Re-Posted from Sept 2016: As Long as Necessary
When faced with a challenge in life it is often how we respond that determines the outcome. I'm sure an illness or an injury is something that every person reading this has had to tackle at some point in their life. In that respect there is absolutely nothing special about me or my circumstance. The only difference is that I'm talking about it on the internet. My most recent challenge has been recovery and rehabilitation of my back. I'm starting the story in this post around the time my back became problematic. There was recovery of a different kind already in progress, but that is not the focus of this post. That recovery mainly consisted of doctor appointments, and mostly required time, patience, and medicine. It took about a year before I began to feel normal.... I mean, to really feel like myself again. Although, by that point in time I was 6 months into a back injury, so maybe not completely normal. In contrast to recovery from my illness, my back injury was something that I could take proactive steps to help the process.
My back didn't instantly go out, instead the injury materialized slowly over the span of 6-8 months. Initially, I couldn't do any or very little rehabilitation work for my back because I often wasn't feeling well. After a while I was able to begin some rehab work, and then eventually some limited strength training. In this post I wanted to discuss the rehab work I did before I could do any sort of strength training. My current strength and resistance routine is also focused on rehabilitating my back, so I'll talk about that some other time. If you are unaware of my current situation you can get the whole story on my blog post titled Getting Shocked by Adversity. This blog post may be a little more nuts and bolts than others, but it was the only way I could figure out how to write it and be coherent. Now, before I go any further I want to mention a couple of things since I have my rehab routine in this post. You should know that:
This is what I am doing for my particular situation. I’m not advocating this routine to be a solution for your injury. Everyone is different, so this may not be right for you, but this is what works for me.
Do not try these exercise/rehab routines, or try to rehabilitate any injury without first consulting your doctor.
Now that we got that out of the way you may ask did I consult my doctor before trying this? The answer is yes, of course I did! I began to feel lower back pain, as well as numbness in my calf and feet. I would also get a stinging feeling and numbness in my leg from picking up something as light as a glass of water. This had been going on for a little while and was getting progressively worse. I initially went to a chiropractor, but that didn't work out at all, so I went to see my primary care physician. After my primary care physician assessed me she referred me to a doctor specializing in spinal injuries and rehabilitation. A MRI confirmed two bulging discs with some annular tears in my low back. I discussed with the spine doctor that I wanted to workout and we talked about some options of what might work for me. I had some ideas, and he gave me his feedback. He had some suggestions, and I took notes. I literally took notes. Based on that conversation I was able to create a routine to help rehabilitate my back, and later workout a strength routine that would keep me physically fit. In this blog post I'm focusing exclusively on the rehabilitation part, and saving the strength and conditioning for later.
Now, before I did any rehab of any kind I had to establish a mindset. I've previously discussed how I believe that words create powerful associations. So right away I basically told myself I would never utter the words "I have a bad back". Those words imply something chronic and incurable. In my mind it's something that a person who has given up on recovery would say. Instead, I say "I have an injured back". An injury is something that is temporary and treatable. So I'll go ahead and establish right now in this blog; I have an injured back. Additionally, I wrote "My back is healthy and strong!!" on my bathroom mirror with a dry erase marker. Every morning I would read it a few times, and as soon as I did I could feel myself standing up straighter. I actually started writing goals on the mirror back when I was in grad school. I would write "I am going to make an A in...." and then I would list my classes for that semester. Since then I do it every time I have a major goal.
Fairly early on in this process I read the book The Back Mechanic by Dr. Stuart McGill. In the book McGill tells the reader to identify things that aggravates your back, and then stop doing them. My spine doctor told me something similar. I love advice like this. It's just so basic; it's really just common sense. I guess that's the genius of it. Before trying some crazy new therapy just stop doing whatever activity bothers your back. I love it! For me personally, the biggest agitator was sitting for extended periods of time. This was something that my spine doctor had identified as the root cause of my back issue, and he had recommended not sitting for long bouts, if possible. As I mentioned in my previous blog post, my core stability was literally nonexistent because I had major abdominal surgery and those muscles had been severed. Basically, I had nothing to hold up my body's weight. Combine that with the slouched position I would sit in because I was feeling sick for months on end after the surgery, and it was a real recipe for disaster.
One of the first things I began to focus on for physical rehabilitation was learning how to sit, stand, and walk with a neutral spine and braced core. This seems so basic, but it's very important when trying to recover from a back injury, and probably even more so when simultaneously recovering from major abdominal surgery. Due to the surgery it also was very important that I rebuild my core strength. I had already been around the gym for a while so I was at least familiar with the concept of a neutral spine. If you are not aware, a neutral spine is exactly what it sounds like: the back is in the correct/neutral position. In this position your core is braced to effectively hold your body up and distribute your weight appropriately. If the spine is not held in a neutral position it can lead to back issues, or aggravate existing issues.
