Archives for rehab (page 3)

Scott has an interesting update on Bruce Lee’s good morning injury that goes into deeper detail on matters such as his recovery process than his earlier entry. Based on his reading of the process, he wisely suggests that he should add more low back work to his routine, which has evolved into a very powerlifting oriented mode over the last months, and goes on to note that

[Bruce Lee’s injury] certainly doesn’t dissuade me from using Good Mornings to their fullest extent. As with any exercise, Good Mornings are only dangerous if performed incorrectly (which may be due to tiredness or a brief loss of concentration, as much as poor technique); although there is a little more at stake than with other exercises such as a Barbell Curl.

Although I think Scott has the right idea here and I agree with the general gist of his statement, I would like to add that proper form boils down to a lot more, specifically neurological and muscle balance issues, than outwardly doing the exercise 110% correctly. Based on these observations, I think I have fairly good grounds for urging some caution with this exercise, while offering my own good morning injury as a good example of what happens when one goes too heavy on them too soon. This is a long one, so bear with me.

Acquired joint control

Let me begin by using McGill’s discussion of an injury that occurred while he was conducting a study on deadlifting powerlifters (Cholewicki, J. and McGill, S.M. 1992: Lumbar posterior ligament involvement during extremely heavy lifts estimated from fluoroscopic measurements. Journal of Biomechanics, 25(1): 17-28).

[U]sing video fluoroscopy for a sagittal view of the lumbar spine, we investigated the mechanics of power lifters’ spines while they [dead]lifted extremely heavy loads. [..] During the lifts, although the lifters appeared outwardly to have a very flexed spine, in fact, the lumbar joints were 2-3 degrees per joint from full flexion. [..] This explains how they could lift such magnificent loads (up to 210 kg, or approximately 462 lb) without sustaining the injuries that are suspected to be linked with full lumbar flexion. [..] However, during the execution of a lift, one lifter reported discomfort and pain. Upon examination of the video fluoroscopy records, one of the lumbar joints (specifically, the L2-L3 joint) reached the full flexion calibrated angle, while all other joints maintained their static position (2-3 degrees short of full flexion). The spine buckled and caused injury. [..] [T]his unique occurrence appears to have been due to an inappropriate sequencing of muscle forces (or a temporary loss of motor control wisdom).
McGill, Stuart (2002): Low Back Disorders, Human Kinetics: pp. 124-125.

Although only round-backed/hunched over good mornings seriously flexes the spine (bending over), it is quite clear that the difference between injury and success can boil down to such small matters as keeping correct form on the vertebrae level itself by skillfully contracting each joint. This kind of form is not visible to the naked eye and is to a high degree an acquired neurological skill that becomes exponentially more vital the more vulnerable a position the spine is in. And in the case of a good morning, the spine is in an extremely vulnerable position indeed (even compared to a deadlift).

Structural imbalances in the spine

Furthermore, as Vincent Scelfo has pointed out, injury can also be caused when there are small misalignments in the vertebrae, especially in the upper back. When I went to see the osteopath in April following the good morning injury, my upper spine was indeed a mess. I was also told that this is very common with people who lift weights. In my case, three of the upper back vertebrae had locked up preventing full motion of these joints. Outwardly the form might look divine, but if the spine is not properly aligned things can easily go awry when you bend forward with a barbell on your back.

Muscle imbalances in both strength and endurance

Imbalances between the large surface muscles is also asking for trouble. For instance, strong hamstrings and a strong static abdominal contraction is needed to keep the package properly together. Otherwise, you will not be able to sustain the proper position in the good morning with heavy loads, even if you think you are outwardly following the exercise instructions to aT. As Louie Simmons puts it in the context of the squat, you need to be biomechanically sound.

To become biomechanically sound, you must have proper muscle control. Very few people have great form. If your back is weak, you will bend over, causing bad form. If your glutes and hamstrings are weak, it is hard to sit back properly. If your abs are weak, you will be weak in the bottom and fold over.
Louie Simmons: Analyzing Your Squat Workouts.

