2004 archives (page 6)

The ABB Adrenalin stack preworkout drink has reappeared on the gym shelves after having been sold out for a few weeks. I took this to be a good omen for today’s bench max attempt. It was then that I noticed that the color of the bottle was much darker than before… and it now read Adrenalyn stack. Don’t know what’s up with that. A faulty omen?

With my system fueled by the liquified omen of dubious nature, I went straight to business. After only a few sets, I could tell that my groove and bench touch were crap. Perhaps a sign of overtraining after all? Started feeling that I would be quite content with just finally breaking the 100 kg/221 lbs barrier that has eluded me since late December. It came up… but just a bit.

Determined to at least set some PR today, I continued with close-grip two-board presses. Did get 100 kg/221 lbs on these ones bettering my record from December with 5 kg/11 lbs. Yay, a little something to add to my progress chart that has seen little updates recently as my back has been raising trouble for my squat/dead exercises and the Prilepin bench program has had me bench sub-max weights for some seven weeks. Then did forward incline dumbell curls, which I also added to today’s video (2.9M).

This was the last workout before heading for Italian Tuscany on Wednesday. Preliminary, my next workout should be 3 May. Around those times we should find out if my bench still sucks after I have gotten some much needed rest. My assistance exercise results have consistently showed improvement on the Prilepin program, so at least something has grown stronger…

I’m back from a great vacation in Tuscany that was capped off with a very happy event (official announcement). After an overdose of medieval culture and a suitable amount of wine tasting, I am now really looking forward to getting back to training again tomorrow. It will be back to Westside for the bench. Not yet sure how I will tackle my squat/deadlift training, depends on how my back feels. I forgot my precious tennis ball at home, with the result that my trigger points stiffened up quite a bit. Sleeping in beds of varying quality didn’t help much either. Luckily, Sanna’s elbow came to the rescue after it became obvious that tennis balls are a scarce commodity in the Tuscan countryside.

Time to face it. My bench is stuck. Has been since New Year’s Eve, when I blasted up 97.5 kg/215 lbs thus ending a nice upward streak that saw me add 22.5 kg/50 lbs to my bench in seven months since my bench journey began in May. Ironically, New Year’s Eve was also saw the beginning of the competition to guess how much I would bench by June 2nd, 2004. Having benched that same 97.5 kg/215 lbs a few times since but no more, it seems that the $15 US dollar Amazon gift certificate will go to my fiancée who had the most conservative guess of 112.5 kg/249 lbs. With some luck I might be able to eke a little closer to that, but I am having a hard time seeing how I could boost my bench that much in 4 weeks. Especially in light of the fact that my attempt to better my floor press PR of 100 kg/221 lbs failed miserably today (VIDEO, 1 M).

Actually, it was not that miserable. 95 kg/210 lbs came up easily enough and 100 kg/221 lbs would probably too if it weren’t for the fact that I spent a couple of seconds hovering the 102.5 kg/227 lbs just slightly off the floor first. At least I have not grown weaker, even though I have started benching with a slightly wider grip (pinkies at rings instead of a little on the inside).

So what do I make of this? Am I crying every night when I go to bed because my bench has grown stubborn? In the final analysis, this is the name of the game. Constant rapid improvement just does not happen 24/7, year in year out. If it would, even if just in my case, I would be outbenching Gene Rychlak in a few years, with no bench shirt, no drugs and long arms to boot. Instead there are periods of progress and periods of consolidation, even occasionally regress. When I began powerlifting a year ago I would have been thrilled with the thought of being able to bench 100 kg/221 lbs only one year later. Come to think of it, I still am. I need to work through this dry season, strengthen what I can, enjoy lifting and… booom! There will be rain. And that, will make me feel better than I would if progress was something that came on a silver platter.

There might be no silver platter, but there is always the infamous silver lining, which is that I will be able to try a lot of new things in my quest for a bigger bench. I expect chains and triple max attempts on the JM Press to enter the scene at any time. My newfound motto is this: “when in dire times, be grateful for the hand that comes from above”. Amen.

Back to Westside for the squat/dead workouts as well. Preliminary, I am striving to at least do the max effort day while keeping the dynamic day as an option if my back is up to it. I think I might be able to box squat, which I find easier on the back than normal squatting. After my back completely locked itself up last time I did freeweight squatting in March, I figured I would play it safe and do Smith squat for a while before starting to work with Mikesell. Indeed, Smith squats served me well one month after I ripped my back.

