How to Fix Discs and Sciatica
Without Drugs or Surgery
Herniated, Bulging, Slipping, Degenerating Discs, Pinched Nerve, Sciatica Plus a little about sciatica not from discs, and from posterior muscle tightness including piriformis.
© Jolie Bookspan, MEd, PhD, FAWM
Answers In A Nutshell
Welcome to "Fix Disc Pain and Sciatica" on my web site DrBookspan.com. I am a research scientist and clinician in human physiology and performance in extreme environments. I study why common training techniques and rehab methods don't work and what works better. I develop evidence-based sports medicine methods that you can use yourself, right away, to fix your disc pain, back pain, knee pain, neck pain, learn smarter stretches, fix injuries, and make your life stronger, faster, healthier, smarter, and sometimes funnier. I worked many years in lab research in environmental medicine of the human body in extremes of heat, cold, injury states, altitude, underwater, and different nutritional states, and put some of those fun stories here on this site, too. I make my web site available for a better world.
On THIS Page: Fixing discs, sciatica, and other radiating pain in healthy ways, so that you can to do more, not less. This article also has links to more free articles on my web site that relate to getting your discs, your back, and your life, better and healthier.
Don't Worry. Disc pain and sciatica can stop quickly. Discs are living parts of your body and can repair themselves like other living body parts - if you know how. This article shows you how to stop sources of the pain and damage so that repair is not stopped by you continuing the damage. Instead of stopping activities you love, this article summarizes how to use healthier movement habits so you no longer damage the area, no longer get the pain, and your discs can repair. You can have your life, better and more active than before. Not all exercise is medicine. Not all medicine is healthy. It's not health care if it's not healthy. I change that.
This is a Get-Started-Right-Now summary, with a wealth of knowledge still to give. See me for appointments and classes, or over a personal online consult to answer your questions, and read my books for more. More about me in Adventure Medicine.
SITE MAP. At the bottom of this page (and every page) are main navigation links, plus buttons to SHARE, TWEET, and LIKE.
Note: If your lower back hurts during and / or after standing, walking, and running, and you feel better to sit, to lean or bend forward or bend over to touch your toes, start with my separate article to fix that different kind of lower back pain, then come back here.
You Don't Have To Live With Pain
Disc injury and sciatica do not have to be mysterious or long-term conditions. You do not have to accept or "live with" pain and reduced activity, take pain pills and other potentially unhealthful drugs for long periods. News reports quote spine specialists saying that back pain is difficult, or that no one knows why disc and sciatic pain occur and re-occur, or that they are caused by weak muscles. These statements are not true (even if they sell a lot of treatments, surgeries, and news articles). Disc injury and sciatica and other radiating nerve pain are usually simple to understand, and simple to fix without surgery or drugs, and without ongoing adjustments, strange exercises, restrictions on impact activity, special beds, braces, or equipment. This article shows you the concepts.
Discs are tough. Discs are firmly attachd to the spine bones above and below them, like a cushion firmly sewn onto a chair or stool. They do not slip off. What can make them bulge and degenerate is years of bending your spine forward - sitting and lifting bent forward - which squashes and degenerates discs in front, and pushes them toward the back.
You accumulate disc damage when you bend over to pick up things, sit rounded forward for hours, do forward bending exercises common in gyms, yoga and Pilates. Chronic forward bending (flexion) also overstretches the muscles and long ligament down the back, and makes room for vertebral discs to protrude. It is easy to see why discs eventually get injured. Bad bending - bending wrong by leaning over at the hip or waist (including hip hinges and hamstring stretches of bending over to touch toes) - continually put shear force on discs, that eventually can degenerate and peel away from their regular position on the vertebrae. Think of how getting braces on your teeth moves the teeth over years. After years of pushing, things eventually move. The good news is that they heal far more quickly.
Discs can heal quickly when you stop injuring them with daily bad habits.
Normal disc between two vertebrae is shown in the above drawing at left. Ar right - the disc has been gradually moved backward (herniated) from years of bad forward bending.
"Bad bending" shears and tears at discs. Chronic forward bending squeezes discs in front, gradually pushes discs outward in back and sides.
Sitting with your lower back rounded and continually doing bent-over stretches can eventually tear and push your discs enough to degenerate and herniate, and press nerves sending pain down your arm or leg. How are you sitting right now to read this?
People do an astonishing number of things every day to degenerate their discs, and push and tear them out of place, bit by bit, and irritate and press on the sciatica area. You know you shouldnt lift wrong, but you do all day, every day picking up socks, petting the dog, for laundry, trash, making the bed, looking in the refrigerator, and all the dozens of times you bend over things. You work bent over your desk or bench. You drive bent forward. If you work out, you may lift weights bent over, do crunches and Pilates which are more bent forward flexion - many bad moves sitting standing and shoulder stands, yoga and PIlates twists that shear discs, stretch by bending forward touching your toes, do yoga bending over at the waist, do aerobic kicks and martial arts kicks with your back rounded and pelvis tilted under rather than neutral, bike rounding forward, then bend over to pick up your gym bag to go home. No wonder your discs are getting banged up. It takes many years of abuse to start degenerating and pushing discs out of place and make the sciatic nerve (and others) raw and painful. It's not aging, but simple mechanics.
Some people think it is a good stretch to bend over forward. Bending over may stretch muscles but also puts the leverage on the spine and off the muscles where it belongs, plus slowly shifts discs outward, eventually herniating them ("slowly" means after years of this kind of bad stretching). Most people know that bending forward and sitting rounded or bent forward injure the discs. Yet they stand, bend, sit, and lift wrong many dozens of times a day, day after day, then compound the problem with conventional exercises and stretches that bend forward in the gym, yoga and PIlates class.
People may do special "back exercises," hoping to fix the pain that results but not be aware that strong muscles will not automatically make you bend and lift properly to stop the source of the damage, or make up for all the things you do the rest of the day to hurt your discs. They wonder why they still get pain even though they take their medicine and "do their exercises." Discs can heal quickly, but you never give them a chance because you spend so much time bending forward, which pushes the discs outward (usually toward the back). Discs, like other living parts of your body, spend time in repair, and you feel better. Then when you go right back to bad bending, bad sitting, standing slouched so that the discs are crushed and pushed out of place and sciatic nerve pressed, it is not a mystery when pain comes and goes. Many people wind up in unnecessary surgery, or long term or recurring pain, not understanding why their physical therapy, pills, or yoga "didn't work."
