Spinal Flow One (SFOne)

The full Spinal Flow, Spinal Flow Complete (SFC) starts below and has it all, once you know it, it should take a little less than an hour to complete inclusive of meditation in savasana.

However, if time is short and both your posture and spine awareness are good, and you are looking for an intense/fast (20-25 minutes) spine safe workout, Spinal Flow “Metcon” (SFMetcon) is here.

If time is similarly limited, you need more work on posture, balance and coordination, and or your spine doesn’t feel up to an intense workout regardless of how neutral and a little more relaxation sounds good, Spinal Flow “Skill” (SFSkill) is here.

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20 thoughts on “Spinal Flow One (SFOne)”

  1. I absolutely love the single leg half fold (reaching floor) and how it is strengthened my back. I am feeling some pressure behind my standing leg knee. Thoughts?

    • Hi Marisa! There are two potential problems, one more likely than the other. First if you are locking your knee out it could be straining the ligaments/joint capsule in the back of the knee. Keeping a ‘microbend’ of the knee should alleviate this. If that doesn’t work then it could be a Baker’s cyst on the back of the knee, which is a frequent point of escape from an inflamed knee joint, usually due to arthritis. Though I would expect the latter to hurt more with lunges or squats.

    • That depends what you mean by upper and lower. You should feel it on the outside of your upper (proximal thigh, towards the hip) as opposed to you lower (distal, towards the knee) aspect of your leg. However, if you mean your top leg vs bottom leg, if you are doing level-1 you should feel it on your top leg. If you are doing level-2 or 3 the hip abductors on both legs are working hard, the top leg actively and the bottom leg isometrically, so you should feel it on both legs.

  2. I see Spinal Flow Yoga suggests practicing meditation while laying in Shavasana. Other guided meditations I have done recommend sitting. Is one way better than the other?

    • Hello Sara,

      It’s traditional as of late to end a yoga session with savasana. Usually people just lye there for a couple minutes and relax then roll up their mat and head on their day. I genuinely do like the idea of meditation as a mental discipline (more so than an awakening) so I figured I would make use of that time to work on real mindfulness rather than just relax. That’s why I recommend some guided meditations during that time, as an intro to learn how. Once you know how the techniques guided meditations are no longer necessary, but still good reminders. Original yoga going back to Patanjali’s Yoga Sutras from was largely about meditation and not about exercise at all. Yoga asana’s for Patanjali was just a comfortable way to sit while you meditate. Since you have done Spinal Flow, you know I don’t have much problem eliminating anything ‘traditional’ that I don’t like, but I really do like Patanjali, and from more modern yoga I do like savasana. I think savasana the perfect neck ‘stretch’ letting the neck and shoulders to relaxingly fall back from what in daily life are near constant flexed and protracted positions. So I figured, “what better position to meditate from?”

      The very real downside of meditation is savasana is that it’s easy to fall asleep. Sitting upright keeps you alert, is usually something we do too much of in current society. Sitting unsupported for prolonged periods is especially hard on the back. I do think sitting prolonged in padmasana (lotus position) is especially bad for people’s knees and hips over-stretching both the hip joint capsules and knees lateral collateral ligaments. Some people have really lose joints and can assume the position easily and for which it is less of a problem, but I think if you have to stretch to get into padmasana then you are just over-stretching ligaments, increasing your risk for arthritis in the future, and giving yourself ‘reactive’ muscle spasms in the now. That’s why a lot of yoga practitioners (especially female) say their hips feel tight yet they have considerably more hip range of motion than their husbands who don’t stretch at all, and don’t feel tight at all. Those spasms are your body saying chill and hold still.

      Anyway back to tradition, in the classic Hatha Yoga text the Shiva Samhita, Shiva himself, allegedly, says siddhasana is the greatest asana on earth, and though he likes padmasana, it’s not the greatest. Siddhasana isn’t near as hard on the hips or knees and still “looks cool.” Ramana Maharshi says any asana is just as good with sukhasana (just sitting cross legged) being just as good. With any of the sitting positions lack of back support for prolonged periods is a real problem. However, neither bringing your Herman Miller chair or assuming savasana are likely to be much appreciated at a meditation retreat. So I did a lot of looking at meditation chairs and the one I bought to test (and it’s really comfortable, with nearly perfect lumbar support) is the Coleman stadium seat for $12-17. I looked at a LOT of other meditation chairs and most were expensive and/or they appeared to back back support but would not hold the lumbar spine in neutral. Coleman should come out with a new model with a lotus flower or Spinal Flow snake on the back, haha.

