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Best Exercise for L4-L5 Disc Bulge & L4-L5 Herniation- Includes Self Tests | Best Exercise for L4-L5 Disc Bulge & L4-L5 Herniation- Includes Self Tests Interested in learning about the products mentioned in today's video: 1)... | By Bob and Brad | - Hey, Brad. We're gonna talk about the best exercise for L4-L5 disk bulge and L4-L5 herniation. - I'm excited to do this video. I've had a lot of patients with herniations or symptoms at this level for all five, including myself. - Very common. - So don't get too excited, it is treatable often times, not 100% of the times, through therapy. - Right? - Okay, so. - You certainly want to give it a go because you don't wanna look at surgery right away unless, you know, you have severe weakness. - Right. Now if you're watching this video and you've already had a MRI and the MRI says you have a herniated or a bulging disk at L4-L5 disk. Let's say you've got that but you don't have any symptoms down the leg. Or, in other words, there's no pain nor numbness, no sciatica, but you have the back pain, that's pretty good news. It means it's not too serious. - We should say right here, Brad, that actually they do MRIs on people that are having no pain whatsoever sometimes and they'll find disk bulge and disk herniations in them, especially as you get older. It's kind of like gray hair, wrinkles. - Right. - It's part of the aging process that things start to break down. - Right. - So don't panic when you get these diagnoses because it's very common. - Right, that it may not be a problem. Your body's adapted to it. However, if you are having symptoms down the leg. - Down the leg. - Then it all makes. And we're gonna show you a couple simple tests. Now if you do have a diagnosis of this and you don't have pain down the leg or any symptoms at all down the leg and just minor back pain, at the end of this video, we're gonna show some exercises, some postures and stuff that you're gonna want to do as well, even though you don't have the symptoms. - Right. - But before we go to that, let's talk about where is this. Cause if you understand the anatomy and some of the tests, you're gonna do better, you're gonna have a much better chance of- - When you have increased knowledge, it always is a positive thing. It's gonna make you more likely to have positive results. - [Brad] Exactly, so if you look here at Sam, L4-L5, we're gonna look, here's a lumbar vertebrae, here's L5, here's L4, L3 and so on and upwards. And if you look, here's L5-L4, so it's your lowest two lumbar vertebrae. And this yellow, and this is pretty realistic, you know, it's about this diameter and the nerves are kinda yellowish, more whitish actually. But it comes out here, then it goes through the pelvis and at this point it is part of the sciatic nerve. There's a nerve bundle. It's just not L4-L5 nerve or L4 is actually what we're looking at. It goes through the bundle and as it comes down it starts to separate, an L4 nerve root is what we're looking at, at the L4-L5 disk. And it comes in through the front of the leg, kind of the front of the knee and down and into the foot. Okay, so that just gives you a general mapping of that nerve. Now if you look here, this red bulge is a model, Sam's model, of a bulging or herniated disk. - [Bob] Right. - This would have to be right here. And you could see where that would push into the nerve, irritating the nerve and creating those symptoms. So the whole goal is to get that bulge out of there without surgery, which is not always, but it can be possible through therapy. - The body wants to heal- - That's right. - If you allow it. And, you wanna show this now, Brad? - Yeah, so what I wanna show you that dermatome, in other words, the location you're gonna feel the typically it's numbness, burning, cold feeling, all these symptoms are related to a nerve pinch. And so we put some green tape on the location and the mapping of where you're gonna feel it on the L4 nerve. So it's in the middle of the back. Now sometimes I have people that won't feel anything here but it'll come down in the leg. Can you turn, Bob? - [Bob] Yeah. - It goes to the front of the thigh, over the knee cap, down the front of the shin, and actually down to the top of the foot. And that's L4, L5 actually is part of the big toe, so they kinda get mished and mashed there a little bit. So that's where a typical- - [Bob] pattern is. And so- - There you go. - That gives you a clue where the problem is at. Like if we see somebody and they come in and they got pain here, the first thing we're thinking is L4-L5. - Right, exactly. And the next thing that you could. And this is a real simple test you can do is a muscle test. Now, one of the muscles groups that L4 innervates is your dorsiflexion, the anterior tip. So if this is my involved side and if you can do this, that means the nerve is not pinched so bad that it turned off that muscle group. One of the typical tests that doctors and therapists do is they say, "Can you walk