There are two individuals that I really like in the musculoskeletal world. Dr. Stuart McGill, Distinguished Professor Emeritus (Spine Biomechanics) at the University of Waterloo, and Dr. Andy Galpin, Executive Director of the Human Performance Center at Parker University. I like them because they give detailed answers to “grey area” questions in interviews but do not speak in the language of “The Best” for anything in terms of what people should be doing exercise-wise. That is because every individual’s needs in terms of getting rid of pain or improving athletic performance is so unique and customized. No two individuals with the same problem end up following the exact same protocol, but we are often fooled by such verbiage as the “The five best …. (insert topic here)… that you need to be doing!”, in YouTube or any other social media titles to get more views. This is understandable, but also incredibly misleading.
The best that you can do when it comes to pain and injury is to make sure your actions have intentionality and are backed by measurement. What is an appropriate action for a condition or goal also comes down to timing. With that being said, here is what I did to recover from two lumbar level disc herniations at spinal levels L4 and L5 that brought pain down to both my legs and into both my big toes, without medication, anti-inflammatory injections, or surgery.
What Happened
The low back pain incident occurred when transferring my treatment table from my work vehicle back in the middle of 2023. What was surprising was that I was working out and physically active at the time. Never before had I suffered a lower back injury of this magnitude where the layers of my discs were compromised completely. In addition to bilateral pain down the legs and into my big toes, there was also a sustained injury to my left medial foot that occurred shortly after the onset of my lower back pain while carrying my table. I won’t get into details about the sustained left foot injury in this post, but certainly, it contributed to the prolonging of the lower back condition as I couldn’t put my normal weight on it when I walked without abnormal forces going up my spine and causing pain.
Protecting the Back
I started off getting better at addressing my back hygiene with supported sitting positions using my lumbar roll at my belt line when sitting at home, in my car, and even when going out. Lying down flat on my back or my sides was uncomfortable and often caused the pain to shift sides of where it was going down the leg of the side opposite that I was lying on. Lying on my stomach was noticeably mellow which was welcomed. Waking up in the morning, the low back was incredibly stiff and painful needing 30-60 minutes to loosen or warm up. This was often a clear sign of the presence of inflammation which was later confirmed through MRI.
In the mornings I would go through my routine. I’ll display pictures of the exercises that worked and didn’t work. I started with repeated extensions in standing based on a colleague’s examination of me.
Keep in mind that just because an exercise does not work doesn’t mean it’s a bad exercise. It just was not appropriate for the specific presentation that I had. This is why no two patients are the same. This maneuver has helped many patients of ours with their radiating lower back pain. It’s a common treatment prescription and can be extremely effective but also aggressive. The thought is that if movements or postures cause the pressure of the center of the disc to break through the posterior outer layers of the disc, like jelly escaping from the center of a jelly donut (by the way, the contents of the center of a spinal disc are way more viscous than jelly for all who hate this analogy), then the remedy should be postures or movements that provide forces posteriorly in the opposite direction pushing the contents back to the center of the disc. It took two days to realize it was not working.
I transitioned to repeated extension in lying “prone press-ups” with a towel (see below) and without a towel but still found that movement to be too aggressive leading me to flare up.
What eventually became most pain relieving was simply lying on my stomach allowing my low back to relax into the floor for 3-5 minutes. I did this at every opportunity that I could which usually meant in the morning and in the evening, and on the weekends for much longer time stretches.
Only then did I start to feel pain relief as gravity naturally helped to ease the pressure on my discs or shifted compression away from my irritated spinal nerves. In my opinion, if we all did this more in our daily lives, we would probably significantly decrease the presence of lower back pain in society.
The second thing I did was stretch out my inner thighs performing the hip adductor frog stretch.
Tight hip adductors limit the lower back in its ability to extend and maintain a slight arch in the lower back to protect it from forward bending forces. It also causes your squat mechanics to not be sound promoting rounding of your lower back which I performed on the job when lifting items such as my table. Just knowing my body and the lack of flexibility that I naturally have I started to incorporate this into the routine and would receive pain relief which further reinforced that I should continue with it. Like the prone lying, I did this as often as possible typically in the morning and evening for 1-3 minutes at a time. On the weekends, I would try to get in 4-5 sessions a day.