The stabilizing core muscles around the spine also need to be strong enough to support the individual vertebrae during the lift, especially in the eventuality that the major surface muscles can’t cope with the load. After discussing the deadlifting injury reported above, the authors go on to note that the risk of this kind of injury increases when there is high force developed by the large surface muscles, but only low forces generated by the small intersegmental muscles (i.e. the core muscles are weak) OR even when all muscle forces were low (such as when picking up a pencil from the floor) following a demanding job. Bringing the core muscle strength and endurance up is precisely what the rehabilitation for my good morning injury is all about, as my therapist feels I have weak core muscles compared to the large surface muscles (based on my initial performance on the stability ball exercises I tend to agree…).

What needs to be realized when discussing muscle imbalances in regard to the good morning is that a lot of the supporting muscle tension required is of a static nature. For example, much depends on whether you can maintain a strong supporting contraction of the abs during the length of the set, i.e. muscle endurance. Absolute strength, i.e. how much weight you can crunch, matters a lot less in this regard. A couple of days ago, I was rewatching the Squatting Secrets video. On the tape, Louie talks about how both setting up for the squat and squatting itself requires continuously flexed abs. His remedy? Weighted straight-legged sit-ups in a low pulley with a static hold at the top (if you think sit-ups are all bad, you might want to read this entry).

Indeed, low muscle endurance of the stabilizing muscles correlates with a higher injury risk in many studies, although I am not quite sure how applicable the results are to max lifts. For example, in another study by McGill et al. they state that

[P]eople, from patients to athletes, must be able to maintain sufficient stability in all activities - with low, but continuous, muscle activation. Thus, maintaining a stability ‘margin of safety’ when performing tasks, particularly the tasks of daily living, is not compromised by insufficient strength but probably insufficient endurance, and probably insufficient control. [..] Having strong abdominals does not necessarily provide the prophylactic effect that had been hoped for - but several works suggest that endurable muscles reduce the risk of future back troubles.
McGill SM, Grenier S, Kavcic N, Cholewicki J. 2003: Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003 Aug;13(4):353-9.

… Breathing

Interestingly enough, in yet another study discussed in McGill’s book (Cholewicki J, McGill SM.: Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin Biomech 1996 Jan;11(1):1-15.), elevated breathing was also linked to bad motor control.

In our clinical testing we observed similarly inappropriate motor patterns in some men who were challenged by holding a load in the hands while breathing 10% CO2 to elevate breathing. (Challenged breathing causes some of the spine-supporting musculature to drop to inappropriately low levels in some people[..]). These deficient motor control mechanisms will heighten biomechanical susceptibility to injury or reinjury.
McGill, Stuart (2002): Low Back Disorders, Human Kinetics: pp. 126.

CONCLUSION

Based on the above observations, I would make the following tentative recommendations for the good morning. Take them for what they are; loud late night musings and blatantly broad generalizations of a man who is neither a doctor nor a powerlifting guru. In the final analysis, it is you who is ultimately responsible for how you decide to approach the good morning, if at all. This is how I would do it based on my current understanding. Comments and corrections are welcome!

1. Fine grained motor control comes only with a great deal of practice, so it is imperative that one does the exercise for some time with perfect form while not going so heavy as to risk injury due to the very lack of this control in the first place. This of course applies to all exercises to a varying degree, but with the good morning it is especially critical due to the vulnerable position. Perhaps a full year of doing the exercise with sub-maximal weights, say 50-70% of your hypothetical good morning max, before starting to go to failure?

2. Lack of strength in some of the major supporting muscles, such as the hamstrings, and weak core muscles, such as the multifidus, greatly increase the risk of injury. Furthermore, a lack of strength endurance (on the order of 30-60 seconds or so, this is no marathon) in these same muscles also increases the likelihood of injury. Therefore, both the strength and short time endurance of these muscles should be improved before going heavy on the good morning. This strengthening can probably be accomplished by doing a well-balanced routine during the year of doing sub-maximal good mornings. It is critically important that this routine includes not only absolute and dynamic strength exercises (glute ham raises, pull throughs, reverse hypers etc.) but also static exercises (ab holds etc.) AND core muscle exercises (recall that they are only activated when we are about to lose our balance, so this means labile environment training, i.e. stability/swiss balls, balance boards etc.). GPP, such as sled dragging, à la Westside should also beneficial in building up local endurance in a powerlifting specific way.

