In this Christmas Eve edition of the Back In Shape Podcast, we dive into a live clinical review of a subscriber's case to demonstrate why a physical examination alone is often insufficient for diagnosing chronic back pain. We discuss why standard orthopaedic tests (reflexes, strength, dermatomes) are designed to provoke pain rather than identify the underlying structural cause, often leading to vague diagnoses like "mechanical back pain" that offer no solution.

We then move to the X-ray analysis, revealing what the physical exam missed: a Retrolisthesis (backward slippage) of L5 on S1. Mike breaks down the biomechanics of this specific misalignment, contrasting it with the more common spondylolisthesis (forward slip), and explains how the loss of the natural lumbar curve (hypolordosis) compromises the spine's ability to handle load.

Finally, we issue our essential Christmas warning: The "Turkey Carry." It is rarely the heavy gym session that causes a Christmas flare-up; it is the awkward mechanics of carrying heavy roast trays across the kitchen while dodging toddlers. We break down how to apply gym-standard hip hinge mechanics to your household duties to ensure you stay pain-free into the New Year.

🩺 Physical Exams vs. X-Rays: Why "ticking the boxes" on a physical exam (reflexes, sensation, strength) often gives a false sense of security, and why imaging is required to see the structural reality.💀 Retrolisthesis Explained: A visual analysis of the subscriber's X-ray, identifying the backward slippage of L5 and the straightening of the spine (hypolordosis) that creates chronic instability.🦃 The "Turkey Carry" Risk: Why household tasks during Christmas are high-risk moments for the lower back, and how to apply proper bracing and hinge mechanics to kitchen duties.

Chapters00:00 Introduction & Christmas Eve Greetings02:40 Patient Case Study: History (L5-S1)06:00 Why Physical Exams Don't Reveal Structure09:15 X-Ray Analysis: Identifying The Root Cause15:30 Retrolisthesis (Backward Slip) Explained28:00 Why "Instability" Is A Vague Term45:00 The Hip Mobility Connection01:07:00 The "Turkey Carry": Holiday Movement Hazards01:09:00 Conclusion & Sign Off

#Retrolisthesis #Chiropractic #BackInShape

Key Topics Covered

Many sciatica and back pain sufferers feel a constant urge to "stretch out" a tight lower back. However, using clinical tools like a dual inclinometer reveals a critical misunderstanding of spinal mechanics. When you perform a toe touch or a forward bend, the vast majority of that movement comes from your hips, not your lumbar spine. The lumbar spine has a finite range of flexion at specific segments. Attempting to push past this biological limit does not help muscles; it strains the ligaments and discs, potentially worsening herniated discs or instability.The sensation of "tightness" in the lower back is rarely a result of short muscles that need lengthening. Instead, it is often a neurological protective mechanism—a "brake" applied by the nervous system to stabilise a spinal segment that it perceives as vulnerable or injured.

By aggressively stretching (such as pulling your knees to your chest), you may be stretching the very ligaments that are trying to heal, engendering further hypermobility and perpetuating the pain cycle. The solution is not to mobilise the spine, but to stabilise it through core engagement and proper hip mechanics.

Key Topics Covered

📏 Measuring True Flexibility: We demonstrate how to differentiate between hip flexion and lumbar flexion using inclinometers, proving that the lower back moves far less than most people realise.

🧱 Spondylolisthesis & Strength: A look at training with spinal slips (Grade 1 & 2). We explain why avoiding weights out of fear is counterproductive and how stability work is the best defence against progression.

⚙️ Spinal Fusion & Adjacent Segments: Discussing the mechanics of L5/S1 fusions and why the segment above (L4/L5) often becomes the new site of issue if hip mobility isn't addressed.

🛌 Morning Stiffness & Sleep: Troubleshooting why you wake up in pain. We discuss how inflammatory accumulation overnight—not just your mattress or sleeping position—contributes to that "locked up" feeling in the morning.

The Roman Chair (or 45-degree back extension) is one of the most effective tools for strengthening the posterior chain, yet it is often performed incorrectly by those recovering from a herniated disc or sciatica. In this session, we break down the two most common errors: rounding the spine (flexion) and instability at the top of the movement. We explain why your goal during rehab is to cultivate "torso stiffness" rather than flexibility, ensuring the load remains on the glutes and hamstrings rather than shearing the lumbar spine.