I knew this was an area I needed improvement. I also knew a couple of techniques that worked okay for getting into this position. However, it wasn't until I bought and read the book The Supple Leopard by Dr. Kelly Starrett that I found great instructions on how to get into a neutral spine position with a braced core. The book basically lays out a 5 step process to brace and get your spine neutral. I still haven't found a better or more in depth explanation. So I practiced these 5 steps a lot! I would do them all the time, all day. Before I would walk somewhere. Before I sat down. Basically, before I did anything I would do the 5 steps. After a while I didn't need to go through the motions of all 5 steps. I would just get into the neutral spine position naturally, and my core and glutes would just fire automatically. This portion of rehab probably took a little longer for me because bracing my core would sometimes cause me to feel a little sick to my stomach. It was always a give and take on this front.
In addition, sitting for extended periods of time was something vital for me to address. So initially I just needed two things:
1) Time. I needed time to start feeling better so I could sit/stand/walk correctly.
2) A game plan on how to reduce the amount of sitting I did through out the day.
I developed an initial game plan, although it evolved with my condition and as my knowledge/experience grew. This was a true learning experience for me. Regardless, I began to implement the plan. First, as previously discussed, I started sitting/standing/walking correctly. That helped. Next, I setup a standing desk for my computer at home. I used the coffee table from my wife's old apartment and set it on top of my desk. I got an adjustable monitor stand and a swiveling foot stool from Amazon Basics for a total of maybe $35, and.....Viola! I had a standing desk. I read the book Deskbound, also by Dr. Kelly Starrett, and it gave very detailed explanation on how to properly set up a standing desk. So I adjusted my new back friendly desk accordingly. A quick anecdote about Deskbound, early in the book it discusses how sitting for extended periods leads to increased risk of heart disease, diabetes, cancer, metabolic syndrome, and many orthopedic issues. It was pretty mind blowing! Overall, I thought both The Supple Leopard and Deskbound were great books. Anyway, it wasn't long before I got used to using the standing desk at home. Later, my spine doctor wrote me a doctor's note, and I was fortunate enough to get standing desk for work as well. I'm not overstating things when I say it has made a huge difference.
I've also incorporated a lot of walking. This was recommended to me by my doctor and seems to be pretty much universally accepted as a great way to help your back. Walking creates a small amount traction with each step, and helps keep the muscles in the legs and back loosened up. When I thought about it walking as a form of rehabilitation it's just one of those things that makes sense. We're made to walk; that's what our hunter/gatherer ancestors did all day/every day. So walking a lot is just getting back to doing what the body was designed to do. I guess this goes back to that elusive common sense stuff I was referring to earlier.
I set the step counter on my phone to 8,000 steps a day. I have no idea how accurate that step counter is but in a sense it doesn't matter. If according to my phone I walked more than 8,000 steps then I know I did a fair amount of walking. I'm a pretty high energy/hyper person anyways, so I'm always moving around or walking already. Setting the step counter just helped hold me accountable, and made sure I did a decent amount of walking each day. Of course, an added benefit of walking is a boost to the metabolism. The one hour gym workouts are just not enough; no matter how intense. It's a priority of mine to stay lean, so walking a lot was something I needed to do anyways.
The primary issue I have with walking a lot is always time. I try to walk for about 10 -20 minutes during lunch if I have time, but often I don't. I used take our dogs for a walk in the evening which would essentially kill two birds with one stone. That was great, however these days one dog can't walk long distances because she has cancer in her leg, and the other is just to small to walk very far, especially in the heat. I'll still get out there and do some walking though; my wife is a big help on this front. On the weekends we may try to do some outdoor activities such as hiking when we can. Also, when I go to a store like Home Depot or Target on the weekend I use those opportunities to get in some walking. Like I said, the biggest restriction is always time. So I'm not always able to hit my step goal everyday, but I do hit it most days.
In addition to all of this, I also have some rehab routines that I do to facilitate my back recovery and help to rebuild my core strength. I believe these routines have helped tremendously, although it took me a while to settle on the exact routine(s). Formulating these routines was an aggregation of my doctor's recommendations, reading, and of course a lot of trial and error! One thing noticeably absent is that there are no sit ups, crunches, or any of those types of exercises. Those exercises are not recommended for someone with back issues. I'll take it one step further and say that if you don't have any back issues you can create one by doing them (just my own personal opinion). To exercise my abdominal muscles I do several plank variations, pallof press, push ups, pull ups, and goblet squats.