3. Consider seeing a joint mobility specialist every once in a while (the osteopath suggested once every few months I think) to see if your spine needs to be adjusted as having misaligned vertebrae will increase the risk of injury, especially in the good morning. As misaligned vertebrae are often related to muscle tension, massage of tight muscles should also be beneficial (the more often the better).

4. Don’t do very high reps on the good morning as it will make you more tired, and will hence make you breathe quicker, which has been proven to decrease motor control. I’ve seen the same recommendation made along pretty much the same lines for the deadlift, i.e. keep the reps low to keep form good. How low to go is perhaps subjective, but perhaps no more than five reps a set. A few quality reps with 100% concentration will always be safer than 20 reps done in a sloppy fashion.

If we assume that these recommendations are valid, then it is painfully clear how unprepared I was to start going heavy on the good morning within a month of making the transition to powerlifting. As per the advice of my therapist, I am now making up for that by strengthening the core muscles, but there is indeed still much to be done on this front.

At this point, I am still unsure about whether I will ever again do good mornings for singles or even triples. Looking through the entries of my pre-injury max lifts on the good morning, fear of the lift shines through.

Decided to go for good mornings, but stop well short of ripping my back in two.
9 June 2003: 2 @ 80 kg/177 lbs

A triple at 90 kg/199 pounds was about as much as I dared to do without a power rack.
16 June 2003: 3 @ 90 kg/199 pounds

Rechecking the exercise description at Elite Fitness, where it says to stop “slightly above parallel”, makes me think that perhaps I should stop a little earlier. Going down that deep is plain scary.
22 September 2003: 3 @ 95 kg/210 lbs

After watching the Westside deadlift video, I came to understand that good mornings are done with pushing the glutes back and slightly bending the legs instead of just going down like a jack knife with straight legs. It sure feels about 5% less dangerous to do them the former way…
10 November 2003: 5 @ 100 kg/221 lbs

The thing is that good mornings felt nice and dandy up to about 80 kg/177 lbs, i.e. about 10 kg/22 lbs less than bodyweight. Anything heavier than that, and the strain on the lower back put me in fear zone. No matter, I would just acknowledge the fear and go for it. Still, this makes me want to add a final parting thought:

5. If you constantly fear injury on the good morning, it will happen sooner or later. By following the previous advice, perhaps you can rationally conclude that the exercise is now safe (it should feel a lot safer too if your supporting muscles etc. are freaky strong), and go for it. Perhaps this is the ultimate indicator of when you are ready to max on the good morning?

Next week I am scheduled to meet with the back therapist again, so it was high time I got my current rehab routine on video (2.7M); the first entry-level program clip is here. Was happily unaware of the fact that the gym is closing 7pm Sunday, which helped me dig down and train fairly “fast” as I arrived at 6.30.

The rehab routine calls for balance board standing and squatting as the first exercise. Since there is no board at the gym and I am not quite ready to stand on a stability ball, these are not on tape. Should have replaced them with kneeling on the ball of course, but alas my memory…

Some quick key notes on the exercises: on both the muscle activation and the upper pulley twist the objective is to try to keep the waist stable and non-moving, for which purpose there need not be a dung load of weight. In contrast, on lower cable twist the idea is to get a large twisting motion in the waist to occur, which, according to my therapist, will train the rotators et al. in a much more functional way than any of those waist twist machines found in gyms (I call it the ab twist machine). Note that the arms should move in close to the body on these; save the full swing for the golf course. A big rotation is also the aim of the walk outs, i.e. turn with the arm. Finally, on the ball hypers the sole of the feet need to be against a wall, otherwise you’ll tip over.

Tomorrow, ME Bench. The rack lockouts I did on Friday did indeed not cause much soreness, but did not think far enough to realize that the massivish overload for the shoulders would cause them to tighten up further. Frantic thumbsaver action going down.

