Q&A for The 16% - Disc Herniation Solution - Recapture Early Propulsion - BillHartmanPT.com

[@zachbrown2514]

Hey I am a chiropractor and a new fan of your content! I find myself often seeing patients with flexion intolerant low back pain and even chronic disc herniations that often slouching while in seated position. Most often pelvis tucked under themselves legs in great amounts of ER, however table tests often show limited hip ER and IR measures. Am I correct in thinking that they are assuming this position in seated position potentially to create ER within the pelvis and hips to then gain the lacking IR necessary to sit comfortably? I’m a little lost because it eludes me why someone who has flexion intolerance bending forward standing would be comfortable sitting slouched in relative lumbar flexion, unless this is a very late stage compensation where they require relative lumbar flexion to open the posterior elements of the spine enough to alleviate compression on neural elements similar to how a individual suffering lumbar stenosis might bend forward to alleviate symptoms. I find these patients extremely stiff and often respond temporarily with manual distraction like techniques. To summarize, why would an individual limited in hip IR/ER measures with table tests and LBP Pain provoked with forward bending continue to assume a slouching posture when seated? Am I on the right train of thinking or what compensations might I be missing? PS. It would make a great video to discuss lumbar stenosis if you have experience managing these patients.

[@BillHartmanPT]

The slouch is compensatory ER. They don't have hip ROM to sit.

[@zachbrown2514]

@@BillHartmanPT thank you for the reply! Much appreciated!

[@skirace009]

Bill, any specific videos for someone with a l4-l5 herniation? Relatively pain free but discomfort in glute w/ sitting, nerve pain in glute with walking / standing. Very limited / stiff left femur internal rotation while spine (performed by PT). Can't seem to get this to subside. Happened in April when I went for a warm up jog one day and came back with crazy pain in my left leg. Been at 2 different PTs, Chiro, Neurosurgeon, cortisone shots, contemplating surgery... Leg pain has subsided, a little tingling /fuzzyness in the foot every now and then but mainly glute pain while sitting. Pelvis seems very rotated and shifted as well. Thanks!

[@BillHartmanPT]

Look at the activities to recapture hip IR.

[@skirace009]

@@BillHartmanPT Thanks Bill. Just started looking into your stuff so trying to figure it all out! Really trying to avoid the knife.

[@BillHartmanPT]

@@skirace009 If you continue to improve, keep going. Surgery is always last resort.

[@skirace009]

@@BillHartmanPT I wish Ifast was in Vermont!

[@RavbarRehabGym]

Did you solve it @Pat?

[@Randomhams1]

What's your opinion on people who use jefferson curls to directly load the spinal flexors to reduce the compression against the liquid that you refer to?

[@BillHartmanPT]

Blind application of any exercise without understanding secondary consequences is not recommended. It's also a gross misunderstanding of the muscle/joint/connective tissue behavior.

[@Randomhams1]

@Bill Hartman Could progressive overloading of Jefferson Curls be used to improve pelvis expansion bias and posterior thorax expansion with the right timing of breathing at the bottom of the eccentric due to the upside down position? Theres a common belief among gymnastics and modern mobility trainers where spinal segmentation training allows the body to manage a more distributed load to the gradient of spinal mobility. This is just my attempt at trying to tie your model into how people are able to load massive weight on Jefferson Curls.

[@BillHartmanPT]

@@Randomhams1 There would be little, if any, segmental movement in such circumstances.

[@Randomhams1]

@Bill Hartman Interesting. Thats definitely surprising to hear against the grain of what people tout as the benefits of Jefferson Curls, but I believe your words more as you are a master of your craft.

[@BillHartmanPT]

@@Randomhams1 Decisions are often made emotionally and THEN rationalized.

[@2fastnfurious4u]

Is it possible that this disc yielding strategy occur also in lower cervical spine

[@BillHartmanPT]

It is possible.

[@DaveMillar1]

so with a right sided issue when you show tilted on the oblique axis it appears the sacrum and lower spine rotates towards the left leg. this seems opposite of the left aic pattern where most people with normal organ layout rotate towards their right leg. am i envisioning this correctly?

[@BillHartmanPT]

I have several videos referring to the oblique axis that should help you.