Hurt All Over

[bkred]

I ruptured a disc (L3/L4) in my lower back in 1994 and subsequently had back surgery to remove the disc. There's a term for the surgery I can't remember now and could never spell. Since the surgery I've been diagnosed with arthritis in my low back. I've continued to be active, jogging, biking, lifting, diving, but rarely does a day go by without some pain/discomfort. On really bad days my left foot will drop or I will limp a bit. Nearly every day since the surgery I've done some sort of stretching - mainly hamstring stretches. I'm getting by but concerned that matters will only get worse with age. Any advice as far as exercise, stretching, supplements would be appreciated.

[Bill Hartman]

Could you start me off with a hard one?? [sarcasm…yes I’ll have some]

First let me say that you have tackled the most important issue of recovery and healing by staying active. Congrats to you.

Recommendations:

Aerobic exercise on your feet. Research will show a positive relationship between being aerobically fit and controlling low back pain (LBP). I would do it on my feet simply because there is a rotational component which will promote endurance development in the deep rotators of the spine. The muscle have been shown to be atrophied in chronic LBP patients.

Increase trunk extension endurance and strength. After back injury, trunk extensor endurance decreases dramatically. Once the pain episode appears recovered, the lack of extensor endurance remains unless corrected.

Avoid repetitive or constant flexed postures, loaded flexed postures and prolonged sitting. These activities increase spinal compressive and shear forces on the spine which can aggravate tissues.

Avoid heavy, loaded twisting movements or flexed twisting movements. Remember the old seated rotation machine from Nautilus and all the copycats? That thing is pure death for a spine.

Now that being said. I have rehabbed a couple of my golfers from discectomies to full activities and exceptional golf using some of the following.

Birddog exercises – down on hands and knee and raise opposite arm and leg. If you went through any rehab you should be familiar to them. I use it as a pre-hab exercise mostly to train the smaller rotational muscles in neutral.

Good Mornings – these kind of break a lot of rules in rehab but do wonders for posterior chain strength and endurance. Just be sure to maintain neutral spine at all times.

Standing one-arm cable rows – the one arm row creates a rotational force without spinal rotation which promotes spinal stability. This exercise also strengthens the coupling relationship of the lats to glutes to hamstrings which is very important in lower back strength and injury prevention.

Isometric Lunges – this exercise promotes increased flexibility, strength and endurance in the hip flexors which tend to be tight in folks with LBP. Work up to reps of 60 sec holds.

Hyperextensions or Reverse Hypers – another great posterior chain strengthener

Lat pulldowns/chins – very important for posterior chain strength and lumbar stabilization.

Standing cable overhead pulls – easy way to load rectus abdominis in standing. Looks like a standing cable pullover.

You’ll need to determine your weak points and select the appropriate exercises. If you give me some more info I may be able to provide more specifics for you.

Be sure to follow the “Statute of Fitness Limitations” for loading parameters and avoid pain during training or prolonged symptoms after training. This should be a long process. Don’t rush it!

Bill Hartman

[bkred]

Bill,
Thanks for the advice. I've noticed prolonged sitting agrevates my problem, unfortunately my job entails a lot of sitting, but I try to get up and move around as much as possible. Same with twisting movements. Birddog exercises have been recommended to me previously and I've done them off and on. The advice to do aerobic exercise "on your feet" is interesting in that most books/magazines seem to advise non-weight bearing exercises such as biking and swimming for back problems. I think it's probably a matter of finding what works best for each person.

Thanks again.

[Bill Hartman]

FYI, regarding the on your feet comment.

Not sure how your rehab went post surgery, but the first thing we do in clinic with post-surg patients is get them walking as much to tolerance. In fact, we have one doc who will only allow patients to walk. No other exercises. That drives me nuts!

Regarding sitting. I've had several long-term clients who are now using a stand-up desk. They love it! They will occasionally use a high stool for standing breaks, but it has made a huge difference in their function overall.

I also don't like sitting aerobic activity for 2 reasons. One, sitting increases disc pressures and compressive loading on the lumbar spine compared to standing. Two, activities like stationary bike promote tight hip flexors which over time will increase shear forces on the spine and facet arthropathy (wear on the joints).

Bill

[Bill Hartman]

bkred,

I got an email from brb brb reminding me that I should have included a recommendation to seek further medical attention for your foot drop symptoms. They may be indicative of further pathology below the level of your initial injury.

Bill

[bkred]

Bill,
I received your email. Thanks again for the advice. My foot drop, occurs from time-to-time, usually when I'm real tired, or when I'm having a flair up with my back. I see a Rheumatologist every 6 months with the next visit scheduled for August. We usually discuss my symptoms in some detail and we've been keeping a record of the foot problem. I think it's been improving so I haven't seen a neurologist of gotten an MRI in some time.

Rehab by bulletin board has got to be tough. Thanks for stepping out and sharing your experience.