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Lumbar Disc Herniation & Herniated Disc Recovery: A Patient Success Story With Vincent Hulk

In this episode we’re joined by a special guest as we talk with Vincent Hulk about his back injury and the steps, he took to manage his disc herniation, which was preventing him from taking part in the sporting activities he loves. We discuss the onset of the injury and the initial approach he took to manage the pain before continued discomfort led him to seek out professional help in his native South Africa. We talk around the rehabilitation process and the things that led to him experiencing a further episode of pain which brought him in to see the Smartstrong team!

Lumbar Disc Herniation & Herniated Disc Recovery: A Patient Success Story With Vincent Hulk

Welcome to the Back Pain Solutions Podcast – Lumbar Disc Herniation & Herniated Disc Recovery: A Patient Success Story With Vincent Hulk

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Episode Introduction

Debilitating back pain is difficult to endure yet is suffered by many at some point in their lives. Patients who have suffered a disc herniation often describe experiencing excruciating pain and fear avoidance as they seek to overcome their injury. Whilst the majority of care seeker stop seeking care within 3 months, around 10% will experience chronic, disabling low back pain whilst some experience repeat episodes. The key is to prevent the transition to persistent pain and disability and facilitate a pathway to functional restoration which involves a movement based approach.

In this episode we’re joined by a special guest as we talk with Vincent Hulk about his back injury and the steps, he took to manage his disc herniation, which was preventing him from taking part in the sporting activities he loves. We discuss the onset of the injury and the initial approach he took to manage the pain before continued discomfort led him to seek out professional help in his native South Africa. We talk around the rehabilitation process and the things that led to him experiencing a further episode of pain which brought him in to see the Smartstrong team! Vincent talks about the consistent things he was doing that he thinks brought on another episode of pain, despite him believing them to be safe at the time. He discusses his experience with pain and how important it was for him to have a long-term goal to aim for as part of his recovery plan. Finally, he highlights the commitment required on his behalf in order to support the work of the therapist in order to build resilience to his injury over time and build a strong back. 

Some of the things you’ll discover…

  • Why understanding your boundaries when exercising, and understanding appropriate exercises is so important to injury resistance?
  • How important it is to understand your limitations and not return to sport until fully healed.
  • Why accumulative trauma is the likely culprit of your injury, not one specific event.
  • The important role the glutes played in the rehabilitation process for disc injury
  • How important it is to make healthy lifestyle choices to avoid injury repetition
  • Just how long it can take to fully recover from a lumbar disc herniation
  • Why a collaborative approach is required to ensure effective recovery from injury

Episode Highlights

Full recovery from disc herniation can take up to 10 years!! With that in mind, and the high incidence of recurrence rates, its fundamentally important to adhere to long term lifestyle changes to support the recovery from back injury. Daily movements, no matter how small, can have a negative cumulative effect which can prevent full recovery. It really is about committing to a long-term exercise program to engrain healthy movement patterns, and build core endurance, if the back is to function optimally and you’re to return to sporting activities if that’s your ambition. There are no shortcuts, and it takes a collaborative approach with the therapist to be successful. You can’t expect someone to do all the work for you and for the injury to go away.

Episode Transcription

Unknown Speaker 0:00
When we’re young, we move with freedom and confidence with a great resilience to injury. But somewhere along the line we develop poor habits and become more vulnerable to back pain, back pain solutions features evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better back health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back the smart way.

Ben James 0:28
Okay, welcome back to the back pain solutions podcast Everybody with me, Ben James, and my co host, as always, Jacob, stay in afternoon, Jacob.

Jacob Steyn 0:35
Hey, Ben.

Ben James 0:36
So today, guys, we’ve got a special guest on the show for you. We’re talking around a case study someone that saw Jacob over in Holland and sought his advice for his back health as well as a previous knee injury as well. And we thought it’d be really useful and insightful to share his story, his background, his frustrations, his successes, and some of the things maybe to think about for all those people listening in this afternoon. So, Vincent Hall, welcome to the show. Thanks for being on.

Vincent 1:07
Thanks for having me, Ben, and Jacob. I really appreciate it. And I’m excited to share my background and my path through this rehabilitation process.

Ben James 1:17
That’s great. And I think it’s really beneficial that we bring some of these stories to life because Jacob and I talk a lot about content, information and what people should do helpful tips advice, but really, it’s it’s great to be able to share their story. And like I say, bring that to life for the people listening. So it’s great to have you on the show. And just a little bit of a brief background, I guess, for for people listening. Who is who is Vincent, where you’re from? And what’s your kind of daily job activities and things because it it does provide a bit of insight for those people listening to relate to I guess.