We also tackle a very common patient question: "Why does standing still (like washing dishes or queueing) hurt more than walking?" The answer lies in "cumulative loading." When you walk, your muscles act as a pump, flushing blood and offloading the spine cyclically. When you stand still, the compression is static and unrelenting. We discuss strategies to mitigate this, including using a "perch" stool and shifting your weight to manage fatigue.

Finally, we address the safety of Hanging Leg Raises for back pain. While popular for abs, this exercise generates massive leverage on the lumbar spine and often causes the hip flexors to pull the back into hyperextension. For those in Phase 1 or 2 of the Back In Shape Programme, we recommend sticking to high-tension, stable floor-based core work (like the Dead Bug) before attempting high-leverage hanging movements.

Key Topics Covered:

👁️ Roman Chair Errors: We discuss why rounding the back (flexion) on a back extension machine defeats the purpose of rehab for disc injuries. The goal is to lock the spine into neutral and hinge purely at the hips.

🩹 Why Standing Hurts: Explaining the mechanism of static compression versus dynamic load. We detail why 10 minutes of washing dishes can often be more painful than a 30-minute walk for sciatica sufferers.

⏳ Hanging Leg Raises: A breakdown of why this advanced core exercise is often a trap for back pain patients, leading to hip flexor dominance and lumbar hyperextension rather than genuine core stability.

Chapters00:00 Introduction02:15 Roman Chair: Instability & "The Wobble"08:45 Rounding the Back: Flexion vs. Neutral Spine15:30 Setup: Correct Pad Height for Back Extensions26:10 Q&A: Why Does Standing Still (Washing Dishes) Hurt?33:20 The Difference Between Static Standing & Walking40:15 Q&A: Are Hanging Leg Raises Safe?51:00 Cumulative Fatigue & Managing Daily Load01:12:20 Closing Thoughts & Christmas Schedule

#BackPain #RomanChair #Sciatica

One of the most common frustrations in recovery is the belief that rehabilitation exercises are causing more pain. In this session, we dissect the difference between genuine exercise-induced aggravation and the natural daily fluctuation of symptoms. Often, pain worsens towards the evening due to the cumulative load of the day, leading patients to falsely blame their afternoon workout. We explain how to conduct a "fair evaluation" of your daily pattern to determine if your technique is truly at fault or if your spine is simply fatigued from daily life.

We also issue a strong warning against "Russian Twists" for anyone with a history of back issues. This exercise combines flexion, rotation, and compression—a "perfect storm" for provoking a disc bulge or herniation . Instead, we advocate for "Correct Choreography" in spine stability exercises like the squat and hip hinge. These movements are designed to hold the spine rigid while the hips do the work. If you feel pain during these, it is likely because the spine moved when it should have remained neutral.

Finally, we cover practical strategies for the holiday season and daily living. From using a rolled-up towel (the size of a Pringles tin) for lumbar support in the car to understanding why you shouldn't push for personal bests during Christmas. We also break down the "Chest Pop" cue—a vital technique to engage the lats and erectors to protect the spine during lifting .

🚫 The Danger of Russian Twists: Why combining forward bending with rotation creates significant shear and compressive forces on the annular fibres of the disc, making this exercise unsuitable for rehab.📉 Daily Patterns vs. Workout Pain: Understanding that symptom fluctuation (often worsening at night) is normal and shouldn't necessarily discourage you from your stability work.🚗 Car Travel & Lumbar Support: A simple hack using a rolled towel or bar pad to support the lumbar curve and reduce pain during long drives.🦍 The "Chest Pop" Cue: How to properly engage your upper back and lats to maintain a neutral spine during squats and deadlifts.

