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Saturday, 8 January 2011

Xmas Back Injury 2010

This is a very personal post about my Christmas injury.  On the 27th December I bent over & suffered a bad back trauma.  This was the second time in as many months I’d suffered an injury to the back.
I began digging into the research & resources all about back issues, the causes of back pain & possible corrections for my condition (NOTE: I’m not a medical professional.  I am a qualified massage therapist & personal trainer, so any actions I use to correct my perceived issues may not be suitable for you.  Always run any exercise program past your medical adviser before you use them).
First off I discovered an interesting fact.  In an acute injury, the injury often recovers at the same rate whatever protocol you use.  That is whether you go to a chiropractor, an acupuncturist, or just use pain killers & bed rest; many acute injuries (one’s that clear up quickly) tend to take the same amount of time to recover whatever you do.  So, the person who said to you “Wow! I went to this person & I was better within 2 weeks!” is just as likely to have improved at the same rate with no intervention at all!  You can get pain relief by using other protocols, but not improved healing on an acute injury.  Chronic injuries are different (injuries lasting 3 months or more), these do seem to be affected by manipulation, possibly acupuncture & several other protocols. 
The real issue with an acute back injury is what you do after recovery as re-injury is much more common if you do nothing.  So, what are the issues that arise in acute back injury - that is a back injury where the pain goes within a few weeks- we are NOT talking about chronic back injury here.  Although some of the advice below may help a chronic back sufferer, see an expert & run it by them as some conditions can be made worse by inappropriate exercise.  First off are the multifidus muscles that run up the spine.  There is some speculation (with research to back it up...but not absolute proof) that these muscles can be oddly affected by injury.  In the area of an injury the fast twitch muscle fibres of the multifidus appear to shrink (the fast twitch muscles are the ones that react quickly & strongly to any change), the muscle also begins to get hyper-stimulated & so are more activated than they need to be (again ONLY in the area of the injury).
For those who don’t know what the multifidus muscles are.  They are a whole group of muscles that run up each side of the spine, they kind of grip one vertebrae to another all the way from the top to the bottom (sometimes they cross two or more vertebrae).  They are one of the main groups of muscles that facilitate spinal movement.  You can only really feel them down by your waistline (& a little above), they are bands of muscle each side of the spine, but as they go up other muscles sit on top of them, so you cannot feel them directly anymore.  So think about it, if these guys are ‘gluing’ your spine together & helping to support the skeletal frame & they only cross one or two vertebrae, then what happens when one gets injured, shrinks & get’s hyper-stimulated?  It will be pulling inappropriately when it doesn’t need to & it will not be able to react to a sudden movement like bending over, twisting or even reacting to a sharp change in balance.  Also remember this will happen on ONE SIDE of your spine only, so what does the other side do, what do the structures immediately above & below do, what happens to the whole spinal support structure?  That depends really on where it is, how bad it is & what you actual do.  There is worse to come.  Apparently the multifidus muscle has this weird atrophy that shrinks the fast twist muscle & it does not appear to rebuild very easily without specific work, which is bad...but it CAN be rebuilt, which is VERY good news!
As well as the multifidus you have to look at the other muscles of the body.  So, checking out glute & hamstring strength (especially left to right asymmetries), hip flexor tightness, adductor tightness, internal-external hip rotation, quadratus lumborum (QL) tightness (again left to right differences can be common here).
In my own case I found the following:
  •          Tight right QL
  •          Weak right glute
  •          Weak right Hamstring
  •          Some anterior pelvic tilt
  •          Some multifidus asymmetries (my bird dog had gone to pot)
So, that’s what I found when I was able to test myself after the second incident.  I believe the first back issue (caused by a poor deadlift) actually caused some multifidus issues, but prior to that I had been developing some left to right asymmetries for some time, pushing much more on the left side than the right.  This was mainly due (I believe) to some nerve damage I have on my right big toe that makes balance a little harder that side & so the body is shying away from fully committing to that side during the big lifts?
So what exactly happened on the 27th December?
OK I will bare all (literally) in these pictures below.
In both pictures I am attempting to stand up straight without flexing.  The pictures are taken on the morning of the 28th Dec & the 2nd Jan. Within 6 days I am back to near symmetry!
Here’s what are you seeing on the 27th December photo?  The right hip is being raised by an ultra tight QL, you can’t see this so clearly, but the spine is completely flattened when seen from the side (no I’m not putting up side shoots as I was naked!  You’ll just have to trust me), the lower spine lost all extension all the spine looked completely flat when seen from the side top to bottom.  The spine took on a scoliosis-like look as it literally appeared to snake up my back, the left shoulder & scapula are raised.  The glutes ‘disappeared’ (again seen better from the side, but I think you can see this well enough here).  The whole back lost any muscle tone, the lats switched off as well – this is the first time I’ve actually witnessed muscles being visibly inhibited & structure being visibly altered in such a drastic way through one injury that took mere days to right itself.  For comparison I’ll put the 2nd Jan photo up, so 6 days later I was nearing total symmetry again, the back has regained its natural curvature & the scoliosis-like effect is gone, the glutes are back, the scapulae & shoulders are near level.
So, everything’s ok, right?....WRONG!
I put myself through a pretty extensive screening once I was able to move correctly.  I found my ability to do a bird-dog on one side had become problematic (that may be a multifidus issues), the weak glutes & hamstring on the right, tight right hand side QL, some anterior pelvic tilt, limited internal hip rotation (worse on the right), tight adductors on the right, I’d also developed a tendency to ‘tail tuck’ at the bottom of even a bodyweight squat.  Obviously I have a lot of work ahead of me!  Looking at the issues it becomes clear that I’ve been developing these issues for some time & only now are the ‘symptoms’ starting to show.  So, this probably isn’t going to be an overnight fix.  So, what are my plans?
Well first off I bought an inversion table.  It seems like that will help with the immediate symptoms while I try & deal with the ongoing problems & hopefully aid in warding off another back issue while I work on the problem. 