Some days you feel dandy and are prepared for soaring to new heights, until you actually start flapping. Did not need more than the barbell itself to realize that the usual spot on the front of both shoulder had again turned into tight knotty bands (blame the chains?). Being all pre-occupied with my back, I have lately come to neglect the shoulder massage, so here we are again. The tightness can usually be dissolved within a day or two by massaging hard for one minute several times a day, i.e. normal trigger point massage. I still find a tennis ball excellent for the job, but have also started to use a so-called thumbsaver I bought from the Thera Cane central for $6.95. Made of wood with a pointy rubber head, it is perfect for staying on the spot and going deep. Doing this with a thumb works, but after that you have a strained thumb on your hands… The thumbsaver is also small enough to be easy to carry around in your pocket, and, unlike the tennis ball, you don’t need to have a wall handy.

Felt the shoulders could handle some work without going spastic; sets of five on close-grip benches were suddenly basking in a very attractive light. Worked up to 5 @ 80 kg/177 lbs, then it was time to bail out. Not wanting to beat the shoulders any further, I just did a single set of JMs before moving into the usual back and forearm work. Just for fun, I tried lying rows with the chains hanging double from the sleeves of the bar. Unlike benching, this movement gets harder the further up you get, so a good explosive start proved imperative if I wanted to get the bar to touch the board. Quite nice actually.

For the first time, I tried some plate curling for the forearms. The idea is simple: grip a weight plate in a pinch grip, then do a normal curl with it. Although it looks like a biceps exercise, the real deal is trying to keep the wrist from bending backwards during the curl. I found a 10 kg/22 lbs plate a little too much, but pinching a 5 kg/11 lbs and a 2.5 kg/6 lbs plate together was just enough. I highly recommend this one. There are several variations on the theme, from curling the plate with a finger through the hole via curling with a board to wrist curling plates.

And oh yes, skipped Sunday’s rehab workout as my hamstrings and pals were all tied up from Wednesday’s lunge workout.

The usual post-winter chores at our summer cottage involve a fair share of lifting in the form of boats, bags of fertilizer for my dad’s countless roses and furniture that wants to come out in the sun. Nothing super heavy, but I was slightly afraid the highly repetitive lifting would be a little too much for my back. Happily it wasn’t.

On the training front, I have occupied myself with thinking about how to best upgrade Toffe’s Gym to an outdoor powerlifting mecca. One of the most urgent additions is a stability ball for my rehab and stability work, but unfortunately I could not locate a ball in the city that was guaranteed to be both burst-proof and loadable to at least 300 kg/663 lbs. Am going back to Helsinki for a few days tomorrow, so will get one there.

With no ball and no cable machine, I summoned Kris the carpenter and set out to construct a balance board that I could do the prescribed bodyweight squats on. After extensive prototyping, I ended up splitting a piece of alder in two with the axe and tapering down the sides of it so that it would rock not only sideways but forward and backward as well. Next I molested an old car tire to get a suitable piece of rubber to drape the piece of wood in. After all, this balance board should be stable in outdoor conditions, even in the eventuality that it has rained. Finally, I nailed a board on top of it and put some more tire on top of the board for the feet. Thus the All-weather Balance Board was born.

Today’s mini clip (520 KB) should give you the general idea of how this board behaves. Although I did eventually manage to do a few bodyweight squats on it without touching the ground, it will be a challenge to get comfortable on top of it. Stability training is never boring, let me tell you. Think I will try side raises standing on the board tomorrow as part of the first hardcore outdoor session of the year. Until then, remember that whatever the road conditions, the All-weather Balance Board delivers.

Broke the routine and did my ME bench workout today as my two latest attempts were foiled by too much soreness from the previous DE bench workout. With a ticket to Metallica’s concert in Helsinki on Friday, I am somewhat likely to skip Friday’s DE bench workout anyhow.

Forgot my latest rehab workout instructions at home, so took the ball thingy to its extreme and did the whole bench workout on it (VIDEO, 4.5M). My training partner Måns came up with the idea of taking the ball to the rack for benching. Pin presses were suitably unstable and more difficult than on a normal bench, JM presses might actually have been a little easier on the ball in spite of the bouncy ride. Also tried doing side raises kneeling on the ball, which was a little easier than I had thought. Still, I did have to adjust my balance continuously lest I throw the dumbells through the roof. Finished off with dumbell curls sitting on the ball. A great workout. I wonder if benching on a stable bench will not feel a lot easier if I keep this up…

If you try this, make sure you have a burst proof ball (will not explode, but deflates slowly if it breaks), have the pins set so the bar cannot implode your chest even if you drop the bar and see that the ball is certified as being able to handle the load.