  3. As someone with spondylolisthesis I have been searching for a neutral spine workout and was very happy to find this one.I tried level one yesterday and am happy to report I had no pain performing the routine. I do have a theoretical question. As someone who has been very active all my life, I’ve found that most of my injuries resulted from some combination of reduced strength and/or flexibility. If we do all of our training with a neutral spine, how will we improve, or at least maintain our L-S flexibility? Thanks.

    • Hi Daniel,

      I appreciate your feedback and I’m very happy you were able to do Spinal Flow pain free your first try!

      Spinal Flow Yoga is still what I would call a minimally viable product (MVP), I learned that’s a thing. Thus you questions are important for me to make Spinal Flow better and to deliver it in such a way as to be most easily understood. The concept “stop doing that which is bad for your spine, and get/stay the entire body fit in a way that is good for your spine” is relatively simple. However, presenting it it a way easily understood, and more importantly, believed, amongst what is a haystack of haystacks of bad information is the challenge. Particularly when that information has been ingrained in us our entire lives. It’s that bad information that literally IS THE REASON chronic low back pain remains the number one cause of disability worldwide, with neck pain coming in at number four. So I appreciate your great question and will probably make it part of a FAQ. If I don’t answer it well enough, feel free to ask follow up questions.

      The basic idea is that as we age and mistreat our spines we often lose range of motion. People who treat those with low back pain often notice and think “hey this person has low back pain AND this person is stiff,” and conclude, “this person has low back pain BECAUSE this person is stiff. That assumption is the killer, and why acute neck and back pain becomes recurrent pain, and later chronic pain that never gets better. Modern spine biomechanics research clearly indicates that repeated and sustained bending and twisting of the spine, combined with varying amounts of compression, is most frequently what causes the spine to be injured and later degenerate. All the while the body is unconsciously spasming to prevent further injurious motion, and yet everyone says “stretch.” Heck, some doctors will even give you medications to lessen pain and muscle spasms while you stretch.

      Later the body responds with arthritic changes and bone spurs to finally limit motion, and now you have some degree of permanent disability. However, if you catch your body early enough in the pain/degeneration cycle you can let the spine heal, pain should decrease, spasms should decrease, and ROM often increase without doing any spine stretches whatsoever. Normal activities of daily should still provide enough ROM to prevent pathologic muscle and ligament shortening. For example most people will still go through full spine flexion ROM every time they pull on their socks, they get good extension ROM when reaching back to put on a seatbelt, and good spine rotation just rolling over in bed at night. So I don’t think spine ROM is something you need to work on. Rather, working on it is what makes things fail to get better and thus worse in the long run.

      In the case where one has spondylolisthesis (for others, that’s where one vertebra is forward slipping relative to the one below it) that segment is compromised, such that you want to make it, and the muscles around as strong and stable as possible. If the ligaments surrounding that disc tightened up some it might actually be a good thing that would help check further slipping. With increased stability pain should decrease and hopefully be eliminated. As pain decreases ROM will likely increase to some extent, but will probably not return to what it was preinjury. In fact you wouldn’t want it to because that increased ROM would likely further injure your damaged disc, or adjacent discs.

      That said, if your hamstrings are tight you would want to stretch (and strengthen) them, because a lack of hip range of motion (and strength) is something that causes people to underuse their hips and overuse their spines. That’s why Spinal Flow Yoga has such an emphasis on total body strength, and hip/hamstring range of motion, while practicing keeping the spine neutral. That’s tricky because it’s hard to stretch the hamstrings without stretching the spine at the same time, which is one of the reasons most exercise programs for low back pain don’t work very well. It’s also tricky because a lot of people with back pain do have good hamstring flexibility, they just aren’t using it enough during their day, and are thus still overworking the spine. That why Spinal Flow has so much practice building awareness and coordination to bend the hips and not the spine.

      In short I would not worry that your spine will become stiff for failure to stretch it. I’ve yet to meet an able bodied person who I thought didn’t stretch their spines enough during normal activities. In fact, just daily activities tend to overstretch people’s spines, so that I’m hoping the awareness and skill learned in Spinal Flow Yoga is carried on throughout the day so as to better prevent and cure back and neck pain. I hope that helps!

