Bad Discs, Sciatica, and Diving

By Dr. Jolie Bookspan

A degenerating disc, or one that is slipped (herniated) can be painful and frightening. Divers may be told to give up diving, or they may find they are too limited to dive effectively. Despite the fact that discs usually can heal quickly and easily, divers are commonly told that a disc problem is a difficult and long-term condition. They are told to accept and “live with” pain and reduced ability. They may stay on pain and anti-inflammatory drugs for long periods. Recent news reports from Time Magazine and The New York Times quote spine specialists as saying that back pain is mysterious, and that commonly used modalities like acupuncture, strengthening, surgery, massage, chiropractic just aren’t working.

Back Pain Is Not Mysterious
Most people do an astonishing number of things every day, year after year, to strain, weaken, and pressure their backs. You know you shouldn’t 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. Drive bent over the wheel. If you go to the gym you probably lift weights bent over, stretch by touching your toes, do yoga by bending over at the waist, then bend over to pick up your things to go home. To go diving, you may sit in bad posture hunched forward on the way to the dive site. On dive boats you sit hunched while the boat pounds over the waves. You stand letting your tanks and weights pull your back into bad posture, instead of using your muscles to stand properly against the pull of the gear. You lift heavy tanks and gear wrong. No wonder your back hurts.

It’s not lifting wrong once that injures discs. It usually takes years of abuse to break down a disc. Most divers know that bending wrong to pick up heavy tanks can injure your back. But they stand, bend, sit, and lift wrong many dozens of times a day, day after day, then compound the problem with holding muscles tightly, and doing bad exercises. They may do special “back exercises,” but not be aware that strong muscles will not automatically give you good posture, make you bend and lift properly, or make up for all the things you do the rest of the day to hurt your back. They wonder why they still get pain even though they take their medicine and “do their exercises.” Many wind up in back surgery, or long term or recurring pain, not understanding why their physical therapy, pills, or yoga “didn’t work.”

A few exercises or “adjustments” will not undo the damage of constant bad ergonomics. Having surgery will not stop you from constantly slouching and bending in unintelligent ways. But you can easily stop the damage you do to your back, without giving up favorite activities.

What Are Discs?
Discs are little fibrous cushions between each of your vertebrae (back bones). You have discs between each of the bones of your neck, upper back and low back. You also have two discs in each knee. A knee disc is commonly called a meniscus. You even have a little disc between your lower and upper jaw bone at your temporo-mandibular joint (TMJ). Discs are living parts of your body. They do many things like absorb shock, and keep your bones from grinding against each other. Discs are tough and strong. But when you abuse them over months and years of bad habits, they can break down.

How Discs Neck Herniate
Years of forward rounding squashes your discs and pushes them toward the back. The discs eventually break down (degenerate) and push outward enough to stick out from between your back bones (herniate). Think of a water balloon. When you squeeze the front, it bulges toward the back. The resulting herniation can press on nearby nerves, sending sciatic pain down your leg. Or 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 and press on nerves, sending pain down your arm.

Tight muscles from years of poor positioning and short resting muscle length can also press on the same nerves mimicking sciatica. Chronic forward bending (flexion) also overstretches the muscles and long ligament down the back, which weakens the back, and pushes vertebral discs posteriorly.

The pressure of your own body weight on your muscles and discs over years of poor sitting, standing, and bending habits is enough to injure your back as badly as a single accident. Think of braces on your teeth. After years of pushing, things eventually move. Then one day, sometimes doing little more than sneezing or lifting wrong one more time, the pain begins.

Not A Disease
An unfortunate situation is that someone with a slipping or degenerating disc is often told they have “degenerative disc disease” or “disc disease.” But it is not a disease. The condition is misnamed. A hurt disc is a simple, mechanical injury that can heal, if you just stop grinding it and physically pushing it out of place. It will heal and stop pressing on nerves. The disc pain and sciatica will go away. It is simple, and depends a great deal on how you hold your body when sitting, bending, and exercising.

Discs Can Heal
Disc injury is not a life sentence. Disc degeneration or slippage (herniation) can heal and stop hurting- if you let it – no differently than a sprained ankle. Stop damaging your discs with bad bending, standing, lifting, and sitting habits and your discs can heal. It takes a long time to herniate a disc, and only days to weeks to let it heal it by stopping bad habits.

Pain Mistaken for Disc Injury
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 structures and abused muscles from bad habits. Just 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.

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 no mystery. Change the bad habits to change the pain.

What To Do Every Day To Stop Ruining Your Discs
– First thing in the morning, don’t sit on the edge of the bed. Instead of sitting rounded, turn over and lie face down. Prop gently on elbows, but not so high that it strains. It should feel good and help you start your day with straighter positioning. Get out of bed without sitting.
– Sit without rounding. Don’t be ramrod straight or hold your muscles tightly. Just hold comfortable, natural, straight position.
– Stand and carry your tanks and gear without forward head, or rounding your low back. (Don’t lean backward either, to “balance” the weight – that causes problems of its own. Just use your muscles to stand straight.
Count how many times you bend each day. 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.
Bend properly for everything, even the water fountain, to pick things up from the floor, to look in the refrigerator, or take things out of the dishwasher. Keep your torso upright and bend your knees. – Lift using the lunge or squat, not bending over. Keep your upper body upright. Bend knees, keeping weight toward your heels. Keep your knees over your feet, not slumping forward, which is hard on the knees.
– Don’t use bad knees as an excuse to wreck your back. Bending properly will strengthen your knees as well.
– Raise your computer monitor off the desk – use a low shelf or phone books.
– Move your TV up higher. Stop curling downward and forward to watch.
– Move desk and car seats closer to sit back not forward (don’t worry about having to keep your feet on floor or keeping thighs parallel to the floor. These are inconsequential. Understand the overall forces on your back and you won’t have to worry about the unimportant details).
– Move your computer keyboard off the “below desk” tray, and back up on the desk.
– Use a lumbar roll (jacket or towel will do) to pad the backward-rounding space in most chair backs. Sit up and lean slightly back. Don’t round against the lumbar roll. More about this in another article.
– Use your muscles, not joints to hold you up. It’s free exercise.

Don’t Exercise in Ways that Damage Your Back
Many people hurt from excessive forward bending. Unfortunately, many exercises they do for their back often involves more forward bending: toe touches, knee to chest, and crunches. Many people are surprised to find that they injure their back doing forward yoga stretches. You wouldn’t pick up a package that way. It is not really a surprise. Don’t stretch by bending over at the waist without supporting your body weight on your hands. Better exercises that strengthen your back by moving it in the other direction (extension exercises), and moves that give you a workout at the same time as retraining better habits, will follow next time.

Summary
A herniated or degenerating disc is not a mysterious “condition” or a disease. Divers spend much of their diving day sitting on the ride to the dive site and lifting gear in the hunched posture that pushes discs out the back. Back at work 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 may do 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 five 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 and diving tasks. Bonus: It burns calories, strengthens, and is a free workout. You don’t have to live with pain.

 

AUTHOR

Ernest S. Campbell, M.D., FACS

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