Not A Disease
A hurt disc is a simple, mechanical injury that can heal. Someone with a slipping or degenerating disc, or sciatica, is often told they have "degenerative disc disease" or "disc disease." I t is not a disease. The condition is misnamed. It is an injury that can heal, and stop hurting and pressing on nerves and other things that also hurt. It is simple. Check for unhealthful movements when you bend, sit, walk, and do all you do, so that you are not continually injuring your discs even as your body is trying to heal them. This is as simple a concept as not scratching off a scab every day in a wound. This does not mean rest. Discs, like the rest of your living body need exercise for growth and repair and health. Use these articles (and books for more) to learn how to identify and use healthy movement, not injurious movement.
Disc injury and sciatica do not have to be a long term problem. It is not a condition you must live with. It can, and should, be stopped in days. It is an injury that you do not have to allow to continue. Disc degeneration or slippage (herniation) and sciatica from all the many causes can heal and stop hurting - if you let it - no differently than a sprained ankle. Stop damaging your discs and nerves with bad bending, standing, and sitting habits and your discs can heal. It takes years to herniate a disc or irritate the nerves, and only days to weeks to let them heal and never come back - by stopping bad habits.
Chronic forward bending can eventually push discs outward (herniate) and break down little by little (degenerate). Continually standing and walking with feet turned out shortens muscles, which can tighten until becoming uncomfortable and also pressing on nerves. These problems are easy to avoid and easy to fix.
Kristine's doctor referred her to spine surgery and a pain clinic, and prescribed dependence-building drugs. Instead she came to work with me. She listened well, and was able to go back to surfing with no surgery, no medicines, and no pain. The sign she put on her board reads, "I had a HUGE disc bulge. I'm out having fun instead of spine surgery."
What Are Discs?
Discs are tough fibrous cushions between each of your vertebrae (back bones), from your neck, down the middle of your back, to your lower back. You also have two discs in each knee, commonly called a meniscus. You have a little disc between your lower and upper jaw bone inside your temporo-mandibular joint (TMJ). (Not all TMJ pain is disc, it can be muscular, and other causes).
Discs are living parts of your body. That is good, and why they can heal. Vertebral discs do things like help you bend (right or wrong), and keep your bones from grinding against each other. They are not soft jelly donuts, as commonly said. The covering of your discs is strong and firmly attached between each vertebrae. It doesn't easily slide around. When I studied anatomy dissecting cadavers (bodies of people passed away) you could poke discs with knives with little effect. It takes a lot to tear and peel them from the bone. Like bar stools with stitched on cushions, they adhere tightly to the bone.That's a good thing, since discs take a lot of pounding. They are tough. After years of bad bending and lifting habits, they can finally fray and break down. Bad bending puts much shear force on discs, that eventually tears the discs away from the bone. It is no mystery. Damage, herniation and bulging are reversible without pills or long treatments surgery.
Which Discs Herniate?
It used to be that the most common disc herniation occurred in the neck and lower spine. The reasons are the same. The lower back discs are the leverage point of bad bending, bad forward stretches in yoga, yoga twists that put high shear forces on discs, and bad sitting. At the neck, people often hang the head and neck forward, or jut their chin forward (or upward) and angulate (pinch) the back of the neck, instead of relaxed upright neutral spine. More about what to look for and how to fix it is in the Neck Pain article.
It is becoming more common for middle back discs (thoracic) to be pushed outward by increasing numbers of sedentary people sitting rounded hours a day, day after day, year after year, with the same poor posture during workouts of popular (yet unhealthful) forward-bending abdominal exercises, a large number of Pilates moves, crunches, and rounded back for Spinning and biking. More in the Healthy Sitting Article and The Fixing Bad Exercise articles.
It takes years of bad bending habits to make a disc start to break down (degenerate) and be pushed unevenly so that it finally bulges out of place. When the disc is damaged, that alone can hurt. If you are lucky, you will get this small warning sign some small pain or pressure in the side or middle of your back and top of your hip in the backside.
Sometimes the sciatic nerve is irritated from bad movement even before discs are damaged enough to press on it. By fixing your spine positioning to healthy daily habits and doing some extension described later in this article, you can stop disc damage and sciatic pain and keep them from coming back.
If you let more time go by with damaging sitting and body positioning habits, discs can begin to push outward, and press on nearby structures, like nerves. That is called impingement because the disc impinges on (presses against, or take up the space of) the nerve. That spreads more pain to other places. After years of damaging the disc, you may suddenly feel the pain shoot like electricity when bending wrong one more time, or reaching for something small, or sometimes, the disc is so ready to give out, you are standing or sitting, thinking you have done nothing at all to bring on the sudden bolt of pain. It was years in coming and no mystery.
When a disc herniates enough, it can press on nerves that goes down your leg, sending pain down your leg. Pain may be down the back if the nerve that is pressed it that nerve that goes there, usually the sciatic nerve. Pain may go down the front if the disc presses the front nerves. Several of these nerves work both for feeling and movement of your leg. That means if you squeeze it, it will hurt and may also reduce the function of your leg. Pain may stay high in the torso if you have damaged your discs higher up.
Discs dont usually protrude straight backward. Their path is blocked by a long, tough, band running down the back of your discs called the posterior longitudinal ligament. That is good because that helps keep them in place and protects your spinal cord, which lies behind the discs. Since the disc can't bulge straight back, if you keep pushing it out, it has to go somewhere and it squeezes out sideways. The long nerves going out of your spine to your body and legs are also on the side. When a disc bulges against these nerves, pain extends down one leg or around one side of your body.
Pain Down Your Arm
If you squash and push the discs in your neck with a forward head posture - letting your head tilt "chin-forward" instead of holding it up straight, the disc in your neck may herniate the same way as discs in your low back, and press on nerves that go to your arm, sending pain down your arm. For what to do to fix that, go to the article on how to fix neck pain, bad cervical discs, and upper back and shoulder pain.
Nice Note From A Reader:
"I work as an emergency room nurse in Australia, and we don't always have time during the course of our work to think about our backs when resuscitating people, but we put your web site up on our large screen to remind us to bend and move in ways that won't have us feeling terrible by the end of our 12 hr shift. Thanks again for your help, it is a pleasure to read your articles."
