[Ana1982]

#21266

Dear Dr. Corenman,

I spoke to you some 3 months ago, around the 2 month mark after my surgery. I had microdiscectomy at l4-5. I equally have a subanular disc bulge at l3-4 and a degenerated disc at l5-s1. Yes, I know it’s a CBS lol.

Anyway, I have been recovering pretty well. It’s been almost 5 months after surgery now. I have occasional nerve twinges in my right leg (knee, calf, big toe, groin, and sometimes in the buttock and the incision site) but nothing major. Sometimes when I overexert myself (i.e. too too many stairs on a given day, or too many squats) my whole back and buttock area becomes inflamed and I need to rest the following day as much as possible but it quickly passes.

I forgot to tell you last time that I am an amateur opera singer (do it only for pleasure and self-satisfaction). I stopped singing entirely when my back pain started last year and I resumed it a few days ago.

What worries me is whether the diaphragmatic breathing used in opera singing, that substantially engages the entire core (intercostal muscles, upper back, upper and lower stomach muscles, obliques AND lower back muscles), may hurt my already overly crappy spine. Or may it help stabilize the core, on the contrary?

The breathing technique is like this: you breathe in 360 degrees into the upper back, ribs and upper belly, you create a “block” in that position, and then you slowly, slowly and gradually exhale, making sure the whole core remains extended as much as possible during the exhalation–this is what enables you to sing high notes with ease. Now when I exhale, I do feel a slight twinge–sort of a sore stiffness–in the incision area. Is this type of breathing and this type of activity dangerous to my already damaged spinal health? Do I further compress the discs in the lumbar area by breathing in as deeply as this and exhaling as slowly as this? Knowing that I have 3 unhealthy discs puts me in a state of scare when approaching any physical activity. Yet I am too young to just give up living, if you know what I mean :)

Your thoughts are, as always, highly appreciated.

[Donald Corenman, MD, DC]

#21268

When you say the “core remains extended”, do you mean that the belly is relaxed and protuberant (the belly is distended)? I assume you must relax the abdominal muscles to fully allow the diaphragm to descend to allow the most expanded lung capacity. If so, this is the opposite of “core strength” which uses the diaphragm as a “wall” to increase the intra-abdominal pressure to reduce the stress on the lumbar spine.

Core strength however generally will not be an issue when singing (unless you do squats with a 200 pound barbell while you sing). Core strength is necessary for spinal loading which I would assume you do not have a need for when singing.

Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Ana1982]

#21269

Dear Dr. Corenman,

I expressed myself clumsily. When I said “the core remains extended” I meant that the point of a singer’s exhalation is to exhale as little air as possible over the greatest possible period of time, i.e. to exhale as if through a tiny hose, which requires you to preserve the initial inhaling position as much as possible.

The starting position is with the belly relaxed, distended. Once you inhale you literally broaden at the ribs 360 degrees and the lower belly goes in. That’s the starting position. Then you stop for a split second and then starts the exhalation which involves maintaining the initial, broadened-ribs position (including the upper stomach and the thoractic back muscles) as much as possible. During the most demanding phrases, your upper stomach should protrude out–you consciously support your highest notes with your upper stomach–and your lower stomach goes in (the second one is the consequence of the first).

Is this type of activity dangerous for the spine?

Thank you and I apologize if the question sounds strange

Ana

[Donald Corenman, MD, DC]

#21281

The type of muscle contraction is not dangerous to the spine.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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