on your heals like this". And that's a good indication if L4 is intact. Now if you do this and your left leg is your good leg, you can do it easy there and you try to here and it just plops down like that, that means you better go see the doctor. - Yeah we a lot of times call it foot slap if it's not working quite right. - Yeah. - If you're walking you hear the slap going on, the right side. - Or foot drop. - Foot drop. - Yeah. If that's the case, you need to be seeing the therapist or the doctor. - Now remember, safety first when you're doing this test. So hang on to something. I don't want anybody falling while they're testing it. - You could just go like this. You don't have to walk. You know, hold on to this and if you do this and that one foot always drops like that cause you cannot hold it up, that's more a serious stage of a nerve impingement. And so what I wanna go to on next is, let's say you have the nerve impingement but you pass a manual muscle test but you have the symptoms. - Some pain going down the leg. - Now we gotta get to the exercise. - Right. - Now we're gonna go to the McKenzie routine, Robin McKenzie, he started a whole system treating symptoms just like this. And it's been going on since the 1960s. It's a whole world-wide system. So we're going- - 30-some countries. - Yep, we're going right to the best. - Yep. - So, Bob, why don't you show one of the most common exercises that works for this. - So what we're looking for here, by the way, is we're looking for the symptoms to get better on the distal, which is the farthest part away from your body. - Right. - So like, what I'm looking on, let's say I've got pain all the way down my leg here. What do we wanna see first, Brad? We wanna see that foot pain go away. - Yeah, so- - Or symptoms. - We're gonna do the exercise that we're gonna show you in a second. And if all the sudden, you know, and I've had this happen with patients, they do- - Oh many times. - They do press-ups and "oh my foot doesn't feel numb or tingly". - Well I'll ask them, cause they'll go "Any change?" and "No, no" and I go "Well how's the foot feel?", "Well I don't feel it now. I don't feel the pain. I don't feel the tingling. I don't feel the numbness." - There you go. - So, that's what you wanna feel. - Right. - And if it gets better and better, it starts going up further and further. - Right. - This goes away. So that's all a really good sign if you're doing the exercises. And that's what you're going for. - That's called centralization of the pain or the symptoms. - Right. - And the way you get that, one of the real common exercises is prone press-ups, which Bob is gonna demonstrate. - Right, you start off, you might lay like this for a bit. Sometimes we even have you lay on pillows to start off with. But eventually you get up onto your elbow and maybe lay there for a little bit. But then eventually you can do what we call micro press-ups. So you're not pushing all the way up yet because you're just starting these, and you're not sure what your range of motion of your spine is. What you don't wanna see is this. You don't wanna be, you're so stiff you're not able to keep your pelvis down. - Right, right here. - If you can't keep your pelvis down, just keep it down as far as you can and just start some, again, micro press-ups. - Now if you do 10 micro press-ups and all of the sudden the foot starts to feel better, boy you are gold, there's a really good chance that if you continue the progression you're gonna get rid of that leg symptoms. - All right that's a very good sign. And then eventually you can get up to this point. - [Brad] Oh, yeah. - You're gonna start seeing some real gains if you keep the pelvis down. Now if you do these and it's not getting better or if it's even getting worse, then you need to try some of these advanced things. - [Brad] Right, should we go to the banana? - Sure, let's go to the banana. Let's say, I know just for their sake, let's say the pain is on this leg, Brad. - [Brad] Sure, yeah. - I would actually shift my hip away from the painful side and I would shift my shoulders over to the painful side. So if you're looking at me, I'm making a banana. - If you look from the top down, yeah his body curves so that the painful side is on the concave side. - The concave side, Brad. - There you go. So it looks like a banana, looking from the ceiling. And then, in that position, you actually do some mini press-ups. - Yep and I would even, a lot of times but I maybe lay like this first. And then maybe even get up on their elbows again. - [Brad] Sure, yep. - Just to see how they do. Sometimes you just wiggle back and forth a little bit here. And then yeah we try some press-ups again, just some micro press-ups. You don't do full ones with this position. - [Brad] Right, exactly. - And again you're looking for the same thing. Is that taking the pain out of the foot, out of the leg. You know, is it going up the leg. Or is the numbness or tingling getting better. - [Brad] Right. - It doesn't just always have