Chapters00:00 Introduction00:40 Evaluating Daily Pain Patterns vs. Exercise Aggravation07:40 "Correct Choreography": Why Stability Exercises Shouldn't Hurt11:55 Sleeping with Crossed Ankles (Sciatica Factors)15:00 Stop Doing Russian Twists (Flexion + Rotation Risks)20:45 Hamstring Tightness vs. Disc Injury28:40 Kettlebell Swings: When Are They Safe?33:30 Christmas Training Advice: Maintenance vs. Pushing36:50 Car Travel Tips: The Towel Hack for Back Pain39:20 IDD Therapy & Spinal Decompression Opinions46:45 Can You Fix "Degenerative Disc Disease"?53:15 The "Chest Pop" Cue for Safe Squats58:45 Squatting with Knee Replacements01:04:15 Conclusion

#BackPainExercises #HerniatedDisc #Sciatica

Key Topics Covered

In this session, we address a critical strategic error many patients make when undergoing spinal decompression treatments like IDD therapy. It is common for clinics to advise pausing rehabilitation exercises during the initial weeks of treatment. However, we argue that building spinal stability and strength should happen concurrently—or even beforehand—to protect the spine during the travel to and from the clinic. We discuss how to strategically schedule decompression sessions, ideally placing them after your heaviest workout days (like Phase 3 or Phase 4 squat sessions) to utilise the treatment as a recovery tool rather than a passive cure.

We also dive deep into the metabolic requirements of healing a herniated disc or recovering from sciatica. A significant topic discussed is the use of creatine monohydrate; specifically, dispelling the marketing myths surrounding expensive "women-specific" supplements. We explain why standard creatine is essential not just for muscle growth, but for cognitive function and recovery. Furthermore, we warn against maintaining a steep calorie deficit during rehabilitation. Healing nerves and building tissue is an energy-expensive process, and insufficient nutrition can lead to increased delayed onset muscle soreness (DOMS) and stalled progress.

Finally, we cover essential technique corrections for the squat and hip hinge to prevent neck pain, using the "pike" analogy to maintain a true neutral spine. We also tackle the misconception of "weak knees" in older adults, explaining why leg strengthening is the solution, and provide a guide on the absolute essentials for a home gym setup that allows for long-term progression without filling your house with equipment.

🏥 IDD Therapy & Exercise Timing: Why you should not stop strengthening your back while undergoing decompression therapy. We explain how to time your appointments to aid recovery from heavy lifting sessions rather than treating them as a replacement for the work.

🥩 Nutrition & Recovery: Why a calorie deficit can be detrimental when recovering from a back injury. Healing tissues and reactivating nerves require significant energy; under-fuelling can lead to poor recovery and persistent soreness. We also bust myths on "specialised" creatine supplements—standard monohydrate is effective and far more affordable.

🏋️ Squat Mechanics & Neck Pain: A common error in the hip hinge and squat is looking up ("cranking the neck"), which disconnects the cervical spine from the rest of the column. We introduce the "impaled on a pike" visualisation to ensure your head moves in unison with your torso to avoid upper back aggravation.

Chapters

00:00 Introduction & Health Updates

01:23 IDD Therapy: When to Start Rehab Exercises

06:25 Dealing with Middle Back Pain (TL Junction)

10:50 Managing the Commute to Treatment

17:00 Supplements for Spine Health vs. The Work

20:45 Creatine Myths: Marketing vs. Monohydrate

27:25 Why Calorie Deficits Hinder Healing

32:45 Hip Hinge Technique: Fixing Neck Pain

35:00 "Weak Knees" vs. Weak Legs in Seniors

44:40 Managing Training During Illness or Stress

49:20 The Dangers of Avoiding Spinal Loading (Paul's Story)

1:01:45 Managing Sustained Impacts (Driving/Riding)

1:04:45 Phase Four Training Frequency & Recovery

1:11:15 Essential Home Gym Setup (Vest & Dumbbells)

1:17:25 Rehab Strategy Post-Microdiscectomy

1:23:25 Tapering off Pain Medication

#SciaticaRecovery #HerniatedDiscRehab #BackPainRelief

The kettlebell swing is often praised as a powerhouse exercise for posterior chain development, but for those rehabilitating a lower back injury, it can be a double-edged sword. While it is fundamentally a hip hinge, the introduction of velocity and the need to rapidly decelerate a heavy load places immense demand on the lumbar spine1111. For someone recovering from sciatica or a herniated disc, attempting this dynamic movement before mastering a slow, controlled hip hinge with significant load (ideally 75-100% of bodyweight) is often a recipe for a setback2. We explore why speed requires a higher level of competence and why sticking to controlled, static strength work is the safer path in the early stages of recovery3333.