Enjoying a first go on the inversion table (there's 
even the box it came came still in the background)
Next up I began a rehab protocol, that consisted of:
  •          Plank
  •          Side plank
  •          Bird-dog
  •          Hip Hiker (standing on a step & raising & lowering the hip)
  •          Internal & external hip rotation (you do external hip rotation as tight external rotators can sometimes stop a hip internally rotating)
  •          Glute bridging
  •          Bodyweight squat (working on keeping the form super tight)        
  •          Hip adduction
  •          Hip abduction
  •         Leg curl on stability ball
  •     Self myofascial release on the back, glutes, hamstrings & hip flexors (try using a tennis ball down the back.  Start with the ball at the top to one side of the spine, arms by the side, raise the arms first above your head, then across the body, wiggle a little.  Now move the ball down a cm & repeat – do that down both sides of the spine to experience some real pain!).  Check out a quick guide I did on self myofascial release (SMR) at pdf version (right click & 'save as') or MS Word version (right click & 'save as') for  some details on how to do simple SMR.
That along with the inversion was the foundation of the rehab, but as things move along I will start to introduce some unilateral lifting (like split squats, suitcase lifts, one arm overhead pressing etc).  Why unilateral? Well think about it, I have a left to right imbalance, if I just ‘work harder’ on the bi-lateral squat or deadlift for example I’ll just reinforce the improper movement dysfunctions I’ve already developed.  I have to learn to strengthen both the left & right hand sides on their own, until the right can learn to ‘keep up’ with the left.  I suspect that due to the nerve damage in the right big toe that I may need to revisit unilateral lifting a few times a year to make sure everything stays in balance.
I’ve suffered a setback, that is very true.  I’ve had to re-evaluate my goals, set some things I had planned for 2011 onto the back burner for this year...but, I’ve found an issue, I have found a weakness, which begs the question “If I fix the weakness, how strong will I get?”.  If I fix myself right will 2012 be a really record year for lifting & gains?  How much have I been held back by being imbalanced?  These are exciting questions that I hope to answer over 2011.  Let’s hope I can rebuild a more symmetrical strength that translates into much better lifting & much better results.  That’s my goal for 2011.  I don’t want to just get back to where I was before the whole ‘back issue’ started, I’d like to soar beyond it, using the new knowledge I have discovered about myself to really improve beyond what I would have been able to if this issue hadn’t come up.
If there is sufficient interest I don’t mind putting up stills or even short youtube clips about my rehab adventure, let me know below if you’d be interested in following the adventure?  But do bear in mind, this is NOT a prescription for back injury recovery.  I am not a doctor, nor am I qualified to diagnose.  If you intend to incorporate any exercise or rehabilitation protocol (even chiropractic work or acupuncture etc) then always run it past your back specialist first as each condition is unique & each person is slightly different, so always check first & even if you get the go ahead NEVER work into pain.   You cannot beat a bad back into submission, it will always have the last say if you try to go head to head in a ‘suffering contest’.  So, be sensible, take things slow, & aim at slowly returning to full physical function (or as ‘full’ as your condition allows).  Any questions, ideas or anything else just write below.
Finally this was a pretty hard post to write.  Baring your all (in the case of some of these photos it was pretty damn close!) & confessing your own mistakes is quite a hard thing to put up online & let the world read.  Hopefully you’ll all take some time & not just post a comment, but to check your own bodies out, fix any asymmetries or other issues before a problem rears its ugly head & puts you onto the sidelines for a while.  Prehab should be an issue every athlete or lifter takes seriously.  Hopefully I’ll be taking a lot more care of the ‘little things’ from now on as by doing that I can keep lifting & hopefully still keep making gains for many years yet!