The third thing, was a kneeling hip flexor stretch.
Again, knowing how tight I naturally was confirmed by a positive Thomas Test (the hip not extending to a neutral horizontal position),
which was an indication to incorporate the stretch as the pull from my hip flexors decreased the flexibility of the lower back and may have caused irritating vertical compression of the lumbar spine on my already compromised L4 and L5 disc levels. This stretch along with the hip adductor frog stretch were my go-to stretches if I could get down to the floor. Like the prone lying and frog stretch, I did this as often as possible typically in the morning and evening for 1-3 minutes at a time. On the weekends, I would try to get in 4-5 sessions a day.
Core Work
Because I was not able to walk normally putting less weight and stance time on my injured (L) foot and putting more steps and impact overall on the (R) foot, the spine itself needed to be protected. Having irritability at spinal levels L4 and L5 on both sides meant that my hip and quad muscles were not receiving proper signals for those muscles to fire and activate. If those muscles were not firing then the forces that were traveling up from the ground to my spine with each heavy step I took were not being absorbed by those muscles and therefore, the spine had to absorb the forces on two compromised discs. Spinal discs cushion your spine but when compromised they can’t do their job and can become further injured. So, protecting the spine was key. I found the McGill core exercises to be gentle on the spine, keeping it in a neutral position, and providing relief from pain for up to an hour and as time passed, up to a day. See below for what was specifically done:
Bird Dog Opposite Arm, Opposite Leg Drawing Squares: Hands under shoulders, elbows straight, chin retracted, shoulder blades back and down, stomach tight, keep a slight arch in the low back, maintain levelness of the hips, and extend the hip back with a straight knee with the foot flexed towards your shin, and raise the opposite arm elbow straight into a Y position making a fist with your hand palm facing down, activate your spine muscles by acting as if you are bringing your elbow to your side but maintaining the Y Position, draw a 12-inch square synchronously with your heel and your fist while maintaining a stiff core for 10 secs. If you cannot keep your core stable, stop the square drawing and hold the position. Once you master that go back to square drawing. Repeat on the other side. Perform 1 of 12 repetitions each leg, 1x/day.
Side Plank: Elbow directly under the shoulder, head/shoulders/hips in a straight line, top foot in front of the bottom foot, raise up by balancing on edges of your feet and elbow, top hand raised up in the air or placed on the stomach, hold for 10 seconds, when coming down hinge at your hip with your butt going back to keep your spine in neutral, repeat 1 set of 12 repetitions. Eventually, progress to holding for up to 95 seconds straight in one shot. Once that gets too easy, apply continuous hip abduction (Jane Fonda’s) for the full 95 seconds. Perform 1x/day, every day, each side.
Curl Up: Keep one knee bent and one knee straight, keep your chin retracted with eyes focused on your chest to keep chin retracted, put both hands under your lower back, lift your head leading with your forehead slightly (just an inch off the floor, if you feel contraction in the side or back of you neck start over. You should only feel the contraction in the front neck muscles only), and raise your head and shoulders off the floor using the mid sternum as a reference point of rotation and raise your elbows off the floor just slightly. You should feel the anterior core muscles fire. Hold for 10 seconds. Perform 12 reps total: 6 repetitions, rest 30 seconds, 4 repetitions, rest of 30 seconds, then 2 repetitions, every day, 1x/day.
Posterior Chain
In addition to core work, pull-ups, chin-ups, TRX inverted rows were performed to engage the upper back, biceps, lats, and erector spinae muscles all while tractioning (separating) or unloading the segments of the spine to relieve pressure. The TRX inverted rows actually brought on my pain during the exercise but went away when I stopped. The exercise was incorporated in because of that as it allowed me to gauge over time that the irritability level was lessening and my condition was improving.