We also tackle one of the most common questions we receive: "Why is my pain worse first thing in the morning?"4. The answer lies in the accumulation of inflammation. During the night, your lack of movement allows inflammatory fluid to pool in the injured spaces of the lower back, while your tissues naturally tighten up to protect the area5555555. This creates a sensation of stiffness and pressure upon waking. We explain the mechanics of this morning "drainage" process and why gentle movement, rather than panic, is the solution to easing those early-hour symptoms6.

Finally, we address the controversial advice often given to patients—that they have "no chance" of recovery without surgery7. Whether you are dealing with an L5/S1 extrusion or lingering nerve pain weeks after a microdiscectomy, the reality is that surgery removes the obstruction but does not correct the mechanical flaws that caused the injury8888. We discuss why activities like swimming or cycling do not count as rehabilitation, why relying on back support belts gives a false sense of security, and how to build genuine, long-term resilience through progressive strength training9999999.

🔔 Kettlebell Swings vs. Rehab: Why adding speed and deceleration forces to a hip hinge is dangerous for early-stage back rehab10.

🌅 Morning Pain Mechanics: Understanding how inflammation accumulation overnight causes stiffness and why movement relieves it11111111.

🔪 Surgery Reality Check: Why a microdiscectomy doesn't fix your movement patterns and why "swimming" isn't specific rehabilitation12121212.

🧱 The Strength Standard: The importance of reaching 75-100% bodyweight on squats and hinges before adding dynamic exercises13.

🚫 Back Support Belts: Why wearing a support belt at work often leads to weaker muscles and a false sense of security14141414.

Chapters

00:00 Introduction

00:13 Kettlebell Swings: Good or Bad for Rehab?

03:05 The Mechanics of Speed & Deceleration

06:20 Doctor Says "Surgery Needed" Despite No Pain?

07:45 Why Back Pain is Worse in the Morning

10:00 Nerve Pain 5 Weeks Post-Microdiscectomy

11:15 Hip Hinge Form: Knee Bend vs. Locked Legs

15:40 "No Chance of Recovery Without Surgery" Myth

19:35 Spinal Orthotics & Lordosis Correction

21:10 Is Swimming & Cycling Actually Rehab?

22:50 Effective Core Bracing Techniques

24:20 When to Start Twisting & Stretching

27:05 Muscle Atrophy from Sciatica

28:30 The Importance of Rest Between Sets

33:25 Sharp Pain in Thighs During Dead Bugs

44:10 Jefferson Curls: Risk vs. Reward

51:10 Should You Wear a Back Support Belt?

01:11:20 Isometric Hip Hinges

01:14:10 Ankle Mobility Routines for Better Squats

#BackPainRehab #Sciatica #HerniatedDisc

In the world of back rehabilitation, the Roman Chair (or back extension machine) is often hailed as a must-have piece of equipment. However, for those recovering from L4/L5 or L5/S1 disc herniations and sciatica, this machine can often introduce unnecessary complexity, cost, and risk compared to the humble hip hinge. In this session, we break down exactly why the standing hip hinge is often superior for building spinal stability and posterior chain strength without the hassle of setup or the biomechanical restrictions of locking your knees in a machine.

We also dive deep into a critical Q&A session covering the mechanics of movement during recovery. This includes why the "Asian Squat" or deep squatting allows lumbar flexion (butt wink) that can derail progress , and why walking uphill is generally discouraged during the rehabilitation phase due to the forward lean it necessitates. We emphasise that rehabilitation is essentially weight training—learning to tolerate load through a neutral spine to build resilience over time.

Finally, we address a controversial topic: can you strengthen a spinal disc? Contrary to some claims, the answer is a resounding yes. Through the process of progressive adaptation and healing, tissues that once failed under load can recover to bear significant weight again. We explain the physiology behind this and how consistent, aggravation-free training is the key to turning a vulnerable back into a robust one.

