Prolapsed disc in the lower lumbar case study

John, a young man of twenty one, came to see me. He was clearly very fit and healthy with an interest in weight training and martial arts. He presented to me with a deep ache in the left hamstring area, which he thought might be just a ‘muscle pull’. He had seen both a physiotherapist and chiropractor who both worked on the back of his thigh and gave him stretching exercises for an overstrained Hamstring.

On examination, despite his level of fitness when I put the lumbar spine under a little load he experienced pain radiating into the back of the thigh. My clinical impression was that he had a prolapse of a lower lumbar disc that was pressing on a nerve root and causing radiation of pain into the thigh and calf. Through his GP we organised an MRI scan, the conclusion of which confirmed my suspicions. He considered the options of spinal injections and even an operation but in the meantime decided to try acupuncture.

Over a few sessions he began to get relief and he returned to light duties at work. I now looked at his training habits and we soon established he was performing squats in the gym with huge weights whilst allowing his lower back to strongly arch which put huge load on the lumbar discs. In addition, he had been told his lower back was ‘weak’ so he was doing exercises arching his back up against a weight. He had been able to perform hundreds of sit-ups and yet his abdominal ‘strength’ was not protecting his lower back. In part this was because he was strong in a forwards direction but less so when challenged in rotation or from side-to-side. No wonder he was vulnerable to jolts or twists. In addition, he didn’t have the same power, control and balance off the left leg, as he did with the right.

Over the years of training in Martial Arts he had been compensating for his weaker left side and this imbalance had finally broken down. Under my guidance, John changed his training routine making his schedule much more dynamic and 3-dimensional including more balance work and exercises into rotation and side-bending. He followed the advice I gave him and despite the MRI scan still showing a disc bulge he is unaware of any pain on a day-to-basis in a heavy job as a site carpenter.