to be the pain. - [Brad] Right, exactly. - If anything's improving. Oh you wanna do road kill? - [Brad] Yeah we could throw one more advanced one in there. - So, road kill, I would actually take the leg and go like this. - [Brad] Yeah. - I'm putting my foot against my opposite knee. - It's kinda hard to see black on black but his foot is against his knee here. - And this is the same thing. I'm gonna start this way and maybe just lay here for a bit. I might lay on my elbows a little bit for a prop. I may wiggle a little bit. And then I might try some press-ups, like this. - And, you know, Bob is saying might do this, might do that, and that's the way it is. We have to kinda work. - Yeah, it's an experiment. - The whole idea is that these positions are gonna get that bulge to centralize, go back in, take pressure off the nerve. So be patient with it. We do have other videos if you do Bob and Brad sciatic. - Well actually we have a whole series on this. - Right, right. - So I'm thinking you go to BobandBrad.com, go to the program section, and look for sciatica. We have 40 videos on sciatica. - Right. - And so we go into great detail on all this. - Right. - So. - And you can go and pick out the video on leg pain, difficulty reducing leg pain, pick that video out and isolate it. - You wanna go over a few more things, though, that you wanted to do, Brad. - Yes, now the other thing, particularly regardless of whether you have symptoms, you have a bulging disk, or you have the pain down the leg, is posture. - Right. - Seated posture, in particular. - A lot of this was probably caused by bad posture in the first place, the slumped and bad posture may have contributed to your bulging disk. - Or it could have been the whole start of it possibly. - [Bob] Right, right. - For sure, you know, if you have a throw pillow, that can be helpful. But they're not always the best. But it's still a step in the right direction. - Especially on a couch or a soft chair. - There you go. - Like a recliner. - You're gonna know it's the right thing, cause as soon as you put it in there, it's gonna feel like, oh that feels like really good support, everything feels better. This is a little bit broad. If you're gonna have, if you have an L4-L5, you probably are gonna need something more specific. You can start out with a towel roll. You just roll it up like this. We put tape on it. And about this size may be good for you. And you're gonna put it right about at that area, at the belt line area. The position is gonna be critical but you'll know. It's like you go back there, it's like boy it feels like it's too high, then just shift it down. And it's like oh that feels better. It's that obvious. - I highly recommend it for your car, that if your car doesn't have lumbar support that you can adjust, I would try a towel. - Yeah. - Eventually if that towel feels fine, pick out a lumbar support off the internet and that's actually a McKenzie roll. - Right. - M-C-K-E-N-Z-I-E. - Yeah. - And it's actually you wanna get one that fits you, like if you're a thin guy, you probably want a thinner support, if you're a big person, with a large buttock and a large gap here, then you want a larger support. - Right. - It's as simple as that. - And they make there's so many varieties of these you have to look at them carefully on the internet. And there's a little bit of a chance that it's the wrong size but they're squishy, they're soft, and they're more comfortable than a towel roll, typically. And you'll use that. Now the other thing I wanted to address is postures when you're standing or if you're gonna bend over to pick something up. - Yeah, cause a lot of, again, you can trace the start of a lot of disc bulging and herniations to poor bending or poor lifting. - Yep. - Roll up rounding out your back like that. - So, if you take a stick about five-foot long or so, we use a Booyah Stik, you could use a broom stick, or anything that's straight. You'll see what I'm gonna do here. I'm going to put it, and I use this with my patients to train them how to do proper body mechanics for lifting. - It needs to have three points of contact. He's got a contact on his head, mid-back, and low-back. - Look how straight I am. That takes pressure off that bulge. And I'm just gonna practice squats. Now the reason I'm doing this, I'll say do 10 of these, 3 times a day. And then use that same body mechanics when you squat to pick something up. You know, you can go down on one knee if you're gonna pick up even a pencil. Because we don't wanna do this and get that bulge to come back out. - Yeah, you wanna picture like that stick is in place even when it's not. - Right, exactly. - Visualize it. - So that's actually bonus cause we only said one exercise. The primary exercise is the press-ups. - Right. - But the posture and the mechanics of bending and lifting are very important. - Brad and I can fix your spine. - Except for. - A broken heart. - There ya go, Bob. But we'll continue to work on that. - We'll stick to it, we'll stick to it.