🏋️ The Roman Chair Reality: While a valid tool for specific conditioning (like Nordic curls), using a back extension machine for early rehab often complicates a simple movement. We demonstrate how a standing hip hinge achieves the same posterior chain activation with greater safety and functional application to daily life.

📉 Squat Depth & The "Asian Squat": Deep squatting often forces the pelvis to tuck under (butt wink), placing the lumbar spine into flexion under load. For rehabilitation, we prioritise a neutral spine, meaning we stop the squat before this rounding occurs to protect the discs.

🧬 Strengthening Spinal Discs: We debunk the myth that discs cannot be strengthened. By defining strengthening as the ability of a tissue to bear load without failure, we explain how the body heals and remodels over months, allowing you to return to activities that were previously impossible.

Chapters

00:00 Introduction

01:35 The Roman Chair vs. Hip Hinge

05:30 Setup Risks & Safety Failures

09:15 Why the Hip Hinge is Superior

16:40 Using the Machine for Nordic Curls

19:50 Muscle Soreness (DOMS) vs. Injury Pain

21:25 Why We Don't Lift Heels in Squats

26:05 Understanding L4/L5 & L5/S1 Protrusions

31:30 The "Asian Squat" & Butt Wink Dangers

34:10 The Healing Scab Analogy

42:10 Screwing the Feet for Glute Engagement

43:55 Learning Pace vs. Target Pace

51:20 Central Sensitisation & Nerve Pain

55:00 Why Walking Uphill is Not Recommended

01:03:20 Can You Strengthen Spinal Discs?

#herniateddisc #sciatica #backpainrelief

Key Topics Covered

Does your sciatica seem to vanish for a few days, giving you hope that you are finally "fixed," only to return with a vengeance the moment you try to resume your normal life? This cycle of relief followed by relapse is incredibly common and deeply frustrating. In this session, we explain the critical difference between symptom relief (the absence of pain) and structural healing (the repair of the tissue). Understanding this distinction is the key to breaking the cycle of recurring back pain and preventing future flare-ups.

Using the analogy of a grazed eyelid, we explore a vital concept: just because you can see perfectly clearly (function is 100%), it doesn't mean the wound on your eyelid has healed (structure is still damaged). In the same way, your back can often move pain-free while the disc is still fragile. We discuss the "Scab Phase"—that dangerous window where you feel capable but are clinically vulnerable. Learn why "testing" your back during this phase is exactly like picking a scab, and how to navigate this timeline safely to build true, long-term spinal resilience.

👁️ The Eyelid Analogy: I recently grazed my eyelid. My vision was perfect—I could see everything fine—but the wound was red and raw. This is exactly like your back: just because you can move (function), doesn't mean the disc (structure) is healed.

🩹 The Scab Phase: There is a window of time where your inflammation has dropped (chemical pain is gone) but the mechanical integrity of the disc is still weak. This is where most people relapse—by picking the scab too early.

📉 Chemical vs. Mechanical Pain: We break down why anti-inflammatories might help the ache but won't fix the compression—and why you need to understand which one is hurting you right now.

⏳ The Real Timeline: A herniated disc doesn't heal in 6 weeks just because the pain stops. True structural resilience takes months of consistent protocols to build.

Chapters00:00 Introduction: Healing the Injury vs. Fixing the Pain03:15 The Eyelid Injury Analogy: Structure vs. Function09:40 Why "Feeling Better" Is Dangerous (The Scab Phase)16:20 Mechanics of a Herniated Disc & Sciatica24:30 Chemical Inflammation vs. Mechanical Compression32:10 How to Stop "Picking the Scab" of Your Back Injury41:00 The Timeline: How Long Does It Really Take?48:15 Q&A: Bed Rest, Walking, and Early Movement56:40 Building Long-Term Spinal Resilience

#Sciatica #HerniatedDisc #BackInShape

Key Topics Covered

Title: Why Your Herniated Disc Pain Feels Like It’s Spreading — Live Q&A

In this live Back In Shape session, Mike explains why an L4/5 or L5/S1 herniated disc can start as “just” lower back or buttock pain and then seem to spread into hamstrings, tendons and other joints over time. He walks through how inactivity, deconditioning and disc thinning work together to make you more vulnerable, why most people simply don’t have much strength “in the bank” to lose, and how this leads to that familiar downward spiral of flare-ups, failed treatments and growing fear. You’ll also hear discussion around epidural injections, laser therapy, float tanks, dry needling, decompression tools and when these can sensibly support your rehab rather than distract from it.

