch in your back - make sure you don't take too much . Keep your legs straight and hold the position for 5 to 10 deep breaths. Repeat as many times as you think necessary.

5. Scrap exercises

Schroth Exercises

The Schroth method is specific exercises that are based on your exact scoliosis and curvature. The exercises were first developed by Christa Lehnert-Schrot and in many cases have very good results. As you can see from the image above, these exercises often involve the use of yoga blocks og foam rollers. Two good aids for training and stretching. See our recommendations below. The links open in a new browser window.

Our recommendation: Large foam roller (60 cm)

Larger foam rollers like this are well suited for actively working into tense myomas. For scoliosis patients, it is particularly beneficial for direct work towards the vertebrae in the thoracic spine. Read more about it here .

Our recommendation: Yoga block (23x15x7,5cm)

Yoga blocks are widely used in various yoga positions. They are used as supports and provide stability in more demanding stretching positions. On the same basis, they can be well suited for scoliosis patients. The blocks can be used to support the crooked part, and ensure that you do the exercises correctly. Press here to read more about how they are used.

Use of a posture vest against scoliosis?

As mentioned earlier, the use of a corset is only considered in cases of scoliosis with more than 30 degrees of Cobb's angle. A posture vest is a milder version. What is important about attitude vests (see an example here ) is that you don't wear them all the time, as the spine can almost become too used to wearing them. But using them occasionally as a reminder of correct posture can be fine.

Summary: 5 exercises against scoliosis

We would like to emphasize that these five exercises can all be beneficial against scoliosis. But they are not individually adapted. Our physiotherapists and chiropractors at the Vondtklinikken's departments all have good expertise in assessment, treatment and rehabilitation for scoliosis. And it is on the basis of this assessment that we adapt and put together the best rehabilitation exercises for you. Contact us welcome if you want help or have any questions.

The pain clinics: Your choice for modern treatment

Our clinicians and clinic departments always aim to be among the elite in the investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Akershus (Raw wood og Eidsvoll Sound). Feel free to contact us if you have any questions or are wondering about anything.

See clinic overview

 

Article: 5 exercises against scoliosis (scoliosis training)

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

Research and sources

1. Kocaman et al, 2021. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial. PLoS One. 2021 Apr 15;16(4):e0249492.

Photos and credit

"Cobb's angle": Wikimedia Commons (licensed use)

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