  4. Chad,
    Thanks for your detailed response-it all makes sense and I’m more than willing to give it a try. As you have noted, we have to overcome our own preconceived notions. I ran for 50 years and I am very tight. Once or twice every year I would go down with the stabbing back pain that basically prevented any movement. About 20 years ago I discovered yoga and did some form of it every morning. In that time I never had any back pain. I knew intuitively that the extreme end of ROM stretching I was doing could be harmful, but empirically it was keeping me pain free and active, so I kept on until I developed my spondy. Since then I’ve been swimming and doing mostly plank-type core work, but I can tell I’ve lost a lot flexibility from my yoga days. I’m glad to hear about the focus on hamstring flexibility in your program. As you noted, most of the literature refers to spondylolisthesis as a forward slippage of one vertebral body on another. But for me it makes much more sense to think about this as a backwards slippage of L5 on L4 because the extensors are so much stronger than the flexors.Thus I’ve been trying to focus on stretching my hamstrings in a way that won’t hurt my back, and your program should help me accomplish that. Thanks again for all of your help. Dan

  5. Chad, Here’s some early feedback. I should maybe mention that I’m a retired MD, so may know a bit more anatomy than your average subscriber.
    1. I’ve been doing the series every other day, but you might want to make a suggestion as to what you feel is optimal frequency.
    2. I’ve been able to get through series without pain which is great considering I have spondylolisthesis, spinal stenosis and foraminal stenosis at L4. I did intuit that I could mix and match from levels 1 and 2 to suit my needs, but as you noted, average user may not appreciate that.
    3. Intensity of the workout is good. I’m sweating when I finish and get into a pretty deep meditative state.
    4. I don’t particularly like the poses where you recommend they be held for a certain number of breaths. In a class the instructor can help us slow down our breathing, but on my own it’s too difficult to regulate. Would prefer all poses be based on time, or reps or counts. I know in traditional yoga breathing is critical, but this series is not traditional and I think the average user won’t understand how to do ujjayi breathing anyway.
    5. For some of the combo posses, like outs and ups, it could be clearer as to how many of each pose we are meant to do. Also when I enlarge the level to read the fine print, I have then close that window to go back to overall window to remember how many sets to perform. Would be nice to have on same window with individual exercises.
    6. Yes, one of the benefits of the centering series is that I am trying to apply to daily mechanics. I found that my shoulders are often forward of my hips and this of course placed constant tension on my low back muscles. Rather than walking around with my hand at the small of my back to check for tension, I decided that as long as my wrists are next to my greater trochanters then I’m pretty close to a neutral position. This has helped my back to feel less tired and achey at end of the day. Also your other tips regarding how to maintain a neutral spine with activities like rolling up your mat have been very useful, but users need to understand they have to extrapolate these tips to everything they do.

    • Thanks Dan, I very much appreciate the feedback. I love that you’re a combination MD/Yogi and you’re doing my flow. That’s so cool! My thoughts…

      I think if you are doing the full flow, I’m calling that “Spinal Flow Complete” (SFC) now. I changed a couple the the names because I want my abbreviations to be different, “Spinal Flow Accelerate” vs. “Spinal Flow Aware” were both SFA, so that was no good. So Spinal Flow Accelerate is now Spinal Flow Fit, which meant I had lose the F full Full, yadda yadda I digress.

      But yes for the the complete flow SFC I think every other day is ideal. However, based on some habit research that I want to blog on, talking to others, and just looking at myself and what makes me want to do my own exercises vs skip them, I think there is something to doing it every day. So since SFF and SFA are each half of SFC I think another good way to do it is just alternate between the two every day. Perhaps not a better way but another way that might better fit some peoples schedules. To me makes each workout less of a chore, but by doing it everyday it becomes “what I do” each day. So like flossing your teeth or wearing your seatbelt it will get to where I feel weird if you don’t do it. The habit research says that takes on average 64 days.

      Also I think you should get to the point where the postural/coordination/motor control aspects taught more in the SFA sequence are well ingrained and at such point continued time spent on them is a bit of a waste. In my case I have been doing hip hinges with a neutral spine for decades so it’s just not something I have to work on. On the contrary the fitness aspects of SFF are “use it or lose it. So now I’m experimenting with dividing SFF in half, alternating it each day, and seeing if that’s something I’ll want to write up. So far I really like it. I think level-3 SFF is too intense for daily exercise, but dividing it in half both makes it less overwhelming to think about, and keeps my daily habit going.

      However, I’m also worried about too many divisions making the flow confusing. I want to keep it one set of exercises, that are the best exercises, and that does everything. But I want it to be modular enough to fit efficiently into most lifestyles.