Often, a person may be in great pain from simple damaging bending and movement habits. They may go for an x-ray or MRI, and the scans show a degenerating or herniated disc. The pain may not be from the disc, but from the strained, tired muscles from bad habits. Like car tires that are mid-life, but perfectly good, some wear may show on exam but may be unrelated to the pain. Pain is falsely ascribed to the disc. Pain continues, but from the poor mechanics. This is no mystery. Change the bad habits to change the pain.
Sometimes, people go for surgery for the "bad disc." But their pain persists or returns because they never corrected the bad mechanics that caused the pain. Or they may herniate another disc for the same reasons they herniated the first one bad sitting and lifting and all the other bad habits that they did not easily change.
This is an important topic. After reading about fixing discs (next), it is important to understand that other sources of pain make symptoms similar to disc pain. That topic follows, with separate ways of fixing those causes. Make sure to keep learning and understanding about all the simple but different causes first, instead of just doing bunch of exercises or stretches hoping that will magically fix anything.
1. Use Good Bending All The Time
You know not to bend wrong to pick things up, but you still do it? Every day. Hundreds of times a day. Instead, bend your knees in a squat or lunge. You already know that. But most people don't do it because their legs are too weak or they do it in ways that hurt their knees.
Academy student Nahy Milad Bassil demonstrates changing bad bending to good bending.
Count how many times you bend down each day to get things for everyday life. For most people, it will be several hundreds of times a day. Imagine the injury to your back by bending wrong that many times each day. Instead bend right. Don't do bad bent over stretches. Check your training and exercise routines for all the many common and unhealthy exercises and stretches.
Use the half squat for most daily bending to crouch and bend for things.
- Bending right is one of the most important things you can do to stop injuring your discs. Bending wrong hundreds of times a day pushes your discs out, no matter how many "back exercises" you do. Let your discs heal and get free leg exercise at the same time.
- Good bending does not hurt your knees OR back, it helps both - if you do it right.
- Keep both heels down touching the ground and your body weight distributed over the heels too, not the front of the foot.
- Make sure your knees do not come forward to bend. If your knees bump a counter in front of you, for example, the knees are coming forward. Keeping knees back over the feet and weight more toward heels will shift your weight off the knee joint and you will feel the difference as soon as you do this correctly. Full knee information is on the Fix Knee Pain page.
- Keep your upper body more upright than tilting or leaning forward.
- Keep neutral spine. Don't make a large inward curve to the lower back. Swayback (tilting the backside far back) was a fad for a while but caused much back pain and poor posture habits. Good bending allows some lengthening of the lower spine which gives a built-in (functional) needed lower spine stretch far superior to bending over forward to touch toes.
Bend well, heels on the ground, knees back over feet, for all the hundreds of times a day you bend and lift.
Don't do squats and lunges as an exercise, but as the way you really move all day for real life. You will save your back, stretch your Achilles tendon, and fix your knees at the same time.
The lunge (below) is not an exercise but a retraining. Use the lunge along with the squat for all the times you need to bend and reach all the things you need in a day. It is many times a day. This good bending needs to be used all the time instead of bad bending over. Retrain bending habits and get free leg and back exercise at the same time.:
Good bending for all the many dozens of times you need to bend and reach things every day.
Keep your front knee over your foot (left) not forward (right). Width of feet depends on what you need to reach or lift, and size of your surroundings (may be narrow or have obstacles).
- Tuck hip to vertical, not tilted, to remove swayback arch. make sure to move pelvis to vertical, not to push it forward. Resulting neutral spine will stretch the front of the hip IN THE REAR LEG. If you do not feel the front of the hip in the rear leg getting nice stretch then you are doing it wrong.
- Bend knees to dip towards the floor without touching the floor. At least dip down a few inches.
- Don't let your front knee come forward. Keep your front knee over ankle.
Bend in this healthy ways for everything, even the sink and water fountain, to pick things up from the floor, to look in the refrigerator, and take things out of the dishwasher.
This is not posture (a static rigid concept to most), but functional body mechanics, good ergonomics, healthy movement mechanics, functional movement.Don't use injured knees as an excuse to add pain to your back. Bending in this healthy way will strengthen your knees as well and when you do it right, it does not hurt.
See how to bend in healthy ways for back and knees on the Knee Pain Page
2. Lie Face-Down
Use lying face down to STOP pain, not cause more, as follows. If it hurts you ARE doing it wrong, stop and make it right or don't use this:
- Lie face down, slightly propped up on elbows.
- Allow your entire spine to "un-round" along the entire length, not folding back at the lowest point and/ or neck. It should feel good and help you start your day with straighter positioning.
- Prop on elbows, not so high that anything hurts. This is not done by lifting up like a yoga pose.. If your lower back pinches, lower until it feels good. If you have tightness, or are doing this wrong, it may hurt. Stop until you know why, and fix that.- Don't force upward. Try a lower position or see if you are bending from one area in your lower back instead of straightening out the upper back more. It should reduce the pain. If it makes you feel worse, you ARE doing it wrong. Don't do this until you check and fix causes. If this makes your back hurt the same way you notice during the day standing, then discs may not be your entire problem, but overarching the lumbar spine. See that article here to fix that separate problem.
If you do this right, and don't have other injury that prevents it, it will feel good and take away pain. Do this many times a day.
Done right, lying face down slightly propped on elbows for a few moments helps you learn to get more range from the upper instead of lower spine, unloads discs, and helps you feel better. Never lie in a position that makes more back pain. Lower if you feel pinching, see more below.
When To Use Face Down Lying:
Use this first thing every morning. Instead of sitting on the bed before exiting the bed in the morning, turn over to lie for a few moments face down, comfortably propped on elbows. Also don't hunch your shoulders or neck to make them hurt either. This technique is supposed to give feedback to you about how you move and if you do things that make your own pain.
Also use this comfortable face down lying for acute pain and during the day. Once you know how to do this right and it stops your pain, use comfortable lying face down, comfortably propped on elbows as above, several times a day. If it hurts, you are doing it wrong. Position yourself so that it feels better, not worse.
Lying face down, alone, is not a fix for discs - all your daily life movement together is the fix.