Vincent 1:51
Yeah, so yeah, I’m Vincent. I’m from originally from South Africa. I grew up the study day up until I was about 26. And yeah, then I got a job opportunity to come to Netherlands in it to work for a startup code examples where we do medical device implants. for cardiovascular purposes, the cardiovascular field, so yeah, I’m a biomedical engineer, working for a startup. Yeah. And yeah, that’s a that’s about that. That’s my background. That’s why I come from. Yeah.

Ben James 2:28
So from being from South Africa, Jacob likes to share how sporty and great he was on the on the field when he’s back in the back in South Africa. Was it similar background for you similar upbringing with sporting activity, sport and endeavours? And is it fair to say?

Vincent 2:45
Oh, yeah, I think I would, I mean, I don’t know the exact but exact sports and the what he did, but I know he also played some rugby in his time. Same for males have a rugby background as well as some track. So yeah, basically, as luck, I could remember, from probably the age of, I would say 10, nine or 10. Literally every single Monday, Tuesday, Wednesday, Thursday, you have either a rugby game, or some athletics meeting or some kind of sporting event, I would say five out of the seven days of the week.

Ben James 3:25
Yeah. Nice. And do you remember, I guess having any, any injuries back then in terms of, you know, when you were younger? Did you remember kind of training approach in terms of, you know, in comparison to some of the things that Jacobs shared and advised along the journey, just interested in Tim’s background? Because it seems to be, particularly when we’re looking at gym trade and things it seems to be a lot of false information or not necessarily false, but not, not information shared about effectively training, core strength and those kind of things. And maybe that’s an issue in terms of resilience and preventative medicine injuries. How was it for you? Did you did you suffer from any injuries when you were younger? Or are you pretty good at all coming over to home?

Vincent 4:10
Pretty much injury free up until the age of 15 when I got my first shoulder injury in rugby practice what so my ACL ligament luckily didn’t need surgery. And then after that, almost every year some kind of shoulder injury as any rugby player would know. I was also a flanker so that made it even more prone. But yeah, I mean, except for I mean, I would like to call it what the people in the fitness industry would go bro science, like classic biceps, triceps and chest workouts every single day in high school. I was never really big into Germany in school, because the athletics kept me busy. So but I will As a result of that, as well, I never really got a proper platform for strength training. Whereas most of the stuff we did was cardiovascular based stuff. When a train on the track for 400 meter or when we jumped into the rugby season, you started immediately with, you know, big aids, big tackles, when never really had a proper, like I say platform. Same story up until I was in grade 12, which was my final year of school, then we actually got a bar connected system that helped us a bit with some proper gym training and gave us proper exercises to do. That was actually quite a good year for me, I did not have one single injury through my whole career of rugby. And yeah, after that, it actually went well, until I would say I was about 20-21. went to university at night at 19. When I was about 20. In my in my second year, I got my first I would say proper injury, which is a disc herniation. And literally just be due to me not knowing what to do and not really know my boundaries were that the Ab extender the Ab roll out, try to come up. Heard something pop. I was like, Ooh, that’s interesting. Let’s leave it here. And yeah, the next year, I did not play any rugby or any sport because I was out.

Ben James 6:38
So it took you out for a long time.

Vincent 6:41
Yeah, yeah. I mean, I think it’s also one of those things prior to through my sporting career in quotation marks, I won’t say to career, but time is too specific. What would you say? philosophies is, if I ever get a neck, neck or back injury, I do not carry on with that sport until I’m fully healed, or fully recovered. that those were the two injuries I just felt was not not something you play with not something you try to bypass. Because the effects can be much more longer lasting than you think.

Ben James 7:28
That’s a great take home message for people listening straight away. As you know, there’s a there’s an element of being resilient and wanting to work into some discomfort from a rehabilitative point of view. But like you say, you’ve got to be sensible. And Jacob I’m sure you’re about to reiterate that message.

Jacob Steyn 7:46
Yeah, well, I want to say you can almost call it a sporting career in South Africa. I like to agree with Vincent day because we we do so much sport. And also I was horrible on the track. I just did it for for the rugby. But between doing swimming, playing tennis, cricket, rugby, athletics. You know, I think we do so much sport, it’s just unbelievable. And I think it’s very good. For us growing up there. It’s a big privilege to have the opportunity to be outside so much and you know, going to a very basic school, primary school but having all these sporting facilities and but I want to say that I had a very similar event to humans and I was at the Anglo European College of Chiropractic in England where I studied and I, I, I was, you know, like always I feel very strongly and I, I trained with Ben like a lot of mornings, but I think it was just before I just started training with Ben I can’t remember or towards the end of my, my college time there but I I started doing cross jobs, which is pulling the cable across from high up, down over your waistline to the bottom. And I was doing it with a massive twist movement, my shoulders on my hips. So I didn’t I didn’t learn to move from my hip. I didn’t fix my torso. I I yanked it through my spine. And so I was delaminating my vertebrae or at least my my discs in between my vertebrae and my low back and so I was the I was my worst enemy back then I literally destroyed my back. And I think that’s where my own back trouble started, which led to a hernia a few years later.