      I’m planning on writing up the various scenarios on page linked from the top left box “how the flow works.” I other words, I 100% agree that needs to go in there, along with how to progress, and I’ll have a lot to say about what’s a good pain, and what’s a bad pain, with regards to moving up. For the most part with neck and back pain, it’s all a “bad pain” that if you feel something other than exertion, then you don’t want to work through it.

      2) Yeah, I need to make that clear that you do want to mix and match. I’m very happy that you’re able to get through the complete flow without pain given what sounds like fairly advanced degeneration. The next level of test is to see over time how much it reduces pain during daily activities. In the long term of Spinal Flow I would like to add tracking of a pain/disability index to each account so you (and I) can see what it’s doing on average over time. For more of a near term pain fix that seems to work especially well with chronic “centrally sensitized pain” I’ve written up what I think is a very complete description of how I use electric muscle stimulation (EMS). It’s not exactly yoga, but I would say combined with my exercise program it (at least) doubles the rate of recovery.

      3) Second only to curing low back pain, that’s what I like to hear. I know my sequence isn’t at all “traditional” but I’m helping it will still achieve all the aims of more traditional yoga. I’m hoping that it will be a bit like “progressive muscle relaxation” but rather than tensing the muscles followed by relaxation you have a total body workout followed by relaxation or even anapanasati where you can really focus on your breath, and not be distracted by your back hurting.

      4) Yeah, that’s been a point of contention for some time. I thought counting breaths would make it feel more like “yoga” than counting seconds. And I have most holds at 5 breaths taken from Ashtanga, but on the inner squeezes especially I think 5 breaths is too long. I was going to reduce that to 3 breaths, but I think you are right about different peoples breaths being different. I think I’ll make the holds 5 seconds in Spinal Flow 1.9, it should be faster than 5 breaths and more consistent like you say.

      Ultimately I REALLY want to make music playlists that keeps the tempo of an ideal rep sequence, and changes to cue when to change the exercise. It would still be ok to go slower but the music would make you want try and keep up. I have a stack of research saying it makes people exercise harder even though it feels easier. I’m hoping that would end the need for counting altogether and if I were teaching a group it would keep everyone in sync and I could focus more on giving individual cues rather than talk through the whole class.

      5) Good idea, I’ll try and do that when I redo the photos for 1.9.

      6) That’s really cool! I still have more to say about carrying the lessons of Spinal Flow throughout your day, so I’m really happy that the implicit lessens in the flow are having that effect. Your cue with the wrists is a brilliant adaptation. Interestingly the centering with the hands on the lumbar spine is an adaptation I took from Stuart McGill (spine biomechanics Ph.D.) and he said by angling forward just slightly caused our spine extensor to “crush your discs” all day. In theory with your spondylolisthesis, centering slightly more upright, perhaps combined with mild uddiyana bandha would lessen shear stress.

      Anyway, thank you again for the great feedback! I’m definitely interested in what you and others have to say. I’m hoping the updates to the site will come more steadily now. So much of the last several months have been spent learning how to do various computer programs so I can more better share the flow, and none of that shows up online. But I think I’m to the point where I can more make the website look and do what I want. It’s definitely a process!

  6. Stumbled across your blog while researching desperately after a 10+ year LBP injury has resurfaced. The first time around I went through so many lame PTs who put me on a heating pad and then a bike and sent me home, before finally finding someone who was doing a program that was almost identical to yours — based on total body training, pain reduction/avoidance, focus on neutral spine, and included (beloved) EMS! Over the past 2 months, the sciatica slowly returned, but I attributed it to just another temporary flare up (has happened and resolved over the years, usually never lasting more than 1-2 weeks, and never getting to pain levels that were intolerable for prolonged times). However, it’s now been 2+ months and at this point I would say I am considerably disabled, and pain reaches 7-8 in the morning, or after walking. My official diagnosis was disc herniation in L3-L4, L4-L5, and L5-S1 (this was in 2007). I have not had more imaging done yet, as I am currently in a holding period for health insurance coverage from my new employer, until later this month. I am hoping to kick start some theraputic practices before then, as at this point I literally cannot walk more than ~10 feet without having to stop and stretch, and cannot sleep thru the night. have even started sleeping sitting up on my couch.