If tightness in the front of the hip and upper leg causes you to overarch the lower back when lying face down, stretch your front hip and thigh muscles with the lunge, described earlier (and other stretches in my Stretching Smarter book). More about why it hurts some people to lie face up or down in the article on Abs, Overarching, and Back Pain.
If lying this way makes your lower back pinch or hurt, your front hip and thigh muscles may be tight, which shifts movement to the lower spine instead of the front hip where it should be. First, lower until you are comfortable to be able to use this helpful position. More important - stop the cause - Stretch your front hip muscles. One way you can use all day as you crouch to reach things is the lunge, described earlier and more fully in the Stretching article. Many other fun and comfortable front hip stretches are in my book Stretching Smarter Stretching Healthier.
3. Sit In Healthy WaysSit without rounding at your desk, car, and elsewhere. Be comfortable; no need to be ramrod straight or hold muscles tightly. That makes more pain, of course. Raise your computer monitor so you don't need to bend over or forward to read. Move your TV higher. Stop curling downward and forward to watch. Use a lumbar roll (soft jacket or towel will do) to fill the concave space in many chair backs that allow rounded sitting. Lean slightly back for comfort - leaning upper back against the chair back instead of pushing lower spine into the lumbar roll or chair back.For more, see the article Healthy Sitting.
4. Carry Loads In Healthy Ways
Stand and carry loads upright, without jutting your head and neck forward or rounding your low back. Don't lean backward to "balance" the weight. That causes problems of its own. Use your muscles to stand straight.
To see common lifting and carrying bad habits that contribute to back pain, and what do instead, see the article on this web site on Lifting and Carrying Without Back Pain.
5. Dont Exercise in Ways that Damage Your Discs - Check All Your Daily Exercise Routines For Bad Exercise
Don't do injurious exercises (described below). Stopping bad and unhealthy exercises doesn't mean to get less exercise or cut back activity, or not have fun. With healthy movement habits you can do more more without working against yourself.Use good exercises to retrain bending habits and how to position your body in healthy ways when moving around (described below).
People say they exercise for their health, but often exercise in ways that are not healthy.If you sit to lift weights, remember that sitting is harder on your discs than standing. Sitting rounded multiplies damaging force. A common exercise injury occurs when sitting rounded on weight machines. After years of unhealthy sitting position, adding pushing against a leg press or other resistance can become too much for the discs and other low back structures, sending pain into the behind and down the leg. Stand to lift weights. For even more healthy training, stand on one foot when lifting (safely) to add balance and stability to your training.
Don't round your hip and low back against resistance (weighted flexion).
The problem is not as much the amount of weight you lift, or that you are exercising, it is more if you are using injurious positioning. Instead of pushing your lower back against the seat or pad, lift up to sit straight and lean your upper back against the seat.
Many people hurt from excessive forward bending all day in their real life. Then they go to the gym and add to that problem with the many conventional exercises involving more forward bending: toe touches, knee to chest, leg lifts, and crunches. Ironically, many people do these thinking these will help their back. Motion often temporarily makes you feel better, however, many of the forward bending exercises are not what is needed (like cigarettes - temporary relief but long term grater problems). It is important to strengthen the muscles that pull back the other way and to learn how to use muscles to straighten the back, not only round it. These are the extension exercises (to follow).
Don't stretch by bending forward at the waist or hip. Many people are surprised to find that they injure their back doing forward yoga stretches. most people know it is injurious to pick up a package that way. It is not really a surprise. Other people think that bending over to pick things up is right and because it stretches the back of the legs. It does stretch, but it is not a healthy stretch. It puts the leverage and pivot point on your discs. LIke smoking, it feels good (to some) but the drawbacks are not worth it. For more interesting information on what exercises harm and which help, read the article on How to Avoid Bad Exercises and Section 3 in the Fix Back Pain article explaining Why Yoga Forward Bends Are Like Lifting Packages Wrong.
As described above, disc pain has a large component of bad movement mechanics, not weak muscles. Strength does not stop you from bad bending that puts herniating forces on your discs year after year. Many people do strengthening exercises and become stronger people who still bend wrong, move wrong, and slouch. "Core" exercises are especially misunderstood and repeated and prescribed without any understanding that stronger abdominal muscles have little to do with the most common causes of back pain. Moreover, most conventional core training exercises are done in bent forward ways that reinforce the same bad mechanics you started with. For the research and interesting story on what abdominal muscles really have to do with back pain, see my article on Abdominal Muscles - what they do may surprise you. Bending, standing, moving, and living your life with healthy movement mechanics is up to you. The rest of this article tells more on how.
Where strengthening helps - Someone may use good body mechanics all day, yet ache with fatigue at the end of the day. That is not a disc injury or true back pain that needs treatments, and should not be addressed with medications. Another instance is someone who really is so weak that they can't hold up their own body weight and instead, shifts it onto their joints, which wear with time and grind under the weight (slouching).
A little strengthening allows you to do more before fatigue pain sets in, and to be more able to use good mechanics instead of slouching. Strengthening will not keep you from slouching or bad bending, and don't fall prey to unhealthful exercise programs claiming to cure disc pain using core strengthening. Almost any movement can make you feel better for the moment. Over the long run, it's better not to use injurious core flexion for core strengthening or random back exercises. Use good mechanics
Strengthening and stretching are good, but alone will not change posture or lifting habits, and so cannot cure back pain or posture problems. Many contribute to the original problem of over rounding and bad posture. Look around the gym to see people hunching forward and bending over to lift things. This pressures discs further. Back exercises are supposed to be used to retrain you how you hold your body all the time. Doing exercises for back pain is not like getting a shot of penicillin or going to confession. It does not fix bad habits the rest of the time.
One common example is doing "pelvic tilts," then stopping your "back exercise" and walking away letting your back flop into bad posture, instead of keeping the proper tilt you just practiced. Back exercises are supposed to be used to retrain your thinking and habits when you get back up off the floor. This does not happen automatically. This is where many people have missed the point of back exercises. Strengthening has no effect on posture if you dont apply the strength the rest of the day to control joint angles for all activities.
A big problem comes when people with disc pain are given exercises and stretches that bend forward. Those may temporarily stop pain from a different problem - swayback spine position (hyperlordosis, or overarched lumbar spine) - but are the wrong thing for discs, and do not stop swayback after the exercise.