Pull-Ups, or Lat Pulls: grip the bar overhand slightly wider than shoulder width apart, keep your chin retracted, shoulder blades back and down, stomach tight, and pull the bar towards the top of the chest clearing your chin, pause a moment at the top for a second, and come down with control to fully straightened elbows (keep your body still during the movement, no swinging). Repeat for 3 sets working towards 50 repetitions total, every third day.
Chin-Ups: grip the bar underhand shoulder width apart, keep your chin retracted, shoulder blades back and down, stomach tight, and pull the bar towards the top of the chest clearing your chin, pause a moment at the top for a second, and come down with control to fully straightened elbows (keep your body still during the movement, no swinging). Repeat for 3 sets working towards 50 repetitions, every third day.
TRX Inverted Rows: Set the length of the TRX at a height that is comfortable for you to pull yourself up fully so that your elbows go slightly behind you. Keep your chin retracted, shoulder blades back and down (the upper trapezius muscles should be relatively relaxed), elbows about 45 degrees away from the sides of your body, knees straight, and posture erect, pull yourself up to where your elbows are slightly behind you, pause at the top for a second and then slowly go back down on a four-count to where your elbows are straightened and the posture is erect. Eventually, work your way until you are nearly horizontal to the floor Perform 3 sets for a total of 45 to 50 reps. every third day.
These three exercises would be rotated through, every other day, and performed 4x/week.
Anterior Chain
Pulling and pushing in the sagittal plane (if you are looking from someone from the side, that is the sagittal plane) is fundamental to being a functional human being so that was incorporated immediately. Regular push-ups allowed to incorporate anterior stabilization of the core while maintaining chest and triceps while the decline push-ups allowed for maintenance of upper chest volume, and anterior shoulder volume, while still stabilizing the anterior core. Typically upper chest and shoulder would be done with exercises performed upright, but because my spine couldn’t handle the loading of excess weight vertically (even bringing in groceries from the car was a challenge in the beginning), this alternative was doable and allowed for progression in a back-friendly position that caused no pain.
Push-Ups: Keep your chin retracted, shoulder blades back and down, hands at chest level just slightly wider than shoulder-width apart, elbows about 45 degrees away from the sides of your body, knees straight, feet together, press through palms with straight posture locking you’re your elbows, descend with control to a slightly greater than 90-degree elbow bend, pause for a second, and rise back up to locked elbow position all while keeping your posture perfectly straight. Perform 2 sets for a total of 100 repetitions, every other day.
Push-Ups Decline: Keep your chin retracted, shoulder blades back and down, hands at shoulder level just slightly wider than shoulder-width apart, elbows about 45 degrees away from the sides of your body, knees straight, feet together, press through palms with straight posture locking you’re your elbows, descend with control to a slightly greater than 90-degree elbow bend, pause for a second, and rise back up to locked elbow position all while keeping your posture perfectly straight. Perform 2 sets for a total of 100 repetitions, every other day.
The regular push-ups and push-ups decline were both performed on the same day, every other day, 3x/week.
I still do some variations of these exercises above to this day for maintenance using my limbs as changing levers or performing on unstable surfaces to test the back. Altogether, it took 9 months for me to get back to my preinjury functional level. Because of my left foot injury, I could not walk as much as I wanted for my back health or do close chain lower extremity work (exercises in weight bearing) for a good three months. Healing was slowed for both the back and the left foot because I continued working which required being on my feet.
The exercises above along with further progression in lower extremity strength exercises such as double limb bridging, single leg bridging, and exercises for my feet, along with icing, got me to a level where in March of 2024, I was able to walk an entire marathon in under 8 hours. That helped to psychologically solidify that my body was ready for more. I am currently training to run two marathons in 2025. If you are going through something similar, yes, it is possible to get through it, without medications, injections, or any surgical procedures. You may just need guidance and it certainly helps to have someone who not only has helped others through it but has also successfully gone through the recovery process themselves. Reach out to us if you need to find a customized solution to getting yourself back to life! Know that better days are ahead for you and are not as far away as they seem!
