Training with Herniated Discs

Last week I received an email from a blog reader with a question:

"I was recently diagnosed with herniated discs in my neck (C-3:C-7) and I am a bodybuilder. I realize that my workout must now change and am looking for a new program that can still keep me in good shape, build lean muscle, while keeping the stress off of my neck. Thanks so much for your help."
MH

Thanks for your question! First of all, I am going to assume that you have clearance from your physician to start training and don't have any neurological deficits (i.e. weakness or tingling in your arms). If you still have any neurological symptoms, consult your physician.

Herniated discs can be a little tricky, but the primary modifications with strength training would be to maintain a neutral neck (spine) and limit exertion of muscles that insert on the cervical vertebrae. If the neck is not neutral, say do to poor posture or muscle imbalances, then your training can (positively or negatively) impact your condition. Lets take a look at some of the muscles of the upper back, shoulders, and neck.

As you can see, many muscles connect to the cervical vertebrae, originating above from the scalp, and below from the scapulae and thoracic spine.

While many different types of training programs with free weights or machines may be effective in helping you achieve your goal, I am going to point out the precautions you need to take with any exercises you do perform. One of the most important things to remember is how you do the exercises is as important or more important than what you do.

1. Maintain a neutral neck with lifting- Be carefull to not hyperextend or flex your neck with exercises, such as squats, curls, presses, etc. Find a focal point to look at and keep your head "tall" as you perform the exercise. Avoid exercises in which it is difficult to maintain a neutral neck, such as a crunches.

Maintaining a neutral neck while deadlifting.

2. Limit stress on muscles that insert on cervical vertebrae-
Muscles such as the upper Trapezius, Levatator Scapulae, and Splenius Capitis all insert on the back of the cervical vertibrae and can exert a lot of stress on the cervical discs. It is almost impossible not to use these muscles, but you can limit them by using good technique. For example, with a cable row, when rowing, keep the weight at a level where you can retract the shoulder blades back and down. This motion limits tension in the upper Trapezius muscle, and stress on neck. Another example is with the bench press. Again, keep the shoulder blades back and down and be careful not to hyperextend your neck into the bench. Think of keeping your head "tall" and chest "forward."

Proper movement of the scapula, back and down, improves posture and puts less strain on the neck.

3. Balance your training so your posture improves- Imbalanced training can worsen posture. So many people, because of the vast amount of sitting, have poor alignment of the spine, shoulder joints, and rib cage. An imbalanced training program, such as one that doesn't address posture and includes a lot of "chest" or pushing exercises can create more problems. I will give a client that has posture problems a healthy amount of "corrective exercises". This will usually include stretching the chest and front of shoulder, increasing extension and rotation of the thoracic vertebrae (at the level of your chest), strengthening the upper back and hips, etc.

Normal and head-forward postures, which put more pressure on the discs in your neck.

Thoracic spine rotation to 'correct' poor posture

A properly-designed strength training program can safely be followed even with cervical disc herniation (without symptoms). While I am not providing a specific program (because I would really like to know more about you), following these three precautions should help you. Of course, if you have symptoms and/or want more specific advice about appropriate 'corrective' exercises, seek out a physical therapist or qualified trainer (hint: most trainers are not qualified in this area). Good luck!

Adaption Is Good and You Should Pursue It

After training myself for 17 years and others for almost that long, a few things stand out. One of the most glaring is the idea of specificity of adaption. Actually, it is a very well-supported principle of human physiology. However, in popular fitness circles, aka your local commercial gym or the "fitness" section at your local bookstore (which is not Borders anymore, unfortunately is now out of business) you'd think it was a four-letter word. Terms like "muscle confusion" and "muscle blasting" are vogue.


"I can barely walk today, what a great workout I had yesterday!" is commonly heard. Delayed onset muscle-soreness is often viewed as the barometer for the effectiveness of a training session. On the contrary, no muscle soreness is frequently interpreted as an ineffective workout. This translation is erroneous and misleading. Muscle soreness is simply a by-product of performing a level of muscle work to which your body is unacquainted, not the indicator of a single workout's effectiveness of improving your strength or fitness.


High-level strength and fitness is not the result of one workout. Quite the opposite, high-level strength and fitness are the precipitate of consistent training, time, and physiological adaptation. You see, physical adaptation is what you are striving to achieve. Physical adaptation is increased: strength, muscle mass, endurance, etc.

Muscle soreness goes away as adaption occurs. This is evident if you follow a training program for a few weeks. You are no longer sore. People view this as a negative, when rationally it is positive. You can now do the program without developing muscle soreness. You have taken a step closer to where you want to be without the negative side-effects. When you do progress the program, your body can respond favorably to it because of the adaptation that has occurred.

"The journey of a thousand miles starts with ones step."

Everyone should follow a training program. As I tell my clients, variety is not a bad thing, but when it interferes with adaption and progression it is counter-productive. You can't progress beyond a beginner-level if you keep changing things up. Additionally, you place yourself at greater risk of injury when your body is not adapted. Plus, it just feels good and is motivating when you can see your strength and fitness improve from week to week.


