Managing L3/ L4/ L5/ S1 Disc Herniation Lower Back Pain

Why I am writing this article:

I have lower back pain and spent a lot of time tinkering to learn about it and tried various experiments to fix it. I feel that if my knowledge/ lessons from my pain can help someone help relieve their own back pain then this will be a great outcome.

This post is about how to prevent / manage back pain caused by disc herniation in Lumbar spine, mainly L3, L4, L5 S1. Modern world back pain is mostly a mechanical condition. Humans were not always upright beings. There is a potential design shortcoming which means our lower lumbar discs haven't sufficiently evolved to bear our upright (read desk slouched) postures.

Mechanical conditions are best dealt with mechanically. The most effective solutions I came across have been around for millennia. You guessed it, it is called Yoga. Although, our neural wirings are largely the same, the trick is in knowing what to do and what not to do based on your specific mechanical condition.

The 2 books that I found to be most helpful (after reading more than 20 books on the topic) are:

1. Healing Yoga by Dr. Loren Fishman: https://www.amazon.com/Healing-Yoga-Postures-Ailments-Backache/dp/0393078000

2. Treat Your Back by Robin McKenzie:https://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/0987650408

What to do:

1. Get an MRI Scan done to confirm your diagnosis.

2. List your symptoms, which can look like:

   1. Pain in lower back L3/ L4/ L5/ S1 region

   2. Sciatic nerve pain running down left leg

   3. Intermittent episodes of upper body spasms causing torso to bend to one side

3. Read the above books to determine the nature of your condition. This is important as the healing yoga books lists tests that you can do to confirm your condition + contraindications (things you should not do in case you have a certain condition) + hints on what to focus on during a pose. The detailed causes can be:

   1. Musculoskelital Back Pain

      1. Quadratus Lumborum

      2. Tight Hamstrings

      3. Facet Syndrome

      4. Sacroiliac Joint Derangement

   2. Neurological Back Pain

      1. Herniated Discs

      2. Stenosis

      3. Piriformis Syndrome

      4. Combination Problems

   3. Injuries and Systemic Problems

4. Construct your yoga routine. For a herniated disc patient, a e.g. of this will look like holding the following yoga poses for 30 seconds twice a day:

   1. Salabhasana/ Locust Pose: https://www.youtube.com/watch?v=1jflO_tZg_M

   2. Setu Bandhasana/ Bridge Pose: https://www.youtube.com/watch?v=g78vfuC4QBI

   3. Ustrasana/ Camel Pose: https://www.youtube.com/watch?v=dhGeqzMzyhY

   4. Virabhadrasana/ Warrior Pose: https://www.youtube.com/watch?v=kkGY3xBnaGc

5. Have a back up stretch for times when doing extensive yoga poses is not possible (in office or during long flights). E.g. Backward bend with hands on hips https://www.youtube.com/watch?v=n-K6uVHC2KI

What not to do:

1. Once diagnosis is confirmed, do not do any exercises that should not be performed in your given condition (e.g. forward bending poses in lumbar disc herniation)

2. Don't carry heavy backpacks that apply additional pressure on your discs

3. Make a list of your triggers/ observations: E.g. Going low in a only body weight squat and add them to your do not do list.

Understand:

1. Discs can heal themselves over time (approx 3 months).

2. Frequency of practice is more important than duration of practice. I find 2 sessions of 10 min a day (morning and evening) are more effective in curbing pain than one session of 25 min.

3. Min effective dosage of exercise for a yoga pose is around 30 sec. So holding it for 30 sec twice a day is better than doing it once a day for 30 seconds. Here is a link to video in which Dr. Fishman explains this a bit more: https://www.youtube.com/watch?v=97o4xh7xEFU

4. The pain in most instances is caused by disc pressing the nerve. You can stop this by either pulling the disc back, or pulling the nerve back (e.g. using backward bending poses in case of herniated discs).

5. Doctors are disease specialists, NOT health specialists. Surgeons know where to cut. Physicians know what pain killers to give. A lot of them don't know how to return you to fully functional painless state without doing either.

6. Physio's / Acupuncture Specialists / Chiropractors etc. are disincentivised to help you recover completely without forming a dependency on them or are interested in you booking next block of sessions with them. If you don't see them, they don't get paid.

7. Disc compression accumulates with age.

What experiments worked for me:

1. Investing in a standing desk made a positive difference. Got one here: https://a.co/d/cCJeIXO

2. Getting a lumbar role helps for long car rides + flights. Got one here: https://a.co/d/91lvtGI

3. Using a rolled towel as a pillow at night seems to help

4. When intense pain/ spasm strikes, cold packs help (more than heat packs).

5. Getting a laptop backpack with wheels: https://a.co/d/2sLaQ94

6. Getting up and simply walking every so often. I find I am naturally more likely to do this if I have a standing desk.

7. Tip: To count 30 seconds in a yoga pose hold, instead of using a clock, consider counting with your breath to make the exercise more effective. E.g. for each yoga pose count 5 cycles of inhalation and exhalation. For cycle 1 inhalation, count 1 to 5. Exhalation cycle 1 count 1 to 5. Repeat in cycle 2.

The above article is not advice but a list of my experiences. I am simply sharing what works for me. I am not a doctor. Consult your doctor before making any changes. I feel the above make a 80% + difference for me, rather than acting as a 100% cure.