Instead of abdominal exercises that bend forward like crunches, much of PIlate's, and toe touches, first understand, then use the following Good Exercises:
Good Exercises to Retrain Muscles and Positioning Habits - Functional Exercise
Back pain exercises are misunderstood. People often injure their back all day then hope to fix it with a few exercises. They don't understand when this does not work. They lie on the floor to do exercises, then go about their real life bending and sitting wrong and all day. It is like eating butter and sugar all day, then doing 10 minutes of exercises and wondering why it doesn't "work" to lose weight. The key is what you do all day, every day.
My goal is that with my information, you can tell for yourself what would be healthy movement pattern. Healthy movement will not tear or injure. Rehab exercises do not fix pain and do not change injurious movement habits. My work is not exercises. It is learning to identify bad movement mechanics and change those, in simple quick ways, to good healthy ways to move for everything you do.
Retraining #1. Instead of Crunches, Pilates and Other Flexion Exercise, Use These:
Isometric Abs. Most people exercise their abdominal muscles by bending forward. Bending forward is a main way you pressure discs outward, eventually degenerating and bulging (herniating) them. The following re-training drill teaches how to use your abdominal muscles without forward bending. It is a better workout than abdominal crunches. It is a myth that strengthening abs will fix back pain. That may sound strange. But stronger abs do not make you stop bending wrong and standing in the ways that injure discs. In fact, most of the abdominal exercises taught are the very forward bending exercises that injure discs and pressure the back more. It is another myth that tightening abs and pressing navel to spine helps in fact, it can make more pain. You can't breathe in or move easily if you tense your abdomen in the way commonly taught.
What do abs do to help prevent back pain? A major purpose of your abdominal muscles is to prevent your lower spine from swaying inward when you are standing. This is called hyper-lordosis or swayback. Swayback is not the primary force that injures discs. It mostly make another kind of lower back pain in the soft tissue and joints called facets. People with swayback get pain after long standing and running. Most disc pain originates from too much forward bending and is usually felt with bending and sitting. An interesting result of stopping swayback is that for someone with a bulging disc, standing swayback presses more on the already hurt disc. Often people with both swayback and an injured disc feel immediate relief when they stop swayback. Check in a mirror if you stand swaybacked, and use this in addition to the rest of everything on this page. Then your discs can feel better now while they heal from no longer injuring them by stopping bad bending and bad sitting.
The following shows you how to do general healthy strengthening and exercise without forward bending. This is not represented as a disc fix, but you do need to understand the concepts to prevent pain from swayback, to get good healthy exercise in general, and to exercise in ways that does not bend forward but uses your core and abs the way your body actually needs - to hold healthy spine position.
I developed this exercise. It is different from the usual "lat or triceps pulls" done lying down. This is a specific re-training exercise IF you use it right.
The "isometric Ab" retraining drill shows you how to keep your lower back from overarching
under loads that you lift overhead, as if you are standing. It is a more effective and functional way to train your core muscles, and better for your discs, than exercise that bend and curl you forward.
- Lie face up, arms overhead on floor, biceps (elbow area) by your ears.
- Press your low back toward the floor to remove the arch. You will feel your abdominal muscles working to prevent your back from arching.
- Hold a hand weight in each hand, an inch above the floor, without letting your lower spine increase in arch or lift up from the floor. Keep your low back against the floor by using abdominal muscles to straighten your spine. It is better exercise to hold two hand weights, one in each hand, rather than one hand weight held by both hands together.
- Straighten your legs so that you can practice the way you need to hold your spine when standing - spine in healthy position without bending knees.
This is how your abdominal muscles need to work all the time, when standing up, to prevent swayback (too much lumbar arching). Use this exercise to practice using your abs to control the posture of your back and spine against moving resistance, simulating real life activity when standing. Notice that you don't need to tighten your abs to do this. Use your abdominal muscles, like any other muscles, to move your body to healthy position without adding tensing and tightening.
See movies showing isometric abs, and more about how abs are supposed to control spine POSITION, on the Abs Article page for fixing swayback (hyperlordosis).
Retrain the Push-up and Plank Position to Stop Injuring:
The exercise itself is not a back pain or disc fix. It is a way to learn how to stop injuring your back when you exercise.
In a push-up position (hands and ball of the feet, not on knees) tuck hips as if you were starting a crunch. Don't lift your behind up in the air or drop your head. The motion is like doing a crunch until your spine straightens. Done right, you will immediately feel your abs working. You will also immediately feel any pressure in your lower spine disappear, that was caused by swayback (arching).
Doing pushups and planks while allowing your back to sway does not give much ab exercise, and sometimes, not any at all. Changing to neutral spine uses the ab muscles to move the spine and hold it in healthier position against gravity and your bodyweight. Pushups and planks with neutral spine is also a better abdominal workout than abdominal crunches.
Use a mirror, if available, to see yourself and learn what healthy position feels like compared to what it looks like. Use the neutral spine repositioning to consciously learn how to use your abdominal muscles to keep your spine in healthy position when you stand up and move around all day. More about how abs are supposed to control spine position, is on my Abs Article on Fixing Swayback (hyperlordosis).
When you tilt your hip under to reduce a too-large inward lower back curve, you will immediately feel your abs working and pressure gone from your back.
The short gif below shows fixing swayback to neutral spine for planks and push-ups. This is my first try at making gifs. Let me know if it does not run automatically. It may take a moment to load:
Stretch Your Hamstrings Without Injuring Your Discs
It is common to repeat that tight hamstrings cause back pain. That relation has not turned out to be true. Moreover, hamstring stretches are often done in ways that degenerate discs.
Leaning over at the waist or hip for toe-touches, both standing and sitting, does stretch your back and hamstrings, and may feel good at the moment, but it is injurious to discs, little by little, building injury. This is true even for yoga stretches with the back straight and for the current fad of "hip hinges." You know never to bend over like that to pick things up or sit like that at your desk. It doesn't magically become good for you by calling it a stretch. More about the studies by top-name spine researchers that are clear that there is no relation between hamstring flexibility and back pain are on my Hamstring page.
The following is not an exercise to fix back pain. The following is a way to fix your hamstring stretching, if you want to stretch them.
- Stand no more than arms length from a wall. Stand straight. Both feet pointing forward, not outward.
- Lift one leg to press the foot and heel toward the wall, directly in front of you.