Ben James 9:35
Yeah, I mean, it’s that classic combination of the flexion and the rotation at the same time, which you know, for add a posterior lateral disc herniation is, is a classic kind of pattern. Certainly in terms of repeated exercises, it sounds a bit like you are very sporty, like a lot of us are when we’re younger, we’re pretty resilient, but you did something, some form of exercise that really was as we call it. This the The straw that broke the camel’s back, it probably wasn’t that alone. Of course, the issue, but certainly that moment in time was when you notice the problem. And before then, had you been doing a lot of kind of setup type exercises, and you’ve been doing that kind of what we call flexion based kind of movements. Do you remember?

Vincent 10:16
I mean, I can’t specifically remember, but knowing I was 20. And the ego being quite high, I would assume you want that perfect sculpted figure. So I think most probably, but one thing I can remember from that time in that specific training block, I did a lot of straight leg deadlift. Okay. For the hamstrings, and, as well, yeah. And I remember that specific day, I think that was my third training session for the day. And that was my last one as well. And when it happened, I immediately knew Yeah, you just overexerted yourself completely. And also, a big problem as well is when you university I didn’t out at that moment, I was not a professional athlete at all, not even close to it. I studied engineering, I was a professional student. So in that sense, doing three sessions a day is already not the best because I don’t have the proper diet plan a professional athlete has I don’t have the proper platform or the proper coach or anything like that. I just go the way I feel. Right. And yeah, like you said, I think that’s the straw that broke the camel’s back.

Jacob Steyn 11:29
Yeah, exactly that I want to mention there that you’ve been working on that injury for a few months. Beforehand, already. So you’ve been building up to that moment where it popped. And it was just yeah. Especially with a disc, this type of injury, you know, so most likely, you’ve been making some movements that were not favourable to, to your back and actually not favourable to real core strength or stability, as we call it. Yeah, that’s exactly what happened to me as well. And it was a massive eye opening experience for me, which led me to be able to, to help guys like you, obviously, yeah. Learning more about it.

Ben James 12:10
Back to the kind of mechanism of injury as well, if you study in a lot, then generally, inevitably, for a lot of people involves a lot of sitting down. So if you’ve already got a bit of a disc injury going on, and you’re sitting down a lot, and you flex in the back a lot that’s continuing this kind of as we call it, picking the scab, aggravating that issue causing that issue to progress, and then bang, you do this exercise, and suddenly it goes and often it’s the case, people just assume that that one incident has caused the problem where inevitably it hasn’t. So it’s a it’s a pretty common I would guess, story for a lot of people listening that have suffered a similar issue. They’ve done something probably that they feel caused the issue. But it’s it’s it’s asking the questions and making sure you see someone that really digs into the history to find out what you were doing before that as well. So what did you do at that point Vincent? And what was? What was the kind of approach for you? Did you did you hope it would just go away? You were studying at the time, presumably, you didn’t have much disposable income to get some help? Maybe I don’t know, what was the what was the approach you took to? To repair?

Vincent 13:12
Yeah, you repair. Yeah, so the initial approach was, while I firstly went to see the doctors and general practitioners, eventually I went to the orthopeadic surgeon, got an MRI and confirmed that I do have a desk herniation. And the doctor recommended that I go to see a bar connected system. I’m not certain if you’re familiar with it about kinecatist it’s a very much a South Africans. But at that moment, our family, we we went really big on rehabilitation. I don’t know it’s just one of those things we we never really investigated. It’s not one of the things we grew up with. So we were gonna throw you, right. I went about three months for this up until the point where I had to, if I had to, yeah, if I had to like put on my clothes, anything it said I couldn’t do any bending movement at all it was it was so painful. Why when she went to my parents and said, Listen, you said Dr. Dad recommend this book. And he says, I don’t want to be like this My whole life. Let’s go and see that. Went to him. And he started helping me out. And it’s about took about a year until I could fully go back to normal routine. Go to the gym, play rugby again. And actually after that I’ve never had any problems with my back at all up until the beginning of this year. So that’s about what five or six years of no pain and that’s including in between another two or three years of full on rugby. Straight through the year.

Ben James 14:58
So it’s a bit of background. Do you remember what what he recommended you do was there? Was there manual treatment? Or what sort of advice do you get human?

Vincent 15:06
Yeah. So I could just remember his training philosophy as well was very much good based on most of the exercises was focused on getting my glutes correct. Well, nice and fine and strong. I can’t really remember how much of core how much he talked about core stuff. I do remember, this was some stuff in it. But like I said, that’s already five or six years ago, but most of it was glute activation type of things getting that real strong. And yeah.