Smith squat I did. But not for long. Felt some acute discomfort already at 60 kg/133 lbs. Taking what I perceived to be the rational path, I aborted the squatting and started hauling 10 kg/22 lbs plates up to the second floor for my makeshift reverse hypers. Could feel my gluteus and back tightening up at this point, so I dashed down to the locker room for my trusty tennis ball. After doing a quick perverse looking trigger point massage for the gluteus, I felt ready to begin. Went well. Before I knew it I had completed the workout that is by now becoming my fallback routine, the Happy Back Workout&reg, when I am hurting. Armed with a set of fully loaded batteries, my friend and occasional training partner Måns made my digital camera sing and filmed all exercises (VIDEO 3.2M).

Mixed up my protein shake and headed for the sauna. While drying myself I happened to catch a glimpse of my shoulders in the mirror, and noticed that my shoulder girdle appeared to be slanting to the right. The more my body cooled down, the more the pain in the lower back increased. Sitting on the bus, I decided that this was the last straw as I refuse to be hurting five months after my initial injury without a battle. As soon as I got home I booked an appointment to a private highly regarded back clinic, Selkäcenter, for tomorrow afternoon. By this time my body was already slanting heavily to the right indicative of what I think is a protective cramp caused by my body trying to protect the old injury, which I now believe is probably not quite healed. Challenges abound.

Waking up this morning the cramp from yesterday had eased a little, but I still looked like one crooked bastard. Unlike yesterday, I was actually able to bend to the right a little. Needless to say, I did not go to work today. Instead I stayed home and felt grateful that I had an appointment with a back specialist in the afternoon.

I was met with a friendly greeting at the clinic, the kind of service uncommon outside the private healthcare sector. The waiting room was filled with pictures showing off acrobatic feats and healthy spines. I can see how some patients might become a little depressed by this after struggling to reach the clinic with an aching back, but I liked them for what I presume was the reasons they were put there in the first place. Help just around the corner. But then, I assessed my pain level as a modest 5 on a scale of one to ten on the registration form… With a major nerve impingement the trapeze dolls could have been in grave danger.

The therapist, a guy about my age, was inspiring and talkative. First we sat down and went through my injury and treatment history. I had actually prepared a somewhat detailed outline that I handed him. Thanks to this blog, it was a breeze to write down exact dates and details that otherwise would have been but foggy estimations.

Underwear time! He had me do repetitions of ten bending in different directions in order to assess whether a certain movement aggravated or lessened the protective response and pain. After I finished a movement his trained eye scanned me for minute changes in posture. He had me bend forward as far as I could go (painful), backwards (felt surprisingly good afterwards), to the left (so so) and to the right (not painful).

He told me that he was assessing me using the McKenzie method, which he proceeded to outline in some detail. If I understood him correctly, he explained that the fluid nucleus of the discs can be displaced causing overstretching of soft tissue around the vertebrae, which in turn would cause pain. The task of the assessment movements is to determine in which direction the spine has to be moved in order to counteract, and ultimately correct, the displaced fluid nucleus. After it was clear that extension (bending backwards with hands clapped around the lower back) caused relief, something that apparently is usually the case, he had me lie down on the table.

First he checked my mobility, such as seeing how far forward he could lift my legs before pain set in while I was lying on my back. Lifting the right leg it started hurting in the back first, with the left it was the hamstrings. After giving him an affirmative answer to the question of whether the osteopath had adjusted my spine, he also had me lie on both sides in turn and he pushed down hard on the leg bent on top. He didn’t do it with quite as violent leverage as the osteopath had, and I could not feel any cracking. I got the impression that he felt that it was way too early to do any heavy adjustments, but these quick jerks showed him that my back is elastic and responsive.

He then turned me on my stomach and had me do ten repetitions of pushing my upper body up with my arms as far as it would go (known as the cobra position in yoga). Then this was repeated in what he called a banana position, where the feet were pushed to the left and the hip to the right (hip away from the pain that is primarily to the left of the lower back). Indeed, I felt like any ripe banana in this position. It did not feel half bad.

Concluding a visit that had lasted a leisurely 40 minutes or so, he wanted to know whether I would be willing to come in for further sessions. Although my wallet is not as full as I’d like it to be, I naturally said yes. We booked a time for next week’s Tuesday, when another therapist will test me on various exercises in their rehab room. The idea here is that she will form her own opinion independent of his and then we will together think of a suitable approach to healing. “Scientific”, I remarked. It might be a McKenzie approach or something else; preliminary he told me that my case shows some deviation from the standard case.