    This is where my question comes in. My herniated discs cause sciatica in my right leg, all of which results in sciatic scoliosis with convex curvature on the right side as well — my upper body is severly tilted to the left of my pelvis, and I cannot correct this due to intensification of sciatic pain in my right leg. In most of the reading I do, sciatica due to disc herniation is worse when sitting, and has a strong flexion/extension preference. For me, the only time my pain is below a 3ish is when I am sitting. While pain is definitely relieved some by flexion (and definitely increased by extension), it is most drastically improved by bending to my left side. Range of motion in right leg is severely reduced — lying down I cannot raise my leg above approx 30*. however, no foot drop. My sciatica at this point has migrated from butt to thigh and down into calf. I have pain in low back and calf, and starting to get tingling in ankle and top of foot. Do you have an opinion on what this means regarding an approach to PT? I cannot truly maintain a neutral spine at this point, due to lack of curvature in my lumbar spine and sciatica when standing, but am attempting it whenever I am sitting. I am just not sure of what is more important — pain avoidance or excessive extension avoidance?

    this morning, I attempted a very very light approach to your LPB program from youtube, including the thigh presses, standing rows, lat pull downs, and modified big 3 core stabilizers from McGill. Pretty much all of these movements caused pain, but not worse pain than standing or walking. I dont feel better, but I am happy to continue if a little bit of pain would be considered OK. I also just paid for the yoga program, hoping it might be a place to start.

    Really, any recommendations you can make at all would be greatly appreciated. Your blog makes me feel hopeful.

    • Hi Julia, I have several comments/rhetorical questions:

      1: You have disc herniations throughout your lumbar spine. I accept that that’s why you have your current pain. But why do you have those herniations? Let me answer that for you. The causes are invariably some combination of this. If you don’t know the causes, no amount of exercises or EMS will help. You’ll just be fitter and have a little less pain in the short term while your spine continues to degenerate at its current rate. So think hard about your bad movements and bad postures, and fix them. Both Spinal Flow and my weights program help teach the right positions and build coordination, and EMS helps with core strength and pain, but if you aren’t disciplined enough to apply the lessons to your everyday life, to include commutes to work, sitting at a desk, sitting in a sofa, exercise, etc., then you’ll be one of those people who wonders why their pain keeps coming back and figures that’s just how it is. The good news is once the discipline becomes habit it’s really not that difficult.

      2: More imaging probably isn’t warranted. It’s probably going to show the same as before, perhaps a little worse, but imaging has almost nothing to do with how you should rehab your spine. The same exercises that are good or bad for a normal spine are generally good or bad for a degenerative spine, it’s just that with the latter all the lessons are that much more important. Insurance companies, rightfully this time, don’t like physicians sending their patients out for MRIs, because statistically they know it doesn’t help outcomes. In fact some research suggests it hurts outcomes because when an MRI shows a herniated disc, which we generally know is there already, it only increases patient anxiety.

      3: After you walk 10 feet, what are you stretching? If you are stretching into spine flexion, extension, or rotation you are probably only making your discs worse. If you are stretching out tight muscles, know that those tight muscles are probably reactive muscle spasms, and they are your body’s attempt to get you to stop stretching your spine.

      4: I would sleep upright in my sofa as little as possible. Or add as much lumbar support as you can handle when doing so, with a goal being to work towards neutral.

      5: Sciatica to the right means probably you have a bulge or herniation of the discs back and to the right. And this disc material is pinching on the nerves going down the leg. The pinch is made worse with extension and side bending to the right as those movements close up the boney space in addition to the disc material being there. However, here’s the catch. Flexion and side bending left offer some short term relief because it increases that boney space, but it’s at the expense of that same movement being what’s bulging/herniating your discs in that exact direction. If you want to herniate your disc back and to the right, bend forward and to the left a few thousand times and it will pop like a jelly donut. If the disc becomes too flat, extension will never feel good because you’ll become bone on bone there and your body will stabilize the joint by growing bone spurs, which can and often do pinch the nerves further. If you let it go this far, it’s not so much about recovery anymore and it becomes more about mitigating further damage.

      6: Good news is even massive herniated discs tend to reabsorb and feel better in a few months time, so you’ll probably start feeling better if you correct your postures as best you can, avoid bending and twisting of the spine during the day, let those spasms do their work, and progress in my exercises as tolerated, but given your pain slower is better and you should not train through increasing pain during exercise or afterwards. If you are still limping it’s a good sign that you still need to wait and rest, and perhaps just gradually work on some of the Spinal Flow Skill/Aware exercises, however if you have gym access the weights stuff I teach is great too. Just start slow, light, with few exercises, and it hurts more you did too much.

      7: PTs unfortunately are not generally taught or taught well enough, what I wrote above. We’re taught Williams flexion exercises from the 1950s, McKenzie Exercises from the 1980s, and spine “stabilization” exercises focusing on the transverse abdominis and multifidus from the 1990s. It all sucks, research has made that clear, but that’s what PTs need to know to pass their board exams.

