Yesterday marked the beginning of my 10th week since my injury, and it also marked my new hopeful 6 week countdown to full recovery. On exactly this date last year, I was just two weeks into starting my Facebook fitness page The All-Natural Athlete, and was celebrating Week 9 of being a clean eater trying to figure my way through the tangled web of losing weight and gaining muscle (click here to see that post). Revisiting that blog post brought back such fantastic memories, since week 9 was when I was finally starting to see serious results -- the running shorts I had been wearing for almost a full decade were now too big for me to wear! That sentiment ironically is identical to how I feel now; I finally am beginning to not only feel better, but feel strong again. I continue to struggle with a stiff back in my sacral region at the end of a busy day, but nothing a little ice and 30 minutes of rest can't do away with. Each week my Physical Therapy team gives me new work to do (this week we've added unweighted back hyper-extensions, and next week reverse lunges will be thrown into the mix) and I'm starting to see the light. In both cases - first changing my whole lifestyle last year, and now this year repairing a variety of sports injuries that were, sadly, inevitable -- the first months were an enormous and often times disheartening struggle. They were a vicious game of patience, and required a lot of trust in the process. Physically, psychologically, and emotionally, there was not one easy thing about making it through the first 2 - 3 months of harsh reality. But in both cases, the strength and lessons learned in keeping focused and determined to change and be better for it have paid back to me more than I ever could have imagined. It was the greatest thing I ever achieved in my life last year to become a clean eater, and I know that healing my body now so that I can come back to be a kick-ass athlete later this year will be one of the greatest stories I'll have to tell for the rest of my life. I am already grateful for the challenges dealt to me :)
With that said, several of my friends and volleyball/fitness acquaintances have been asking me what my PT guys have been doing and teaching me to rehab my back, both in the acute stages as well as in the strength/preventative care stages. I've been meaning to share everything, so here goes!
I would like to start this by saying I have absolutely NO formal education in any of this. I am merely regurgitating everything I understand as being taught to me by my PT guys based on my own individual situation. For more details on my own situation and the cause of my back injury, please read my blog post here (about halfway through the post I discuss my anatomical maladies). In short, I deeply sprained my L4/L5 and L5/S1 discs as a result of my quadriceps completely overpowering my hamstrings and gluteal muscles, causing my pelvis to be pulled forward, which then created a tug-o-war effect between my quads and my spinal erectors since my hams and glutes couldn't do the job. Thus, my therapy has been geared toward stretching out my quads, opening up my hips, and aggressively strengthening my hamstrings, glutes, abs and lower back muscles in order to rebalance the torque being placed on my pelvis, and to stabilize the whole region to protect my lower lumbar from unnatural strain.
THE ACUTE PHASE (First 3 weeks): The first 3 weeks were rough. I was in terrible spasms and my discs were slightly slipped and pressing on nerves, causing nerve pain in my hips, glutes, and down my left leg. Physical therapy consisted of ART (Active Release) treatments. Chiropractors and physical therapists actually have to be certified in this type of therapy; it should not be done by a street masseuse. I was placed on a table the bent back and forth at the waist, creating movement in the spine, and had ART therapy done to me in my lower lumbar region along my spinal erectors to help break up pre-existing scar tissue from previous injury, and to help release the spasms in my back. At home, I was told to take 800mg of Advil twice a day (morning and night, 12 hours apart, with food). I was to walk for 15-30 minutes in the morning and the evening on flat paved ground with proper footwear; even if it hurt, I was to walk. Walking helps loosen the muscles and open the hips to help release tension. I was to heat my back in the mornings and the evenings, particularly before I went walking. Otherwise, I was to ice several times for 10-20 minutes, particularly when my back started to hurt. I was to avoid sitting as much as possible since it compressed and pinched my spine. Ideally, I was either standing, or laying in the only position I was allowed to sleep in - with my back flat on an egg crate mattress, a thin pillow under my head, and my knees up and bent at near a 90*-angle, similar to the photo above (I would just stack 3 pillows under my knees). This position helped TREMENDOUSLY.
After 2 weeks of the above routine, I was taught to do 2-5 sets of "Prone Hip Extensions", holding the position for 20-30 seconds each. Lying face down, knees touching the floor, toes pointed and heels slightly pointing outward, I was to squeeze my glutes and "tuck my tailbone underneath me". This action activated the glutes and hamstrings to pull my pelvis back and into alignment. Here is a video of that action. Please note: In the beginning, I did the first version of this video. As I progressed, I now do the second version demonstrated in this video:
In addition to this, I did 5 - 10 very gentle "cobra" movements (Here is an image of cobra pose - only held for 2 seconds each time)
THE RECOVERY PHASE: In weeks 4-6, I was more or less taken away from "therapy", and shifted to active recovery. I was still heating, icing and "Advil'ing" during this period. In addition to doing the Prone Hip Extensions shown earlier by video (with bent knees), my PT guy did some brutal (but of course, highly effectively!) therapy to my hip flexors near my abdomen and groin, and discovered my quads were full of scar tissue so we did some deep ART massage there.