In the meantime, he told me that I should do repetitions of ten in the banana position once every hour and any of the other movements we had tested that felt good. Self-assessment is key in this phase.

This visit left me feeling quite good. Although I confess to having hoped that he would crack me straight (in retrospect I can see why this would not make much sense at the moment, cf. Vince’s excellent comments) and felt a little tender from all the end range of motion movements, especially the forward bending that made me hurt at the spot of the original injury, I was very impressed his thoroughness and willingness to listen and discuss. He agreed with my thoughts on trigger points and was very encouraging when it came to my training. Before the visit I had visions in my head of him shaking his head when he heard that I injured myself doing a good morning (”stupid stupid”), but no. He also agreed that I could well continue my bench workouts as normal, although I might consider going a little lighter than singles. I mentioned doing reverse hypers and that they did not seem to aggravate my condition and he gave the green light for those as well. Not that I feel like doing any of those, or any benching for that matter, before my body is upright again.

This continuing back pain saga is inducing a split personality… On the one hand it sucks that I haven’t been able to go for any deadlift or squat records in five months, but on the other hand I am intensely intrigued by this opportunity to learn more about how my body works. I am now doing things with tennis balls and banana shapes that I could not have dreamed of before. I also hope that these posts might be of some help to others with similar injuries, while functioning as a gentle reminder to the healthy among you. Lift strict, learn what you can ahead of time and never hesitate to consult professionals. I for one will be very happy about this knowledge once I get old enough to walk around with a cane. Perhaps I won’t even need one.

Although he is not (yet? hehe) doing strictly powerlifting, Scott Bird’s fitness blog is well worth a read. With cameras having become standard gym equipment for many, chances are you might also find something of interest on his front page.

        Every hour, every day
        I hit the floor to combat decay.
        On the floor I twist and extend
        I am the banana, or so I pretend.

This piece of sub-standard poetry goes merely an inch of the way in conveying my happiness about being almost straight again. The protective cramp is not totally gone yet, but today my right shoulder is drooping just slightly. I saw some improvement already Saturday morning, but I regressed almost to square one after I dropped my credit card while shopping for eggs and some milk. In an effort to look half normal, I went down on one knee to pick it up with the result that not only my back tightened up, but also my abductor muscle on the left leg (at first I feared I had caused muscle damage, now I suspect it was merely a cramp). Took a while to limp home and do the banana extension again.

This morning I was nearly straight, but I had the worse pain yet quite evenly distributed over the lower back. Before it had been almost exclusively on the left side. This is actually a good sign according to the McKenzie method, named after its founder New Zeelander Robin McKenzie. The theory, known as the “dynamic internal disc model”, is that back pain is generally due to the fluid nucleus of the discs being displaced, causing them to put pressure on surrounding nerves or the disc annulus itself (article about how the discs work). Sometimes the pinched nerves cause pain to radiate down into the buttocks and/or legs, sometimes it is more local like in my case. By assessing which end range movement (bending as far as one can in one direction) lessen pain for the patient (usually bending backwards, i.e. extension) and having the patient do this exercise frequently throughout the day, the displaced fluid material should gradually return to normal. As the pressure on the nerves is gradually decreased, the pain will tend to move away from the periphery of the legs and buttock towards the center of the back after which it should disappear completely if the end range movement is continued. As McKenzie has made clear in one of his books that I borrowed from the library, Treat Your Own Back, that pain might actually increase during this process.

Now, pain does not centralize for all patients, in case of which there is a problem that should be dealt with by other means. The McKenzie method has actually shown to be effective both in separating patients with disc problems from patients with non-disc problems and in determining whether the disc annulus is intact or not.

The elicitation of pain “centralization,” an improvement (favorable change) in pain location in response to repetitive end-range testing, typically occurring with only one direction of test movement(s), predicts a high likelihood of successful response to conservative care, even in the presence of neurological deficits. Irreversible conditions are characterized by symptom aggravation by all directions of testing, including the absence of the centralization response, predicting a poor response to non-surgical care. In those whose pain is unaffected with similar testing, evidence indicates the pain is likely nondiscogenic. A dynamic disc model has been described as a possible model for these varying pain responses. Insight into annular integrity of symptomatic discs is also provided using this repeated end-range/pain response (McKenzie) assessment.
Wetzel FT, Donelson R. The role of repeated end-range/pain response assessment in the management of symptomatic lumbar discs. Spine J. 2003 Mar-Apr;3(2):146-54.

In fact, McKenzie has even been shown to be more effective than MRI (magnetic resonance imaging) in this regard, which might explain why my back therapist thought a MRI was not necessary at this stage.