      8: You’re in a bit of a catch 22 right now, but things should get better. You want to avoid pain, and gradually work yourself back to neutral. Likely you freshly worsened something and much of your pain is due to inflammation. That’s chemical and will just take some weeks to calm down. There isn’t a lot you can do to hurry it up either, but you want to learn to not make it worse. Then when you feel better you want to work hard to stay better. It’s like you just had a car accident and you weren’t wearing your seat belt. Putting it on right now isn’t going to help, but you definitely should always wear your seatbelt (metaphor for good posture, good fitness) going forward, or else, well you know exactly.

      9: I do think you have a lot of room to be optimistic. Know what degenerates your spine, stop doing that, and as you start feeling better start working on overall fitness in a spine-healthy way. By doing so you are giving your body the best chance to heal itself.

      Regarding Spinal Flow, I’m currently editing videos to replace all the still photos, and I have a lot of new ideas to add. Spinal Flow is good as it is, but it’s about to get better and my delivery of it especially so. I hope that helps. Feel free to ask follow up questions. 🙂

      • Chad, so glad to get a response from you! I do indeed have some follow up questions:

        How can I stop doing the things I know degenerate my spine, when they are also the only way I can exist pain-free? For instance, when I said I have to stop to “stretch” while walking, you’re indeed correct that I am not stretching a muscle but rather pulling my spine&disks away and to the left to alleviate pressure on my sciatic nerve. However, if I don’t stop to do that but instead try to continue walking with my spine as straight as possible (i.e. upper body pushed right, back to center), the sciatic pain becomes really intolerable. Does this mean I should limit walking to as far as I can go before the pain is unbearable, but without needing to do deep left side bends ? I’m trying to work out if this all means I should try to set up an arrangement where I don’t need to go into my office every day. The commute definitely requires some walking. At my office I do have access to breakout rooms/private meeting rooms that I could use to stretch throughout the day, but I am unable to sit in a manner that does not involve leaning my spine to either side, or forward, without constant pain. Pretty much I’m asking — do you think a period of relative “bed” (aka sofa) rest with regular breaks to do some spinal flow movements would be a good (necessary?) way to deal with my immediate acute pain ? yesterday & today, not in the office, I change positions every 20ish minutes, and do some folds, squats, and arm-only bird dogs every 2ish hours. That makes me feel better. I can’t pull that off at work. Working from home is not really an option, but maybe I can get my employer to agree if I really think that a week off with this routine would improve my pain.

        I have managed the commute ok by biking as much as possible, but then heard that biking is also bad for my disks b/c it increases compression. However, I’ve found that biking actually alleviates my pain, and I have increased mobility and reduced pain after being on my bike. I am not a competitve cycler, and my back is not flexed while i’m on my bike — i have my seat/handle bars adjusted such that I can easily ride with a neutral spine, and without the pressure of standing, I am able to keep my spine straight (in the left/right plane). What do you think about biking in my current condition ?

        I’ve also heard that I should try swimming as an exercise while other things are more painful. Havent read anything about swimming in your blog, so I’m wondering if you would recommend it ? I definitely do need to find a way to stretch my right hamstring; could the folds be enough, or do you think swimming would be a good addition?

        I am overall a fit & healthy 25 year old. Prior to this injury, I was a regular exerciser. I worked with a trainer who know about my back due to small flare ups that occurred every once in a while, and so was squatting & deadlifting with I believe a pretty decent spine position awareness. However due to life changes, I lost track of my regular work out routine a few months before this injury occurred. By not reinforcing good spine motions at the gym, I’m sure they also slipped away from my day to day life. I also recently got a new mattress, which is very soft & smushy. It was super comfortable before the back symptoms came bakc, but now I am wondering if you think a squishy memory foam mattress may have contributed to the recurrence, coupled with a break from exercising regularly and maintaining regular corrective spine positioning thru those work outs?

        Also, I went to a PT appt on friday and was not encouraged– after an assessment, he did stim + heat on my back for 15, then some manipulation and massage. Then we attempted some stretches that I couldn’t really do b/c i was in too much pain, including the back extensions while lying on stomach and side glides. I walked out feeling worse than when I went in. To me, it does not seem like it will be beneficial for my current pain management. Wondering if you have a reaction that?