I was also given my first homework to start doing. First it was the Prone Hip Extenions and cobras, but now we added "Hip Openers with a Stability Ball". I did 4 sets of the Hip Openers per each leg, holding the pose for 30-45 seconds. Follow this link to the video; for some reason, Blogger can't locate the video for me to upload: "Kneeling Hip Openers" (link redirect: http://www.youtube.com/watch?v=FAolljf8vps) In this movement, for various weeks I did this stretch staying erect or leaning back a little bit, before my quads were loose enough for me to then proceed with the exercise and lean forward.
Next, I had to foam roll my IT bands like crazy. They were so painful in the beginning, it brought me to tears!
I was also taught "Pelvic Tilts with Tidal Breathing". Tidal breathing is breathing slowly in through your nose and letting your belly extend outward (instead of breathing "upward" into your lungs), and then breathing slowly outward through pursed lips. Pelvic Tilts had me laying on my back with my knees bent. Breathing in and letting my belly rise, it would lift my lower lumbar off of the table. When I breathed out, I was to tuck my pelvis underneath me so that my lower lumbar touched the table. This creates movement in the spine and is good for it (although I cannot site specifically why..the video explains :D). Here is a video showing this exercise:
I would do 25 sets of the above exercise once a daily, sometimes twice later on.
THE REBUILDING PHASE: PART 1:
Between weeks 6 to present, I have continued to gain new exercises each week I receive therapy. I was assigned to do forward planks and to do 4 sets of 20-60 seconds each. The proper way to do a forward plank is here (again, Blogger cannot locate this video. Ugh!): Forward Planks Video (link redirect: http://www.youtube.com/watch?v=uQtvkzhg-Ls)
I was also taught to do lateral planks with a foam roller between my knees. As this video explains, that is to keep a neutral alignment of the spine and pelvis. Blogger won't let me updload the video, so here it is: Lateral Bridge (Link Redirect: http://www.youtube.com/watch?v=001_lfX1rjM)
I was also prescribed to do 4-6 sets of 10 reps at 70% strength of two separate hamstring curl exercises: The first was the seated one, the second was the prone (laying down) one. In both instances, I was to have my toes slightly pointed inward, to target my medial hamstring which is very weak. Here is a seated leg curl tutorial:
And here is a prone leg curl tutorial:
In addition to these exercises, I was allowed to start walking hills for 30-45 minutes each day, which I progressed to hour-long hikes eventually.
THE REBUILDING PHASE: PART 2:
2 weeks ago, the "T Exercise" was added to my repertoire. This, to build my glutes, low back, and also my thoracic region which has also been in flexion. Again - SHOCKER - Blogger won't let me upload the video. So here are the links: Y's and T's (link redirect: http://www.youtube.com/watch?v=zoi2KmtNHaY) *Please note, I have not graduated to Y's yet*
I was also given Floor Bridge exercises to do. I was taught two of them: One using a stability ball, and one just lying on the floor. I only do the floor one (don't tell my therapist!) :) Floor Bridge (link redirect: http://www.youtube.com/watch?v=sSQhcG-aqYQ)
And last week, the back hyper extension exercise was added to my routine. I was told to do this 4 sets of 10 reps but I've only been able to do 3 sets of 8 reps.
I do all of these exercises in conjunction with all the ones previously assigned me. I'm 2.5 months into this process and I now only take Advil when needed, I ice each evening and anytime after I work out, and I heat every morning when I wake up, every time BEFORE I work out, and I also place the setting on low and sleep on the heating pad each night.
I know that soon, I will be adding reverse lunges and stuff, and will post those when I cross that bridge. The goal in all of this, as mentioned before, is to train the back of my legs and get them strong enough to pull back against the force of my quads so that my Pelvis comes into a neutral position. Also, to continue to stretch out and massage scar tissues away from my quads so that they will loosen up on their pull on my pelvis.
My back still cracks a lot, I have a standing desk at work to avoid much sitting, and I still sleep in the same position each night (or on my side with a pillow between my knees). I have good days and bad days, but I more or less am in a position to move about freely without pain. I don't lift heavy things or do anything not prescribed by my physical therapist though. I do, after all, intend to make a full recovery and train to run a half marathon in November, not to mention still train to do maybe a figure competition at some point :) More updates to come soon!