The McKenzie assessment process reliably differentiated discogenic from nondiscogenic pain (P < 0.001) as well as competent from an incompetent anulus (P < 0.042) in symptomatic discs and was superior to magnetic resonance imaging in distinguishing painful from nonpainful discs.
Donelson R, Aprill C, Medcalf R, Grant W.: A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. Spine. 1997 May 15;22(10):1115-22.

At this point in my treatment, the aim is to see how my back reacts, which should help provide some clues as to what the continued treatment should look like. I believe I probably have some soft tissue problem left from December, so even when pain is gone there will probably be some healing left to do. I am not yet a 100% sure that the pain is centralizing for good, but I do know that the banana extension helps ease pain tremendously.

If I am straight tomorrow, I might go ahead and do my ME Bench workout. If in any doubt, I will rest instead. It seems like the biggest changes in my posture takes place during the sleeping hours, at least thus far. It actually feels a little bit like Christmas to wake up and get in front of the mirror to see whether there has been any improvements. In the spirit of this, I bid you good night and good back health!

Further reading:
Louis Kuritzky and Jacqueline White: Extend Yourself for Low-Back Pain Relief. The Physician and Sportsmedicine, vol 25:1, January 1997.

“Rest for back pain is an advice of the past, be up and about”, the doctor told me in Finnish with a German accent. “I’m writing you a muscle relaxant and a pain killer, both commonly used in sports medicine where it is essential that medication don’t affect mental functions. Even if you need to work, these will keep you sharp. You might get some stomach pain though”.

But let me back track. The doctor’s call for activity was not news for me. It was actually the very same advice that made me return to work today despite my hip still protruding to the left with the drooping right shoulder as the most visible side-effect. Everything went well until I had to do some sudden twisting movements to deal with an unexpected situation. Presto! The body let me know that I should leave its friend, Mr. Lower Elmore J. Back, alone and punished my actions by deepening the cramp. The Leaning Man from Pisa and so on. Advice taken, I should be in a more predictable environment if I want to avoid regress.

Thus I journeyed to the occupational health clinic to get me some sick leave and a physician’s referral to the back clinic (i.e., a letter recommending I get some physical treatment for my back), which in our Finnish welfare state allows me to get some of the money for this private treatment reimbursed by the state.

After a quick ten minute wait, the doctor received me. After asking me the standard questions, observing me bend in different directions and having me walk on my toes and heels, he had me lie down on his table. With therapy tables quickly becoming part of my daily life, I could not help noting that it was the standard light brown model. He twisted my legs, lifted them, and knocked my knees and ankles with a stereotypically tiny hammer to check my reflexes. Not surprisingly, he concluded that I did not have any serious disc or other problems, but was suffering from a muscle related cramp. “Lumbago!”, said the printer.

He gave me the physician’s referral I so craved and prompted me whether 6-10 treatments should be enough. “It works like a prescription. If you give me a call we can extend it if needed.” Hope not.

I also got a general guide for people suffering from back pain that described suitable exercises, essentials like how to best get out of bed and what movements to avoid. The best advice was to hold the nose while sneezing. A useful little leaflet, from where the skinny lads accompanying this post are ripped. Aren’t they adorable?

It was then he started talking about the medicines after first announcing that he would give me ten days of sick leave. He prescribed 30x2 mg of tizanidine (Sirdalud®) as a muscle relaxant and 30x50 mg of diclofenac (Diclomex®) as a pain killer. The pain killer can be taken as needed, with the muscle relaxant taken either one to three times during the day or just before sleep. As I don’t want to mask my pain too much, I plan to take the pain killer only upon waking up when my back is at its most painful and stiff. Since I tend to straighten up during sleep, I will also try popping 4 mg of the muscle relaxant before going to bed to begin with. Tomorrow, I can consult the other back specialist I will see about how they recommend I use these medicines if at all.

Needless to say, today was no time to do a ME bench session. Hoping to be able to speed bench on Friday though. Until then, you will have to bear with this Powerlifting Rehab Blog. Take a pain killer twice daily if you need it.

The muscle relaxant did its job and pushed me over the edge. After being a rightist for the last six days, my body is now straight again! The back is still in a volatile state, but nevertheless, this was the perfect day to graduate to the next level by another visit to the private back clinic, this time to the exercise room.