        Final question is: given my level of pain & inability to tolerate most exercises (pretty much anything beyond very gentle & modified folds, squats, and arm-only bird dogs), would it maybe be beneficial to add pain controlling meds to my routine to make progress easier? Right now I have a muscle relaxer for the spams resulting from holding my body so crookedly for weeks on end, but you mentioned letting the spams “do their work” — might the muscle relaxers have a negative affect in the end? What is the “work” the spasms are doing? Currently I’ve just been taking pertty high doses of NSAIDs, which helped manage the pain a few weeks ago but don’t do much anymore.

        thanks again!
        – Julia

        • 1) This is your catch-22, and I don’t think I have a very satisfying answer except to say as inflammation decreases and your body reabsorbs the disc material and you should be able to walk straighter. So limiting how much you walk might be prudent. Of course I’m taking your word for you back posture when you walk, which historically isn’t the most reliable method. You might be walking in a flexed posture as well, causing your spine muscles to tense and clamp down on your nerve. You could also try self traction, rather than a stretch, which in theory would increase nerve space but not cause deleterious changes to the disc. Stuart McGill teaches it like so for stenosis, which might or might not help in your case. Worth a try though! Same with an overhead hang.

          2)I love the back support of a properly fitted and adjusted Herman Miller Aeron chair. I’m sure their are other and less expensive options, but the Aeron, I know works (the one with the “lumbar pad” NOT the “Posture Fit”). Usually you can pick them up off craigslist for $250ish. How good is your lumbar support in your car? In my experience most don’t have enough and even when they do it is useless because their seat is reclined so much they have to flex the spine to reach the steering wheel when you drive. An optimally adjusted seat allows you to rest both wrist over the top fo your steering wheel while your head is on the headrest. At first it will probably feel like you are driving a clown car but professional race car drivers have their steering wheel so close to them that they have to bolt in in place after they sit down.

          3) You might be doing too much. It depends what your folds look like, and even squats increase spine compression, which might be too much too soon. Bed rest almost never helps, sofa is worse because you’re usually in prolonged flexion. You might not want to do any exercise for a while, just be active but spine smart, learn to log roll so you’re not twisting your spine too much when getting in and out of bed. You sound like you’re in the “too early for Spinal Flow” camp and unfortunately I haven’t got around to writing/videoing all of that up yet.

          4) With a neutral spine (low seat and high handlebars) biking should be cool. It sounds like it is. Just don’t think it’s a cure and overdo it.

          5) There’s a paper that found swimmers and baseball players have the highest incidence of herniated discs. I suspect it’s the turns, the dolphin kicks and the dives. I wouldn’t recommend it, but I wouldn’t tell you not to if you can keep your spine neutral and it’s not irritating you in anyway. Just because your hamstring feels tense doesn’t mean it needs to be stretched, at least not yet. Once that disc calms down the hamstring will most likely loosen up. Trying to stretch it now will probably be stretching/irritating your sciatic nerve instead.

          6) I wouldn’t blame the mattress, there’s very little research on it, but memory foam is what I like. I get the impression that you are overdoing it. With people who work out a lot, abdominal training is usually the hardest on the back with repeated spine flexion/extension and twisting, next is squatting so deep that the spine flexes. Leg pressing with both legs at the same time, letting the butt curl up from the seat in the low position hits the discs really hard too. Also simple things like setting dumbbells, towells, and water bottle on the ground that then have to be picked up. It’s good news that you are young and otherwise fit, it means you probably have a lot of bad spine habits you just need to clean up, then everything should heal. If you were 50, obese, and had knee and hip arthritis, I wouldn’t call it hopeless, but you would have way more work to do.

          7) I agree with your assessment regarding your therapist. Extension and side glides means he treated you with “Mckenzie method,” you might have read my blog on that already. Lots of people comment it makes them worse, but meta-analysis says it’s as good as “advice to stay active” just more expensive.

          8) I’ve never, ever, had a patient tell me, “boy those muscle relaxers really helped.” Your body is spasming in an attempt to hold your spine in a more stable position. Here’s a blog I wrote on research as to what causes lumbar spasms. Unfortunately, I don’t think anti-inflammatories will help much either. In theory you are working against your body. Inflammation is your body’s attempt to heal itself. Pain is an evolutionary adaptation that keeps you from overworking an injured area. Another blog I did on massive disc herniations found the bigger ones actually healed better, the theory being because of the greater inflammatory response.

          9) I know it sucks, there’s no quick fix, but your prognosis is good, particularly since it seems you are really learning. Maybe take the money you’ll save on PT copays and order a Globus Triathlon direct from Italy off of ebay (the USA models have dumbed down software). Then message me about getting good electrodes and straps for it. That would at least build core strength and you could EMS the weaker leg while you wait for things to feel better. Might help with the pain too, especially if the anti-inflammatories aren’t working so well anymore.