There are times when you can or should change your training program. But, that time frame is in weeks and months. This is an adequate amount of time to give your body for adaptation to that specific program. When you decide to change programs, it should be a subtle changes in variables that are still in-line with your long-term goals! The complete abandonment of your past training is misguided. If you are a runner, you need to still run similar distances/paces. You may make a few slight changes to the variables in your program. But, as a runner, you wouldn't abandon running, use the elliptical trainer, and expect yourself to improve or even maintain the level of running at which you had been. That is cross-training and is counter-productive! Remember specificity of movement.


The SAID principle or specific adaptation to implied demands is the primary principle that exercise training is based upon. It is ignorant to ignore the SAID principle. Then again, nearly all people buying those books, dvds, or attending an exercise class that promote "muscle confusion" are and will always be beginners. The muscular soreness they experience from those workouts gives them false sense of accomplishment. Muscular soreness (or even vomiting) can be induced with about five minutes of heavy exercise with a beginner. But, in reality they have only added one small brick in the training wall, or perhaps maybe even set themselves back if they can't train for a while because they are so sore. Adaptation to an appropriate program, followed consistently over time, with subtle changes made to it over time has and always will reap tremendous results. However, since the training adaptation process does take a time, it is easier to induce muscular soreness and declare it progress to the impatient trainee.

Diaphragmatic Breathing for Efficiency and Stabilization

Breathing is an ubiquitous part of our physiology and plays a large role in exercise, but is rarely discussed.  Oh, sure when your breathing is labored and you are sucking wind you think about it for a few seconds.  But, usually, you just think that you are out-of-shape and wonder when you will recover from this discomfort.  You probably aren't thinking about breathing efficiency and spinal stabilization.  That is exactly what I will discuss in this post.

The diaphragm is the primary respiratory muscle that is located between the abdomen and thoracic cavity.  Its, location, just under the lungs, and its unique dome structure allows it to play this vital role in respiration.  We rarely think about how our diaphragm is functioning, but hopefully I will change that. 

My first experience that gave me an appreciation of how crucial the diaphragm came when I was working in cardiopulmonary rehab.  Every once in a while we would run into patients with a paralyzed or partially paralyzed diaphragm, often stemming from surgical damage to the phrenic nerve.  Walking a few steps would be a chore for these patients as they would be challenged to exchange enough oxygen and  remove carbon dioxide using only their accessory respiratory muscles (more on them later). 

For the rest of us with a fully functioning diaphragm, we may still not know how to use our diaphragm properly, especially during strength training and endurance exercise. First, lets look at typical labored breathing (which uses accessory muscles as much or more than the diaphragm), and a more efficient technique called diaphragmatic breathing. 



Typical, labored breathing, which is common with moderate or hard exercise, involves a combination of diaphragm and accessory muscle breathing.  While diaphragmatic breathing emphasizes an almost exclusive use of the diaphragm and little use of accessory muscles of the rib cage and neck.  Diaphragmatic breathing is advantageous and should be used for two reasons: it is more efficient and it provides better stabilization for your spine and torso. 

Efficiency:  The diaphragm's shape and location make it the most efficient muscle to draw air into the lungs.  The accessory muscles of the torso and neck can expand the rib cage to draw air in, but this action is not very efficient.  With endurance exercise, respiratory inefficiency can be significant, and increase energy expenditure/decrease efficiency. 

Stabilization: The diaphragm's location and shape allow it to also play a pivotal role in lumbar spine stabilization.  Think of the abdomen as a box, with the abdominal wall compromising the front, the oblique muscles compromising the sides, the lower back muscles compromising the back, the pelvic floor muscles compromising the bottom, and the diaphragm compromising the top.   With a co-contraction of these muscles, and inhalation by contraction of the diaphragm, intra-abdominal pressure increases.  This muscular tension and pressure provides extra stabilization of the lumbar spine. 

You can learn to use your diaphragm more efficiently during breathing by copying the drill I was doing in the video.  Stand in front of a mirror and take some deep breaths with one hand on your chest and one hand on your abdomen.  Watch to see which hand moves.  Practice breathing down, into your abdomen with each breath.  As you get better, you will see less movement with the hand on your chest and more expansion of your abdomen.  After you can regularly inhale and only make your abdomen expand, you can practice abdominal bracing and diaphragmatic breathing.  The ultimate challenge is to be able to both, breath deeply to exchange oxygen and carbon dioxide, and develop intra-abdominal pressure to strongly stabilize your spine. 

Movement Force-Rate-Duration Theory

This weekend, while biking, I started thinking of how 'cardio' training is misleading. We have categorized 'cardio' as a specific type of exercise because cardio-respiratory capacity will increase when that specific type of exercise is performed on a regular basis. But, this is short-sighted. What happens when you train one specific exercise pattern for a while then go to another? Little. There is little carry-over to another type of 'cardio' exercise because the benefits are movement-specific. Additionally, 'cardio' implies that neuro-muscular capability is not important. A great example is the triathlon. Most people come to the triathlon with a training background in either: running, swimming, or cycling. They are weaker in the other two movement patterns, and need to specifically train those movement patterns to improve as a triathlete.