From there, the focus shifts to what actually turns things around: learning safe technique on squats, hip hinges, dead bugs and marching bridges, then progressively loading them through Phase One to Four so your spine, discs and hips genuinely get stronger. Mike tackles common myths (“my glutes don’t fire”, “swimming will strengthen my back”, “core work doesn’t heal discs”) and shows how to think about flare-ups, imaging and timelines more realistically. Use the chapters to jump straight to the topics that match your current phase, then come back to the replay whenever you need a reset. Start here → https://backinshapeprogram.com/start/

Highlights

🔹 Why herniated disc pain seems to “spread” over time
🔹 How inactivity thins discs and deconditions your whole system
🔹 Epidural injections, laser and gadgets — what they don’t do
🔹 Squat and hip hinge done properly vs chasing “glute activation”
🔹 Swimming, stretching and cat-cows vs real rehab and strengthening

#backinshape #sciatica #herniateddiscs

Today’s livestream starts with a deep dive into what “engaging your core” really means when you’re rehabbing an L4/L5 or L5/S1 injury. Mike contrasts a lazy, bicycle-style dead bug with the properly braced version, shows how to use diaphragmatic breathing to brace without moving the spine, and explains why filming yourself from the side is essential to spot the tummy rising and then creeping back up as soon as the legs move. He stresses progressively tightening the brace as the legs travel further away, using the dead bug, marching bridge and everyday tasks as a way to practise variable core engagement rather than just going through the motions.

In the Q&A, he tackles a run of common rehab sticking points: why Roman chair back extensions are essentially an expensive, less safe hip hinge, when to move from Phase One into Phase Two, and why single-leg raises and extreme seated hip hinges are usually a bad trade for people with disc injuries. There’s detailed guidance on when to start rehab after a herniation or discectomy (basically now, but at an appropriate level), how to progress from low-hold squats and hinges with dumbbells towards barbell work, and how to troubleshoot hip hinges with bands when hamstrings or fear are in the way. He also addresses anxiety about MRIs, anterior pelvic tilt and cauda equina, uses his own eye injury as an analogy for why pain is a terrible measure of healing, and finishes by clarifying that Phase One is about mastering movement and reducing daily aggravation first, so that genuine strengthening in Phase Three and Four is both safe and effective.

Highlights

🔥 Turn your dead bug from lazy leg flaps into real core work.
🧠 Use video feedback to catch tummy “pop-ups” and fix technique.
🏋️‍♀️ Know exactly when to move from Phase One into Phase Two.
🎯 Unlock safer, stronger hip hinges with bands and better cues.
⏳ Stop waiting to “feel better” – judge healing by what your back can actually do.

Chapters

00:00 Intro: protect your lower back with core

01:06 Why core engagement matters for L4-L5 injuries

02:02 Dead bug done badly versus properly demonstrated

03:58 Using belly breathing to switch the core on

07:56 Roman chair versus hip hinge for safe strengthening

09:51 How long to stay in Phase One safely

11:52 Why leg raises are risky for injured backs

12:47 Problems with seated hip hinges and better alternatives

18:10 When to move from dumbbells to barbell squats

22:01 Troubleshooting hip hinges with bands and tiny ranges

27:06 Stuart McGill overlap, McKenzie criticism and neutral spine

28:00 Post-discectomy training, protein, and cold weather stiffness

31:53 Anterior pelvic tilt, imaging limitations and rehab priorities

39:18 Eye injury analogy: why symptoms mislead your decisions

43:20 Post-discectomy hip hinge still causing nerve pain

52:47 Second surgery, loose screws and struggling with rehab

1:01:53 Daily flare-ups from chairs, doors and poor habits

1:11:59 Why Phase One technique comes before real strengthening

#HerniatedDisc #LowerBackPain #Sciatica