          If you have more questions feel free to ask. I’m going have to write up all this “acute pain” stuff eventually anyway and responding to direct questions I think brings out my best work.

          • Hey, thanks again for the detailed info. I’m just feeling a bit confused about what to do! I have lived the truth of bed/couch rest being detrimental beyond a very early initial acute pain moment. However, I’m struggling to figure out how to stay active when I still can’t walk. I am overall feeling better, but I’m pretty sure that’s just because I’ve pretty much entirely taken walking more than around my office/apartment out of my routine. I bike everywhere, because I am in pretty intense pain after 10 minutes of walking. I still try once a weekish to push myself, and go for a walk, but if I walk too far, or walk when I’m already feeling achy I have increased back and leg pain for days following. My continued inability to walk is troubling to me, and makes me wonder if I am actually getting better at all. I watched some of mcgills videos & tried the self-tractioning, but it also increased my sciatic pain; I think b/c it resulted in some spinal extension which I know causes increased pain.

            I am also worried by the fact that I still cannot hold my body in a more neutral position — correcting for the left lean in my upper body, trying to push my right hip back in and down, causes intense sciatic pain. I’m not sure if I should be trying to correct my posture since it causes pain, but I do know that my current postures are likely aggravating my disc bulges/herniations since in them, my spine is in flexion and bending left, creating more space for my discs to bulge into.

            I am finally at a point where I feel like I can “work out” a few times a week (mostly b/c I am sleeping a little better which means I have energy after work to do something besides immediately collapse into bed/couch) which right now looks like some very carefully executed body-weight dead lifts, overhead pulls, hamstring curls (but standing, with no weight), bridges, and standing rows. So far not feeling better yet, but also not feeling worse. However I plan on keeping it up, does that seem reasonable to you?

            Going to go ahead and order the globus! Should I email about electrodes & straps?

          • Right now there isn’t a whole lot you can do except ride it out. Walking a little bit but stopping when it hurts more isn’t a bad idea, riding your bike seems well tolerated so that’s good. Some gym and Spinal Flow exercises seem okay, but you don’t want to do anything that makes you worse. But mostly you need time, and by time were very likely talking another 4-8 weeks. My educated guess is that you have a disc fragment that is pushed back into your spinal cord or nerve where it exits the cord. This would be highly inflammatory, and would explain the pain in the leg and extension (even to neutral) making it worse. What you are waiting for your body to do is reabsorb this material. The best you can do is try and stay fairly active so that the rest of your body doesn’t atrophy, while you avoid extremes of flexion (as that will make the herniation worse) and apparently any amount of extension as even neutral seems to make you worse. As your disc fragment reabsorbs over the coming weeks you should gradually be able to tolerate a more neutral position. Once neutral feels good you should be able to do more of the Spinal Flow exercises, or more of my weights routine. I would think you would start feeling better at an ever faster rate at that point too because your standing and sitting postures would be more neutral also. So yes, you want to correct your posture over time, but only as much as your body is letting you. That position which is least painful, but is still closest to neutral is probably the best you can do.

            I would abort the self traction if, like you say, it doesn’t help. It sounds like you have a good understanding of what’s going on, you just have to be patient while your body does the rest, which unfortunately isn’t as fast as any of use would like.

            As for electrodes and straps, I took my store down from AbsolutePT.com while I work on Spinal Flow, but I have them and can ship them for $120 total, anywhere in the USA. Just paypal that amount with your address to SpinalFlowYoga@gmail.com.

  7. Hello,
    I got large rubber carbon electrodes for my Genesy 300 Pro and together with the programs you recommend they make such a big difference! The only thing I ‘m having trouble finding is good elastic velcro straps. Do you have any suggestions? Also, what regiment would you advise (electrode placement, program, frequency, etc.) for lifting and toning weak, saggy, square-shaped glutes? Any guidance and tips would be greatly appreciated. Thank you so much for your time.

    • Hi,

      Yeah straps are an issue. You can find elastic/velcro straps on ebay but they aren’t very good. I had to have my own custom made and bought imported in bulk from China. When I’m done developing putting all the Spinal Flows online in a format I like and finished with my educational material I’ll probably put up a store up for supplies. In the meantime I still have them. My basic straps kit is $70 including shipping anywhere in the USA. If you want to paypal that amount to SpinalFlowYoga@gmail.com I could mail a set out to you. Hip ES #2, #3 and #4 from this page are all good.

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