- Stand upright. Don't round your back, or let your hip curl under you. This is a functional hamstring stretch - you need to stand, lift legs, and balance without being so tight you are pulled into unhealthful rounding.
- Use this retraining drill to stretch and straighten the front of the hip. See the stretching article.
This hamstring stretch is different and more functional than putting one foot up on a bench.
Practice keeping the rest of your body in healthy position when you lift one leg to the front. That is part of the healthy aspect of this new approach to stretching.
If you feel lower back pressure, stop. You're doing it wrong.
The point is not to pull your leg up high, make it hurt, or round your back and use unhealthy position to do it. The idea is to use this move to learn how to lift your leg WITHOUT doing all that. Then transfer that retraining to how you lift your leg all the rest of the time during real life. Only lift to where you get a stretch. Then you are getting the intention. Height is not the point of the move. Gaining the benefits is. See what you need, then move accordingly.
Healthier Walking and Exercising
Walk with feet parallel, not turned in or out. Weight on entire sole, not pressing inward flattening the arches.
Walk, move, exercise and sit down with shock absorption, not stomping.
Notice your upper back position - prevent rounding the spine and shoulders.Notice lower spine position. Check if you are allowing a slouch that tilts the pelvis forward which overarches the lower spine, pinching the vertebral joints called facets, and the discs. Use your muscles to move to neutral spine - important for disc health - see Neutral spine article.
Stop Bad Posture RulesMany people have heard "pull your shoulders back" as a "posture rule. However when most people try to follow that rule without understanding it, they mistakenly lean the torso backwards from the lumbar spine. Leaning backwards at the lumbar spine creates swayback. Swayback creates a lot of pain of its own and intensifies some disc injuries.To understand swayback (hyperlordosis) and what it creates so much mystery back pain, see the page on Fixing Swayback and What Abs Have to Do With It.
Instead of "pulling shoulders back" what most people need to do is to stop rounding their upper back forward so much, and instead, straighten ("unround") the upper spine. easily straightening the upper spine away from a rounded forward position, in a relaxed manner, without leaning backwards, can solve a lot of pain in upper and lower body. More about fixing upper body, shoulder and neck pain is on the Fixing Neck Pain page.
How Long Does It Take To Fix Disc Pain, Pinched Nerve, and Sciatica?
If your pain is from damaging movement mechanics, you should begin to feel the difference the same day as you use everything presented above as intended, and stop injurious movement.
If you're not feeling better right away, check what you are doing compared to what you have learned above and in the other free articles:
- If it hurts you ARE doing it wrong. Stop and assess. Check what you are doing compared to what is presented above. None of this is "exercises" to "do" but retraining drills to learn to stop doing what hurts and change to healthy movement.
- Are you doing bad exercises from other sources? It is common to do a few movement from my work, but continue or add injurious moves from other sources that slow recovery and re-injure.
- Are you tightening or clenching any muscles? Tight muscles can hurt and impede healthy movement.
- Are you overcompensating? Are you making new bad movement habits that seem opposite of original unhealthy movement thinking that will "undo" or fix?
- Do you have other unhealthy movement habits? For example swayback creates pain of its own, and can cause existing discs to be pinched. If you have pain when standing and feel better to bend over (hunch forward) or sit, then you are probably overdoing the inward curve in your lower back. This is often confused for other pain, including disc and hip. See the separate article on Fixing Swayback (Hyperlordosis, S.I. tilted pelvis).
- Is something else causing the pain, such as infection, shingles, growths, Lyme Disease, Sickle Cell conditions, allergies, food sensitivities, taking medications with pain as side effects, or other non-movement based medical situations?
It takes years to hurt a disc, but only days for it to start repairing once you no longer are bending badly and damaging it. Make sure there is not something else contributing to your pain. It is is almost always quick and straightforward to start getting your life back and start feeling better right now. Don't wait.
When Pain and Impingement Comes From A Different Cause, Not Disc
Sometimes lower back or posterior hip pain with or without pain down the back of the leg is automatically thought to be a disc when it is from something else nearby. Other times, scans do show a disc is protruding or degenerated to varying amounts, but the pain is not from the discs. It is also common enough to have several different injuries at once, which are confused for only discs. Disc treatments continue with poor or random success. Often, pain from lower back discs is not felt in the lower back, or only in the lower back, but lower in the posterior hip (in the "buttock cheek"). There are many muscles and structures that connect things that could be tight, or damaged from acute injury or bad chronic habits. With some direct identification of the sources of the problems, you can make direct fixes of the right things. It is usually not hard to do. Otherwise, scattershot actions trying to randomly hit the right things may work, or not, and leave all involved mystified and frustrated (except the people collecting money from repeat indirect, ineffective treatments.)
Tightness - Lower back, Posterior Hip, Piriformis, and Other Muscles
Tight muscles in the lower back and posterior hip can make the lower back uncomfortable, and also press on the same or other nerves as an injured disc, mimicking radiating nerve pain and sciatica. In cases of pain down the arm, tight muscles in the front of the chest and shoulder from years of rounding your upper back and / or keeping your neck hanging forward or pinched back with chin lifted, can send pain down the arm, even when a disc is not involved. To help identify and fix arm pain and numbness, see the page on Fixing Neck and Upper Back.
Posterior hip tightness can come from many common bad habits, such as habitual swayback which shortens the lower back, from standing and moving with the hip bent instead of neutral spine, common in conventional exercises in gyms and yoga studios, and lack of healthy bending and other movement that would build-in stretch to the area just from daily life (see the Fitness and A Lifestyle Page for these healthy movement habits). Another contributor (of several) to posterior hip tightness causing sciatic pain down the leg is standing, walking, and moving with legs turned out - duck foot. Muscles that turn your leg outward are in back of your hip (in your behind). They fasten from the back of your hip bone to your upper leg bone going sideways. The sciatic nerve passes near or through one or more of these muscles (which may be the piriformis muscle or the other deep lateral rotators that work with it). When these muscles get tight from years of walking, sitting, and standing with your hip bent, your feet turned out, and lack of healthy movement that would have stretched it, the tight areas can press and add to sciatic pain. Another part often confused for piriformis or disc is injured hamstring attachment, more on this below.