Jacob Steyn 15:40
Was there any talk about avoiding pain triggers, you know, education on movement? Or how you?

Vincent 15:47
Um, I can’t actually say specifically, I remember there was one point yeah, at the end, I would say my last rehab rehabilitation block. He did mention that, yeah, there were certain movements that caused this. But I have to slowly and systematically go back into that movement. So that my body can get used to that again. And for me, it was that rollout. And one of the progression steps was to do a type of rollout similar to that pot stirrers.

Jacob Steyn 16:21
Yeah.

Vincent 16:22
You just roll forward.

Jacob Steyn 16:25
On the ball, or with ab wheel?

Vincent 16:28
No, on the ball? No, no, no, no. He said, I should stay away from the Ab wheel, which I have, I’ve never touched the ab wheel again.

Ben James 16:38
You’ve got some, some, from what you shared there some pretty good advice in terms of your ads are what a lot, you know, a lot of the stories that you hear that kind of glute activation and setting that stable, strong platform is, is really, really important. They’re the kind of stir the pot type exercise, you suggest is a very great, good way of training the anterior abdominal wall in neutral spine in a neutral posture would you recommend, but you say it took a good year to to really feel the benefit of that approach? Do you think that was because you’d left it for a period of time before getting that input? Do you think?

Vincent 17:20
Um, I have to be honest, I would say about six to seven months in ours actually good enough to go back to normal sports, but I think the year board was very much a mental part as well. I think that was the extra five months to add to that year, or four months to add to that to that year cycle arm, because there was always this kind of thing nagging at the back of my head, oh, man, if I’m going to do some kind of movement, attack a guy like this, if I get up like this, that the thing is going to trigger again. And it actually did happen. You know, there were certain movements were the next day I could feel my back’s painful, sore again. But it was actually more of a mental thing than actual pain. So that was where the four or five extra months came in. It’s more to get mentally over the fact that, you know, I did do my rehab, correct? I am, I’m fit enough to do all these things at the base I did before. I just need to believe that I’m I’m fighting.

Jacob Steyn 18:26
That’s a big deal. The they call it fear avoidance behaviour. And I know exactly what you’re referring to with my own experience, you know, coming back from my hernia also took about a year. And you just you you know, you want to have certainty and you want to know that you’re ready to go back and you get these little twitches in your back and you’re like, Oh, what’s that man is like because I’m I better have my back there. And you have to mentally get over that. And you know, I don’t think within a year, even two, three years, you’re ever back to what it was like before, because McGill does the research that we follow about the back. He says to recover fully from a hernia. Maybe I’ve mentioned mentioned this to you during the treatments. Vincent is the you need 10 years to fully recover. What he refers to there is for the disc to actually fully stiffen again, to become very durable and be able to cope with forces that go through it takes up to 10 years, you know, so one year is a short time. But then I think if you do the if the rehab is good, and you you know, you train the neural input to absorb certain forces, if you go back directly and anything like that. You can do it. Absolutely.

Ben James 19:47
Yeah. And I think that’s why it’s so important. And we need to reiterate this message so often. It’s the daily hygiene is the daily routine. It’s the daily things that that we’re doing each day that allow that recovery to occur because Inevitably, the lives that we lead, are often the problem because we were not designed to do what we do whether sitting at a desk all day or doing those repetitive motions. And so it’d be interesting to kind of get your input now in terms of how this this back pain started again at the beginning of the year, do you feel that you kind of drifted out of this that reset rehab mindset or that approach? What was there anything that that was a triggering factor at the beginning of this year? Can you remember? Do you feel you might have got a bit complacent with it? Do you think?

Vincent 20:33
Oh, Ben, yeah, that’s a really interesting question. To be honest, and I’m still kind of baffled about that, because as a Jacob also mentioned earlier in this session, is that I actually went to him for a knee injury. So quite a messed up knee. And it’s been about three or four years that I’m trying to rehab it and fix it up. So all of my rehab up until now was very much glute based erm rehabilitation base, which I would think kind of transfers into getting your core nice and strong. But so that was while I was quite baffled getting this disc herniation pain again, I think what might have triggered is at that point, I was in between a training block that I was kind of upper body trading now that I wasn’t sure what to do. So I did a lot of battle ropes, a lot of stuff, we do a lot of extension of the back. And very much in a hinge position, which I think might have triggered that. Yeah, just that desk to give some more trouble again.

Ben James 21:49
Yeah.

Jacob Steyn 21:51
You didn’t? You didn’t do any any deadlifts or any good mornings, again, the beginning of the year?