The physiotherapist (known as physical therapists in the United States and Canada) figured my problem to be disc related judging from the positive effects of the McKenzie extension protocol on both my pain and protective cramp. She asked me a lot of detailed questions about my training and how I stretch various key muscles. “How do you train the stabilizing muscles of the back?” was the most tricky one. “Well, I do these exercises known as pull-throughs and reverse-hypers”, I replied immediately sensing the inadequacy of my answer. “That’s good, and you should continue doing those, but these exercises only focus on the major surface muscles in the back.” Pointing on a plastic spine model she continued, “The core muscles I am talking about attach to the vertebrae themselves and help stabilize the spine region. These deep muscles are mainly activated as a final resort when we lose our balance and need to be trained in that manner as well”. I had a flash of sudden enlightenment.

She taught me a number of exercises that either used quick repetitive motions with light dumbells or a swiss ball (aka stability ball) to induce a labile and rapidly changing environment that should force the core muscles to fire. Many of these were surprisingly heavy and my poor unsuspecting body was shaking like a leaf. She said that it is quite individual how easy it is to get them to activate, but these should do the job. I then got to hang upside down on an inversion table to stretch the back, while she prepared me an exercise handout using PhysioTools, a Finnish program very common in the health care sector. As I was a little misaligned again when she took me down, she concluded that I should probably avoid upside down hanging for now. She then told me to do the exercises 2-3 times a week, focus on stretching the hams, gluteus and quads, and continue doing the McKenzie extension program, but gradually starting to do the back extensions with a straight back instead of in the banana style. “In two weeks, we can meet again and I can show you more advanced exercises using pulleys and such that allow you to further overload the core muscles.”

I suspect this consultation will forever influence the way I train. Training in a labile environment is not in itself a novel concept for me, recall the ball presses I’ve done, but I never understood this in terms of hitting completely different muscle groups that are central to spinal stability and thus essential for injury prevention. The physiotherapist confirmed that it is an unfortunately common scenario that injury occurs when the strength of the large surface muscles outgrow that of the core ones close to the spine. I’ve just discovered the weakest link of my chain, one that I before did not even realize existed.

See me fall of a swiss ball in tomorrow’s special rehab clip.

First swing at the rehab and core training program I got from the physiotherapist yesterday. The first movement had me shaking 3 kg/7 lbs dumbells rapidly up and down while spreading the arms. Contrary to what the major shoulder burn might suggest, the whole point is to activate the core stabilizers by causing the balance to rapidly shift. Just look at my midsection in today’s video clip (5.8M) and you’ll see what I mean.

I then found myself balancing on a swiss ball, which again forces the core muscles (usually defined as the multifidus and the transverse abdominis) to switch on and off to keep the body upright on the unstable surface. The ball proved to be much firmer than the one I tried this on yesterday causing me to avoid the anticipated nasty falls. Wasn’t much of a challenge at all [sigh]. Walk outs, the next exercise, was quite the opposite. Walking out with feet on a suitably low ball while trying to keep a neutral spine (not bent forward nor backward) and then alternately raising hands and feet off the ground was heavy work. Five reps later I did not know whether to make my 96 kg/212 lbs of bodyweight, my weak core muscles or my injured back the fall guy. Also started thinking ahead about how it would feel doing this with a 50 kg/111 lbs plate across the back…

Then it was on to lower body ab twists with feet on the ball. After frying my abs with walk outs, 20 reps to each side was easy. Still, with no support from the arms folded over the chest, I did feel like I was about to tip over at any time. Next, I did static holds with arms on the ball by first tipping the ball right, then left and finally back (can’t go forward) for a 15 second hold at each position. Me shake, ball shake. Big shake.

Neural mobilization (aka neural flossing), a controversial method to maintain or restore the mobility of the neural tissue in relation to its surroundings developed by David Butler of Australia, was next. If I sit with my back firmly against the wall I cannot extend my legs fully. But if I clasp my arms behind my neck and bend forward at the upper back I can. Sanna has been craving Butler’s book for the expanding health care section of our library for some time now, so will probably read up on this at some point.

A quick ten reps of non-banana back extensions and that was that. Capped of with some partner assisted hamstring stretching (my back wouldn’t accept it for the right leg though), gluteus stretching and quad stretching.

Overall, this was an interesting workout. The dumbell shaking aggravated my cramp, but the subsequent ones felt really good and actually helped normalize my posture again. Leaving the gym, I had a dull pain smack in the middle of the lower back. Writing this I can definitively feel more pain than before the workout, but this is probably to be expected. Will repeat this workout on Sunday, perhaps even on Friday in conjunction with my speed benching if I am not sore. Ciao!