What To Do for Tightness That Relates To Pain
Good bending (healthy functional squat) will give healthy stretch to the lower back and hip built-in to all you do. Don't do it as 10 squat exercises but for the hundreds of times you bend all day. Good bending prevents damage to the discs and back muscle strain, and also gives needed motion-stretch which helps cellular repair.
Use healthy low squatting instead of bending over for hamstring stretches. See below about Hamstrings.
Use healthier hamstring stretches (as explained on my Hamstrings page and in my Stretching Smarter and Fix Pain books), not bending over to touch toes. I developed these different hamstring stretches to build in the function needed from hamstrings during running, kicking, stepping up, and other real life. They don't use bad bending. They also help re-train length in good ways that help prevent the kind of "pulls" that result in tight un-stretchy sit-bone attachments that hurt when you sit or lift the leg.
Some posterior hip stretches, for example the very effective "Ancient putting on shoe stretch" and good bending to avoid disc pain are on the Fitness as A Lifestyle page.
Several specific stretches for tight posterior back and hip that are not bad for discs are found in the book Stretching Smarter Stretching Healthier.
Pain from Swayback - Too Much Inward Curve in Lower Back: Hyperlordosis
A major hidden cause of ache in the lower back comes from allowing too much inward curve in the lower back - called hyperlordosis and swayback. This kind of pain is usually felt during /after long standing, walking, running, lifting overhead. Sitting or bending forward relieves this kind of pain, leading to all kinds of indirect and strange exercise rituals. Preventing the slouching posture will stop the pain and injury from it in the first place - see this article on fixing hyperlordosis. This article also explains relation of this kind of slouching to disc injury. During my original lab work investigating swayback, I thought it was unrelated to disc and only caused its own pain to the facets and surrounding soft tissue. Then evidence came in that certain people with bad discs, even really bad discs, also felt far better from neutral spine. The swayback was pinching on their protruding discs. It was also making less room in the posterior areas where nerves exit. Bending over is often given to these people, and they are even told to walk bent over! or bent over a walker. A terrible idea. Of course, bent forward, the rear compartment is opened but the front is squeezed and favors further disc damage. Neutral spine allows upright comfortable walking with needed healthy spacing in front and back. I have lots more I am working on about this. The 4th edition of my book The Ab Revolution explains more. The Ab Revolution deals with the topic of swayback. I need time to work on the print edition and to rearrange it to make the concepts even more immediately accessible. Get that book for full information, and for short summaries read below and The Abs Page.
If you get full lower back relief by bending forward far enough to touch toes, it is not likely the disc is what is the cause (or main cause) of your pain but something else. That is why bad stretches are often prescribed for disc - it was not the disc but something else that felt better. Then people with injured discs try these wrong cures and don't get better. It is no mystery. Truly injured discs do not like that kind of movement. Injured discs will let you know by hurting. If bending forward relieves the pain, then you are likely to have two other causes - tight muscles back there that feel better to be stretched so that they are not tight, and/ or you stand swaybacked. Swayback is too much inward curve to the lower back. The severe angle pinches and presses. Leaning forward reduces the too large inner curve.
A problem comes when patients who have pain from tightness or swayback, but are wrongly told they have a disc problem, are given forward bending stretches. Most conventional forward bending stretches are bad for discs, but since the person doesn't have an injured disc as the source of pain, they feel better. In this way, unhealthful forward-bending stretches get prescribed for disc pain, in error, and people say they don't know why it "works sometimes and not other times."The reason is that they did not know what they were treating, and randomly help sometimes and make it worse other times. Not good medicine, and certainly not good science. Especially for the pain-wracked people who thought "they tried everything" and go to unnecessary surgery, or become dependent on pain pills. The difference should be very clear to spot and know what healthy fixes are needed. For people with both disc and tightness, the right stretches are needed in addition to stopping unhealthy bending. This is no different than what anyone else benefits from.
Back muscle spasm can be breathtakingly sudden and painful, but can be eased out the same way as a leg cramp - with specific directed action to make the muscle release from contracted state. Spasm may accompany hurting a disc or occur by itself. Spasm is another big area where people are wrongly diagnosed as having a disc injury, with wrong treatments and stretches (or tragically surgery) prescribed for disc. See the Fix Back Pain article for more about spasm.
Pain From Other Nerves Than Sciatic Nerve
Not all pain that goes down the arm or the back of the leg is from discs. See the information on this page and the Fix Back Pain article for more about muscles tightness, spasm, and hamstring involvement. Also, not all pain that goes down the back of the leg is from the sciatic nerves. It can be from other nerves, and can be also fixed with stopping unhealthful movement habits.
Bad Hamstring Stretching
Another thing commonly mistaken for sciatic pain is hamstring strain or damage at the place the three hamstrings all attach to the posterior hip - the "sit bones" called ischial tuberosities. The pain may be in the backside and can go down the leg. This can be confused for disc pain during a badly done "straight-leg" raise test.
Check if pain is actually located on the bump you sit on where the hamstring attaches, and only when isolating the hamstring, properly, and checked in several ways. Damage all along the hamstring may be felt down the back of the thigh.
An even more common source of back and disc pain is bad hamstring stretches themselves. Check if you are doing conventional hamstring stretches by sitting or standing bent forward. They are a classic mechanism for degenerating discs and pushing discs outward. There are far better and more functional ways to stretch the hamstrings, described below, in other free articles on this web site (like the Stretching Smarter Article), and in my books. I did lab studies that found no relation between hamstring flexibility and lower back pain - click to see why it is so often mistakenly prescribed for back pain, and what to do instead.
Carla first wrote to me in terrible pain, worried that she would not be able to go back to school for a degree program she was interested in. After our work together, she excitedly wrote me that she was accepted to University. She also wrote that her Mother listened to what I told her about her knees and was also better. Carla sent happy notes over the next years about being happy and busy with school, then sent the graduation photo below. I am popping proud:
On Dec 15, 2016, at 7:29 AM, Carla Murador wrote:
"HI Dr. Bookspan, this is Carla. I hope you know that I remember you all the time!! I am sending you this picture in order to thank you for all the support and help you gave me in my hardest times. Also, because I was able to graduate pain free! Thank you very much!! Carla"
RAP Song to Remember Good Bending
Here is a fun rap to remember good bending as one of many components of back health. It is the same rap lyrics as on the Fix Back Pain page, but with emphasis on the Backman! (tm) drawings for better learning. I wrote the Rap lyrics (Dr. Bookspan). Rapped for us by Raymond Lott, former United States Marine Corps sergeant (RSonic, The Marine Rapper), who served combat tours with infantry battalions in Iraq 2006 and Afghanistan 2008. (NOTE: I wrote lyrics that when you bend wrong, back pain "IS NO" mystery. Sgt. Lott changed it to, "ain't no...") Other than that, learn and enjoy:
If this Rap for Good Bending does not load, try the direct link on my Flickr page:
To see this rap featuring Marine combat veteran Sgt. Raymond Lott, who made me these videos to help the world fix pain, click the Fix Back Pain page.