Vincent 21:57
Um, no, no, not. Not that I remember of that. Well, deadlifts are currently just to my knee.

Jacob Steyn 22:07
And different environment, maybe in the Netherlands. Do you think that might have been a contribution to the pain coming back?

Vincent 22:16
Environmental stuff?

Jacob Steyn 22:16
So cycling, or…

Vincent 22:19
Yeah, I mean, there’s so many different things. Like a, like I said, I don’t know, I think what might be is Yaga, we also talked a lot about this, I used to have this racing bike, this old school racing bike, I thought I look really cool on it. Let’s get a hipster type of bike that I can go to work with. And also in the Netherlands, you cycle everywhere, literally everywhere, everywhere. So I was on that bike, that was my main mode of transport. And I think being in that very much extended an odd position, hinged the whole time over in front might have just like slowly contributing each day, you know, not, not one specific thing that happened, but just like 14141.

Ben James 23:12
And its interesting that you talk about the bike because I had a patient recently. And he’s a key mountain bike. And he was talking about how particularly going going up the slope is, is a bit of an aggravating factor. And when you look at the postures, and you really dig deep into that, you are far more arched over going up and then on your way down, you’re you’re kind of a bit straighter in the back and, and kind of almost squatting off the back of the saddle. And and until we really dug into the the kind of background to what he does. He just didn’t see that as a as an issue as he’s doing. sighs so we think what I’m doing that posture could undoubtedly have been been a contributing factor, particularly if you’re, if you’re doing that go into work in the morning, particularly you get on the bike early in the morning and not giving yourself that kind of warm up. First 30 minutes of the day having a bit of a walk before jumping on the bike, maybe then go into work and sit in a lot at work. Maybe work was busier as well. So there are so many factors that it’s it’s sometimes difficult to pinpoint, but no doubt there was something there that was a contributing factor and the bike sounds as though it could have been one of them. So did you did you feel that it was a real kind of sharp acute pain again, was it was it like you are back to to square one what was the experience at that point, given all this work and effort you’d put into getting stronger again?

Vincent 24:33
Yeah, so I was very much in denial about this. Also, it wasn’t the pain that I was used to it was a very much a started very mild. I could go on and then just started to increase or increase more during the day. Up until that one night. That not I couldn’t even walk down my stairs. Which was like whoa, this is scary. Having had this in a really long time went to the physio and they actually thought it was just my QL being quite stiff. And they just did try to loosen that up a bit. And I was playing with him as well because I was in denial and it’s not my back. And also the week after that, I would have gone on my while I did go on my first ever ski trip. So even more than oil. I don’t want my back to keep me from going on a ski trip, you know. So playing with that, and them saying, Oh, no, my QL is just a bit stuff. And yeah, I was like, yeah, yeah, definitely. Yeah, completely, not about my disc herniation I had five years ago.

Jacob Steyn 25:44
Yeah, we, we get that a lot. You know, I get patients and they go. You know, I’ve just got a few stiff muscles in my back. And I’m like, right, you know, I kind of hear that with one year and the other year, I’m just kind of keeping closed, because why would the qL stiffen up? You know, for no reason. And we talked a lot about this, myself and Ben, when said, like, you know, the QL is such a big important muscle next to the spine. That guy doesn’t just cramp up, there’s a reason why it cramps up. You know, it’s like, I don’t know who said that a while ago, but the muscles are just simple slaves of the brain, the brain tells it what it should do, so the brain knows what’s going on down there. And it tells the muscles to either be nice, supple and relaxed, or to be stiffen up. So if the QL stiffens up, you got to know. Okay, something’s up, most likely with a spine.

Vincent 26:38
Yeah, no, exactly. I fully agree with you there. But just again, being in that denial, pine side, or at that moment, I kind of felt, yeah, this is my disc again. But like I said, we going on the on the ski weekend or the ski week, the next week. The QL seem to be a better diagnosis at that moment.

Ben James 27:10
So you went up in trip and and how was it on a skiing trip? And what what ultimately took you into, into Jacob’s treatment room.

Vincent 27:18
So the skiing trip was actually quite fine. As soon as I warmed up and everything everyone was fine. The last, I would say the second to last day, my back was acting up quite a bit. So I just stayed at home for the morning that a couple of rollouts, and did some mobilization exercises. And yeah, as soon as my back was warm again, everything seemed to be fine. But, yeah, that actually went fine. The reason I actually got to your cup is a mutual friend of ours. Like I said, I’ve actually been struggling with my knee for quite a while. Recommended Jacob and said yeah listen to this Jacob guys lives in Nijmegan it’s quite a distance for me. But uh, you guys seems like you have very similar interests and the way you train and stuff and yeah, maybe can help you. And at that point, also, I’ve never been to a chiropractor at all. So I was like, you know, I’m not going to say no to any to someone that might be able to help me. And when I went to him, I initially booked for my knee. But the day that I went to him, actually said, listen here, my back started up again. So we kind of tried to do that in tandem. And yeah, that was a bit more than six months ago. Now. I think February was our first contact session.