Two weeks have passed since I got my initial stability routine. During this time span I have gone from having a protective cramp pulling me out of alignment and having a hard time moving normally to regaining normal mobility and posture. And best of all, this change took place during fairly strenuous core muscle training that I would not have dared to do if it weren’t for the fact that they were prescribed to me. The first workout made me hurt more, but after that it has been all downhill.

Today I got some sense of the proportion of the hill. The back therapist told me that I can expect my discs to be fully recovered within another six months, provided I don’t do anything stupid. By that time, I will also have much strengthened core muscles that will go a long way in preventing this from happening again. The mind-set I have know is one of conditioning as opposed to brutal bar bending singles. Squats, like other main squat/dead lifts, will start figuring in my routine in this context, as will an emphasis on GPP (don’t worry if you don’t what that means, I will get back to that when I start sled dragging sometime this summer). Although I should be able to train my upper body much as normal, some of this new thinking will no doubt rub off on that as well; can’t wait to try JM presses on the swiss ball…

Today’s consultation was focused on helping me build my arsenal of stability exercises. First up was bodyweight squats on a balance board; hard at first, doable in the end. She then took me through various cable movements, including some twisting exercises. She assessed my degree of muscle activation in these by holding her hands on my lower back, concluding that my left side is working at full capacity, while the right does not get fully activated (a neurological problem I will address in a later post). Then she tried another neural mobilization exercise on me, but as that mainly stretched my inflexible calves she dropped that one. I was also asked to show her all the exercises from the previous rehab program, some of which she modified to make a little harder. “It is obvious you have done these quite a lot”. Small ego boost there.

Regarding the McKenzie extension protocol, she said that it would probably be enough if I continued doing them lying down before hitting the bed every night. But I should continue the habit of bending backwards standing now and then, especially following prolonged sitting, driving and such.

We agreed that I would come in for a follow-up visit on 20 July, which would allow her to assess whether my muscles have regained their balance or not, and help us talk about how to proceed vis-à-vis squatting and such. Tomorrow then, I take my rehab downstairs from the stretching area into the heart of the gym.

Had to drag my behind to the gym today. Once there, the music (AC/DC, imagine that) combined with a bottle of Andrenalyn stack transformed me into a well-oiled training machine. The Blakley speed benches, which I now did in classic Westside style for nine sets with three sets for each grip width, went a lot more smoothly than last week. Most things felt great today, even did some one-handed rows in a ultra-strict slowmo fashion on the Kraftwerk one-handed row machine.

Also decided that from now on, I will start to do more bicep work. After starting to powerlift, I have usually done something like zero to three sets of direct bicep work a week. This might be enough for powerlifting, but the fact that I used to curl with 24 kg/53 lbs dumbells easily during my bodybuilding days but am now struggling with 18 kg/40 lbs gives some reason for thought. Could also use a little more volume on the front of my arms to balance the growing triceps. I have almost forgotten how fun training the biceps is.

As usual, I did my rehab work at the end of the workout. Finally adjusted the training day counter in the sidebar (this way –>) so that it now shows the correct workout on the correct day. As you might have noticed, I am doing the standard Westside four day split, but with benching on Monday and Friday. The reason for this is that my training partner is usually training on those days, so assistance is readily available for benching if need be. Since I have gotten into the habit of doing rehab after every workout, the Sunday DE squat day is in practice a rest day until I can box squat again.

My back is doing a lot better now. I seem to be straight and I can move normally at last. Like McKenzie suggests in his book, I have cut back on the frequency of back extending, but am still doing them several times a day or as needed. For the first time, I could also do assisted hamstring stretching for both legs without the back complaining. A week ago I could stretch the right leg, but could not even get a mild stretch in the left before it started hurting like h*ll in the back. The sweet taste of progress. On Tuesday, it is back to the back clinic for what will probably be the last consultation before I am on my own.

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!

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.

“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.