To send your own Rhymes and Rhythms for Remembering Health, see the Projects Page.
To keep this article a quick and easy summary, much is left out. The books tell more.
A herniated or degenerating disc, and sciatica and pain down the arm or leg, are not a mysterious "condition" or disease. The cause is often simple mechanics. People spend their day sitting, working, walking, and driving in the very hunched posture that pushes discs out the back. They hunch over the computer, lifting and bending wrong all day, walking heavily, and slouching all day, and then exercise in ways that strain and pressure discs and muscles. They do yoga and Pilate's exercises that forcibly pressure discs. They try remedies that do not address the cause of the problem, do physical therapy in ways that exacerbates the original problem, give up favorite activities, have surgery then return to previous injurious habits, then everyone is astonished that they "tried everything and nothing seemed to work." It's like eating butter and sugar all day, then waving your hands in the air for 5 minutes and saying "I don't understands why I don't lose weight, I do my exercises." How is your body positioning right now? Use your muscles to stand and bend properly for all daily tasks to stop pushing the disc out to the back, degenerating and herniating it. Do back extension exercise to take the pressure off your discs and help retrain how you extend the spine - evenly, not yanking or bending more from one segment while leaving the rest without movement. Bonus: beside fixing injured discs, standing and moving in healthy ways for real life burns calories, strengthens, and is a free workout.
- Doing a few exercises or stretches will not fix your disc. You need to stop bad exercises, bad stretches, bad bending, and bad sitting. You need to do good bending as shown in this article, good sitting, further explained in the Healthier Sitting article, and use healthful movement instead of bad movement for your daily activities as well as your exercises, as described here and throughout this web site and in the Books. Then you will stop causes and the discs can heal and impingements stop.
- Not all exercise is healthy, just like not all food and medicine - there is junk food and unhealthy medicine. Use my work to understand the concepts so that you can tell what is healthy movement for yourself. Then apply it to your life - happy, healthy, active. Healthy exercise is more than good for you - it is crucial for recovery.
- Watch other peoples posture, gait, and movement habits. It will remind you how often you may be injuring yourself.
- Notice injurious postures in fitness magazines doing "fitness and health" moves. It will remind you not to do them, and why pain is no mystery.
- Notice your own habits. Use the principles of my work to identify and eliminate the cause of your own pain.
- Does using my work mean you never do any flexion? Of course not - that is misunderstanding the concepts. The idea is notice if you spend most of your day that way and then use predominantly flexion exercises on top of that. Then it is no mystery why you hurt. Understand, don't memorize arbitrary rules.
- Please don't combine conventional injurious stretches and exercises that I explain to skip, then come back to me and say my work isn't fixing that.
- Make sure your pain is not from medical conditions (vascular, infection, allergy, Lyme disease, Sickle Cell, other) or from many medicines known to have body pain as side effects.
- Send me photos showing the principles in action, Prizes for best candid.
- Send me your success stories about using these principles. Send typo corrections, nice notes, and success stories.
- Please do not e-mail saying you are "doing the exercises 10 times and want me to tell you how to fix your discs." I get hundreds of those mails. Here is the answer now: If you stop hurting your discs with bad bending, bad sitting, and bad exercises, then a major source of disc injury will stop. It is not the exercises that fix things, it's you. Sure, send nice e-mails of what you are trying, and photos of your happy successes. First make sure you understand everything in the free article above. The books tell more. Smile, breathe. Pass this knowledge on to others.
Don't Change These Concepts and Methods Back To "What You Know" - These Methods Work Only As Written and Intended
It has been said, "Any man who afflicts the human race with ideas must be prepared to see them misunderstood" Even so, please don't change my work back into what you know, or what others say, or what you learned somewhere else. his is different and works differently than the pop fads that have become ingrained in fitness and health. To paraphrase Bertrand Russell, "An untrained man's report of what a knowledgeable man says is never accurate because he unconsciously translates what he hears into something he can understand." My work is primary source, and often - not what we learned in school and the gym. Remember, that is good.
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Healthy Martial Arts
Top level book for all athletes to train thinking, spirit, and top performance. Healthy Martial Arts is the top of the line book (of my books) for exercises and athletes. Sun Tzu's "The Art of War" is the classic strategy manual in business and power. "Healthy Martial Arts" is the strategy manual for your life. For everyone, not only martial artists, who want to move, live, eat, and be happy in healthy ways. Direct from Amazon - Healthy Martial Arts.
Fix Your Own Pain Without Drugs or Surgery
Neck pain, back pain, shoulder and hip pain, knee pain, ankle and foot injuries, wrist pain, and "when everything hurts," featuring actual patient stories in every chapter. Many common exercise contribute to pain and aren't natural movement patterns. Learn fun healthy ways to get healthy movement back as part of your real life.
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The Ab Revolution Fourth Edition - No More Crunches No More Back Pain Print 4th Edition.
Core training the way your body actually needs. Part 1 - Learn neutral spine to stop a major form of lower back pain. Part 2 - Apply Part 1 for functional strengthening from simple moves to the toughest you can get. Parts 1 and 2 let you get started quickly and clearly. Details on the anatomy and physiology are expanded and moved to Part 3, plus other improvements in photos and organization in the 4th edition.
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Fun Letter from a Reader:
On Mar 24, 2012 Rexford Darko wrote:
"I have been using your books faithfully with great results (where do I post the endorsement?)"
On Apr 12, 2012, Rexford Darko wrote:
"Doc, I am now virtually pain free except for the occasional reminder of poor bending. You are entirely responsible for this and I'll go on your site to find where to post the endorsement. Thanks, Rexford"
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