Jacob Steyn 28:50
Just just before the covid.

Vincent 28:52
Yeah, yeah.

Ben James 28:53
Okay. Jacob. Difficult question for you. for you here. What was his what was his core strength Really? Like?

Jacob Steyn 29:02
I would I won’t mention his glut strength that he’s bragging about but er…

Vincent 29:09
I’m not bragging at all here!

Jacob Steyn 29:10
I’m just joking. I’m just joking. No. Now I didn’t specifically test this corner beginning I was more concerned with he supposed to chain and making sure that we get everything from his feet up to his knee hip working properly you know, I just more or less assumed as I could see a young healthy South African in front of me that score would have been Alright, so I didn’t go in on that too much in the beginning it was more testing blood need and making sure popliteus and the knee works properly and and eventually we got on to doing some footwork so we can fix his arch and you know giving giving giving the knee or what looks like a you know, like something with a patella and maybe something anterior and joint line to be about. problem to give that the best possible possible healing opportunity. But then gradually we moved on to, to ease back with the treatments. And you know, and in the beginning it was it wasn’t that bad. But I have high standards and events and as a healthy guy, so. So he had to work a little bit and gradually got better with his core. And I, you know, I mean, his body took it, he could see he made it his own quite quickly.

Ben James 30:32
And what were the movement patterns like them? Were there? Were there things there that you thought? Yeah, that’s a potential trigger from from your side, as a clinician, and then Vincent, from your side, after as a patient? How was that experience for you compared to what you had before? And how it helped, I guess. So Jacob, first of all, I guess, or background in terms of Yeah, what could have been the aggravating factors that were stopping that, that recovering at that point.

Jacob Steyn 31:00
So a little bit of lower cross syndrome, you know, flaring of the ribs delves a little bit tilted forward, typically, with very strong lower back muscles, so he has a strong middle drive to the low back, which means it gives a lot of work to the, to the erectors, you know, wanting to load up the back with these, with these back muscles, and maybe could have done a little bit more with the anterior abdominal wall. And then what was significant was the the glute needs, they were a little bit on holiday. And, you know, I like to explain it like that, usually, they’re not just temporarily gone, they’re coming back. And, you know, so once we fixed that, and a lot of cool work, actually. So a lot of side plank, building up to the sideline, hip thrust and making that dynamic, and eventually going into what Vincent is doing now. But stir the pot and side plank roll, you know, all with a lot of control.

Ben James 32:04
So it’s, it’s interesting just to jump in there, when you when you talk about the QL. Because a lot of people therapists practitioners would, would potentially jump on that QL and start to really focus on massage in that deep tissue massage. Whereas for you, the focus was very much on there, the kind of endurance and let’s get that muscle working effectively, again,

Jacob Steyn 32:27
Yeah, let’s let’s look at an exercise that’s going to ask that muscle to work. You know, that’s how I look at it.

Ben James 32:35
And was there much in the way of passive treatment at this time in terms of manipulation and any soft tissue work? Or was it very much based on movement exercise, given the background and given given the specific presentation at that point?

Jacob Steyn 32:49
Definitely some stiffness in the low back, which I adjusted, you know, and just into extension, so not wanting to trigger any flexion movement in his lower back. And that went quite well. Vincent might tell you different, but I hope you will agree. And, but I think the main, the main part of the treatment was especially the, you know, building the stabilization, removing the pain triggers. And once he mentioned to me that modern racebike appears we had to remove, we had to remove that factor. You know, I don’t have to see him on it. I can imagine I already feel the pain. When I when i just imagine it.

Ben James 33:38
Yeah, yeah. And Vincent, have you is it quite a? Was it what you were expecting? You said you hadn’t seen a chiropractor before. But some people imagine that it’s very much that kind of manipulation, passive treatment, and off you go, and then you come back until the pain disappears. Not always and sweeping generalization, but not always. Any advice on exercise? And certainly not an approach that Jacobs just described in terms of that real core strength and movement based approach to rehab. How did you find it? What was the experience for you?

Vincent 34:12
Well, Ben, firstly, that is exactly the reason why I still go to your club, even though it takes about three to four hours out of my day, to get to name mega, have this session and come back for exactly the type of treatment that I got. There wasn’t at all what I expected of this idea of a chiropractor, you go in, you know, crack some bones, go out five to 10 minutes. That’s it. And our first session was, if it was not an hour, it was maybe a bit more than an hour. And our first two sessions he didn’t manipulate my spine in any way at all. It was literally all just okay, the second session doesn’t count because it was online. That was in the middle of this COVID situation. those first two sessions, it was purely just movement based exercises and identifying pain triggers. And I think that just put me in a whole different mindset of, you know, this is the guy that I want to work with. I like the way he’s thinking and the same thinking as well. And yeah, actually, our last session was second last session was the first time ever he manipulated my spine. And that also they did work. But exactly like you said, it completely was the opposite of what I thought is going to happen.Yeah.