Specific, neuro-muscular movement patterns are the most important factor in exercise training adaptation. The cardio-respiratory system's capacity does improve. But, it improves in context of the specific neuro-muscular movements. Unfortunately, the lay public will simply view it all as just 'cardio', failing to appreciate the important differences in movement patterns.

While all of this can get complex, I like to distill this complex physiology into a simple and applicable theory.

The Movement Force-Rate-Duration Theory

The specific neuromuscular pattern of any movement has three, interrelated performance components: force output, the rate that the force is developed, and the duration that the force and rate of force development needs to be maintained. Here is a diagram showing the relationship of the three components.






For a given movement, all of these components are required at a minimum level. Our genetics determine partly the development of these components, hence why people gravitate toward a given sport or exercise. Additionally, if we have a deficit in one of these components, it needs to be developed with proper training.

Lets apply the Movement Force-Rate-Duration Theory to running a 5K race. A low-moderate level of force needs to be developed at a modest rate and at a moderately long duration (for the average person). If we determine which component is the weakest, we can focus on improving it. If force development is weak, then slow strength training with adequate resistance will help. If the rate of force development is poor, then training to develop force development with explosive strength training (and moderate resistances) or plyometrics will help. If the ability to maintain the force or rate (endurance) is poor, then that needs to be trained as close to the same neuromuscular pattern as possible by running in the same environment (surface, incline, altitude, temperature, etc.).

Another example of how to apply The Movement Force-Rate-Duration Theory is 'cardio' for golf. A client of mine, who is an avid golfer, has been using an elliptical trainer and spin cycle many days per week in addition to his golf. I changed his 'cardio' to uphill walking, kettlebell swings, rotary medicine ball throws, and lateral low-box hopping. The walking is a basic movement on the course, and the ability of the hips to withstand fatigue in extension and rotation movement patterns are also very important. These movement patterns are closer to the what he will be doing over the duration of three hours on the golf course than the elliptical or spin cycle.

Conventional categorization of exercise into 'cardio' or strength training is not only misleading, but a disservice to trainees. Adaptation to any exercise training is neuro-muscular pattern-dependent. It is not a choice between using your muscles or your heart. It is a question of what movements do you want to improve. Once you have developed foundamental movement patterns (mobility, stability, coordination,etc.), applying the Movement Force-Rate-Duration Theory to your training will help you address the three performance components of physical movements (force, rate, duration) and will help you achieve superior results.

"Fat-Burning Zone" Misunderstanding

I received a question from a friend the other day regarding the use of a heart rate monitor to assist with fat loss. She was following popular instructions given for training in the fat-burning zone by keeping exercise intensity low, because she is trying to lose body fat. The recommendations were to stay between 50-65% of her age-predicted heart max. However, a brisk walk was putting her over her heart rate limit.

The fat-burning zone, popular in fitness centers and in weight-loss arenas, is actually based on a misunderstanding of exercise physiology and some short-sightedness. It is true that at a low intensity, you dervive the greatest percent of your energy from fats over carbohydrate versus high-intensity exercise. But, that is just part of the story. High-intensity exercise may derive a lower percent of energy from fat while you are exercising because fat metabolism is inhibited, but high-intensity exercise will result in a greater energy deficit overall. While fat metabolism is inhibited during the session, it actually increases over the next 48 hours after the exercise session.

We have what is known as metabolic flexibility, we can shift back and forth between fat and carbohydrate metabolism. Certain situations shift our metabolism one way or another (see video below). But, the biggest factor in losing body fat is the energy balance. High-intensity exercise is more effective than low-intensity exercise in developing a large energy expenditure and therefore a greater net body fat loss (especially when combined with appropriate nutrition) in a given amount of time (most of us have limited amount of time to exercise). So, following the heart rate fat-burning zone is actually disadventagous. Instead, ditch the heart rate monitor and work as high of an intensity you can safely handle. Intermittant exercise works very well. Lastly, make sure you are always keeping your body strong and moving well, as this will help you better tolerate high-intensity exercise.

Here is a video I made last year about metabolic flexibility to help you better understand the basics of fat and carbohydrate metabolism:

Upper Cross Syndrome

More and more people are suffering from posture issues from sitting, repetitive motion stress, and lack of physical strength. A very common result is a posture characterized by rounded-forward shoulders, internally rotated arms, and a forward flexed neck. This syndrome is called Upper Cross Syndrome or Shoulder Cross Syndrome, originally by Dr. Vladimire Janda.

Upper Cross Syndrome moves joint surfaces out of proper alignment in the cervical vertebrae (neck), lumbar vertebrae (lower back), and glenohumoral joint (shoulder joint). Often, people with Upper Cross Syndrome don't tolerate basic strength exercises (such as push-ups, overhead press, and others) very well, and can often experience more pain and dysfunction in these joints. I often have to spend a lot of time on modifications or alternative, corrective exercises before a client can safely and effectively perform these basic exercises. It is a constant battle to stay out of Upper Cross Syndrome. You need an appropriate, comprehensive training plan consisting of flexibility, strengthening, and motor learning to reverse Upper Cross Syndrome.