Early on I couldn't do these rehabilitation routines. They made me sick. Walking was my rehab when I'd feel sick. Then later, I think the only things I could do were push ups, glute bridges, and some body weights squats. I would also do a lot of foam rolling. As my condition continued to improve I incorporated more and more stuff. As I added things, I had to figure out what worked for me and what didn't. It took some time, but I eventually landed with these two routines for rehabilition.
Morning Rehab Routine - Everyday
2-3 Sets/10 Reps Bodyweight Squats superset w/ Walking Lunge.
2 Sets/10 Reps Lateral Lunge
2 Sets/10 Reps Leg Swings
2 Sets/10 Reps Lateral Leg Raise
1-2 minutes of Foam Rolling with a Foam Roller, Peanut, Tennis Ball.
1-2 Minutes of Static Stretches
I've become very efficient at doing this in the morning, and I can usually knock it out in about 5 minutes or so. My spine doctor liked this routine because it would help open up my hips and loosen up my muscles. I've learned that tight hips are a major contributor to lower back issues so increasing hip mobility is a priority. That's also why I prioritize movements like squats, lunges, and lateral leg raises. It gets the muscles loose and synovial fluid (the stuff that lubricates joints) circulated around the joints. In regards to foam rolling and stretching, many of the techniques I use are straight out of The Supple Leopard. When foam rolling I always start rolling with the bottom of my feet, then work my way up to my calves to my hamstrings and quads to my hips. This is also when a tennis ball or the peanut roller come in handy.
Evening Rehab Routine - 3-5 Days a Week
8 Reps Cat - Camel
3 Sets/6,4,2 Reps Bird Dog (Hold each rep for 10 seconds)
3 Sets/Planks (Hold each rep for 30-60 seconds)
3 Sets/6,4,2 Reps Side Plank (Hold each rep for 10 seconds)
2 Sets of Glute Bridges
It took me a while before I could begin doing this routine because planks and side planks would make me sick. Eventually I would be able to do it one or two days a week, then three, and so on. Most of this rehab routine is straight out of The Back Mechanic. I added planks, which replaces an easier exercise called the curl up. Also, I added the glute bridges at the end. Mcgill and many others recommend these for activating the glutes. I have to admit this routine was surprisingly difficult, especially if you’re not used to doing side planks. These days I'll often just tack this routine onto the end of my strength training routine, which works well. I may also add in some variation on some of these exercises or add in a set or two of a different exercise. Early on, I picked up an instructional booklet on Amazon called Lumbar Spinal Stabilization by Dr. Donald R. Murphy for about $12. This booklet had some different variations of these exercises and was really worth the 12 bucks.
I also do some other rehab exercises intermittently or as needed. One such exercise is the press up which helps relieve pressure off the discs in the lower spine, although it may also cause problems in the facet joint of the spine. For that reason I tend to use these sparingly or on an as needed basis. It's definitely an exercise that should be discussed with a doctor before attempting. Another thing I do is the dead hang from a pull up bar. This allows for some traction in the spine, plus you get the added bonus of improved grip strength. I do these every time I work out. And finally I will sometimes lay outstretched on a decline bench for a minute or two. Again this allows for some gentle traction of the spine. I don't do it often, just as needed.
So that is my rehabilitation routines and my rehab history to date. It's been a work in progress, but I like where it's at right now. Even though I consider these "rehab" routines I will probably continue to do them indefinitely. I mean, why not? They seem to help my back, plus keep my hips and muscles loose and flexible. As for the million dollar question: Did any of this work? The answer is, yes, it has worked and it continues to work. All the numbness I had been experiencing in my calves and feet are gone. That being said, my lower back still gets sore sometimes, and I'll occasionally get some stinging feeling as well. I've been able to resume some strength training, even some barbell squats, albeit with some seriously light weight. I also still have to be careful about what I do or lift etc.... Inevitably about once or twice a month I do something stupid like try to move some furniture which reminds me that I'm not out of the woods yet. Overall I'd say I've made some real progress.
The progress I've made has not been linear, but instead a very bumpy road. I've had a lot of set backs, which at times has been very frustrating. Though, I can't be too upset; I've been moving forward. Something that recently helped hammer that point home with me was a YouTube video of the famous power lifter Mark Bell giving a seminar at a gym. He rhetorically asked the listeners when you are working towards a goal how long should it take to achieve the goal? He then answered "it will take as long as necessary" to reach the goal. He then went on to cite several examples and made the point that the time it takes doesn't matter as long as the progress is there. So when I ask myself: How long will I keep at this? How long will it take me to fully rehabilitate my back? I answer: As long as necessary!