Ben James 35:40
And was it a surprise for you to, I guess, get the input about those daily habits and those simple movement patterns? Did you kind of stop, stop and think you know what, this makes so much sense, and I’ve never really thought about it before. But, but actually, these are the small things that so many people do everyday that can cause a problem that with a lack of education, and the lack of input from the practitioner or the therapist that they see, you know, can be overlooked and a real problem.

Vincent 36:11
Um, I would say I knew it to a degree, I think you Jacob just reiterated again and just made me aware of how important that actually is. Just do that like Jacob, what you said that my glut meds were on holiday? You were you 100% right because I just came back from a three week holiday in South Africa, so so they went on holiday. Erm but that..

Jacob Steyn 36:36
Do you reckon they stay behind?

Unknown Speaker 36:38
Oh, well. I hope they come back soon! No, but exactly do that. And that was a scary thing for me, especially me doing specific knee rehab for for three years, four years, either. I wasn’t, once I was arrogant, but I was quite confident in my glute meet. Because I know any knee based exercises, starts with your glute meet and coming to him and basically, realizing that it’s non existent was quite an eye opener for me. And that just reminded me that I should just reassess how I do my rehab again.

Ben James 37:16
Yeah. So Jacob, what sort of glute Meade exercises Did you focus on Did you scale it right back and do very simple clamshells to kind of get those muscles firing again? Or did you kind of take a different baseline given the rehab, given the age given the sporting background and say, right, we need to challenge more from the often I’m confident enough to do so?

Jacob Steyn 37:34
No, absolutely. back to square one. And, you know, I mean, I, whenever I have a few sports, literally high level sporters here in Nijmegan have come to see me, it’s also recommended to come and see me and, you know, I test them. And if I see that it’s not up to par, then I scale it right back, you know, because it’s not about I don’t want to see how strong they can be within a couple of weeks, I want to really strengthen the communication between the brain and those muscles. So we start with clam shells, you know, basic loop clam shells. And then you build it up, slowly monster walk, you know, hip airplane, once we fixed the feet, as we did with Vincent. And eventually it thrusters those sort of things.

Ben James 38:25
And how how’s it at this point in time? Do you feel? Do you feel you’ve kind of that that resilience to it happening again? Do you feel in a good place with your with your core strength at the moment? How’s it feel now?

Vincent 38:37
Yeah, I mean, I my pain is 100% away yet, but from the day I started with yoga till about now I have about 90 to 95% recovered, if you can use the word recovered in that sense, where most of the time um, where usually it would have been eight or nine out of 10. The most been I would feel in the last one or two months was probably a four or five out of 10. And that is the especially when, depending at work, if I if we have a session where for that week, we had a lot of documentation to complete, then, for instance, last we got a bit of pain, but the week before that, we had some a lot of documentation to complete. So this week, it’s a it’s almost back to the two or one or two out of 10 pain rating I would give it so yeah, but just just on that just to give some more. two cents on that what you’d say resilience, at this moment, have a bit of this philosophy, I would say call that compound interest. So I know that’s a very much a financial term. But I believe that this compound interest one day of rehab is not going to fix my back, but skipping one day rehab is also not going to, like, keep me from fixing my back. But if I skip one day of rehab, once a week, do that for four or five months, that’s going to end up to, you know, a couple of weeks of sessions you missed out. And that’s where that compound interest comes in. With that one session might not be significant. But if you escalate that to six months where I’m on now, that is going to make a big difference. And I truly believe that’s one of the things I would have done right, if I can give myself to myself that that fame is a firmly believed in, you know, yes, I have to do this, even if it’s just half the work out, I have to do at least these three big sessions a week and smaller sessions in between that one session skipping, it might be fine, but I sure as hell need to do that session next week there and make up for that.

Ben James 40:57
Yeah, and I think that’s a, that’s a hugely valuable take home lesson for everybody listening, that suffering from back injury, you know, the, the biggest frustration I’ve ever had in practices, when people have said, I just don’t have time to do the exercises, make time to do the exercises, you know, important that you do them as part of a recovery to a low back injury, particularly an injury of this type. And, Jake, when I talk a lot about lifestyle choices, and building this into your lifestyle, life style forever, because only then like you say, you’re going to get that compound kind of growth, that strength, that resilience, that you can be confident that this isn’t going to come back. And not only that, you kind of cement a lot of these movement patterns and, and, and things into the subconscious. And then they’re, then you’re doing it without thinking. And that is where you really build the resilience in there.

Jacob Steyn 41:46
And I, I want to agree with you that Ben, and I think you’ll quite often have the idea in my head that if somebody doesn’t have the time to do their exercises, they don’t have the time to get better.

Ben James 41:57
Right. Exactly.

Jacob Steyn 41:59
And, you know, that sounds very harsh, but I’ve had patients where I feel very discreetly and very nicely put told them in a second appointment, that if we don’t, if we don’t go ahead with the exercises, and they don’t do them, then I don’t think there’s any value for them and their situation, depending on the patient to continue with me because I can’t guarantee them any. Any success. Yeah, exactly. And it’s, it’s very interesting to see their faces quite often I have I don’t have this very often, but then they look at be very surprised. And maybe I maybe maybe they’re confused by my approach. But I think it’s you know, we have to be a little bit harsh, we have to be honest with ourselves, what do you want out of it? And if you’re happy with, you know, unpredictable pain, then I think you you’re kind of doing your exercises.

Ben James 42:55
Yeah. And I think it’s about collaboration.

Vincent 42:59
Yeah, I fully agree with that, and actually thought about it a lot. And, for me, it’s also having an end goal in mind, my end goal is I want to be able to run again, I don’t know when that’s going to happen. But I would like to be able to run if it’s in, if it’s next year, this time. Or if it’s going to be in five years, my end goal is going to be I want to run some time again, without any pain. And I thought about it a lot. And just thinking like, your desire not to have back pain should be higher than your desire to sleep in, or your desire to not go to gym. And this is this is maybe going to be a bit harsh, but as long as your desires do have an hour of extra sleep, then they too have chronic pain for the rest of your life, then, you know, that’s going to be a bit harsh of me, but you know, then you should kind of live with it, then and not complain about it. Because I think that one hour of sleep that you’re gonna miss. I’m not saying you should sleep five hours a night, but you can surely get some time somewhere else and do that rehab, that’s going to be far more beneficial for your for your back pain, then yeah, you not doing it.

Ben James 44:15
Yeah, I think that’s a another hugely valuable and relevant point there and a great way to start wrapping up the show, I guess. You know, Vincent from from your point of view, there’s some some great insights there into how this injury occurred, what you’ve done to to recover what you’re still doing and the the insights and the expertise you’ve had from from Jacob, is there anything else that you would share with the listeners as part of your story, other than what you’ve talked about today?

Vincent 44:44
Ah, yeah, it’s gonna sound very stupid, but just want to reiterate on the importance of how important your glutes are. And I remember the first time during my post grad studies, we had a gross anatomy session and why dissecting the cadaver the glutes, that was the first time I ever actually saw how big of a muscle your glutes are. It’s crazy. It’s, it’s crazy. I couldn’t believe it. And when I saw that, my whole ideas of how you gem I do any training just completely switched. And I know the stuff of cadavers on for everyone, but I just kind of wish that everyone can have that visual feedback of how big of a muscle you could meet glute max, like all your glutes are all three of them. How important it is due to the your course and your posterior chain. And if you have that visual feedback, then you would understand how important these stupid exercises like monster walk, like clams, like ball, glute bridges, hip thrusts how important they actually are. It’s not these we call it holiday holiday muscles or what back, get back for back. I get biceps and triceps type of exercise, but the ones that actually help you the non cosmetic muscles.

Ben James 46:17
Absolutely, they are the guys that if you’re listening in and you’ve sought some advice for your back health and you haven’t had any input on exercises, then challenge those, those guys that you see in that practitioner therapist to give you that input and goes the same with the glutes. If you’ve had no input on those glutes, then there’s a problem with the treatment. So, guys, thank you very much Vincent, really appreciate you coming on and sharing that story. Some great insight, some great stories there behind your your rehab and your recovery, I think is really valuable for the listeners. So really appreciate your time.

Vincent 46:49
Thanks for having been in Jacob. It was a really a great session. And yeah, I can’t believe that’s already 50 minutes.

Jacob Steyn 46:56
Thank you. Thank you, Vincent. great man. great talking to you.

Ben James 46:59
Well, there you have it guys, a patient experience of recovery from herniated disc and taking a movement based approach to their rehabilitation. So thank you as always, for listening, we invite you to head on over to the smartstrong.co.uk website. Take advantage of our free ebook and start taking back control of your back health within the next seven days. As always, we ask you to head on over to the iTunes website. Give us a rating give us a review. Help us share the show with others around the world to help them take back control on their back health and start getting back to the activities they love. Thanks again for listening. We’ll catch you again on the next show.

Transcribed by https://otter.ai