Ten days ago, I had a busy Friday schedule with one 45-minute gap between patients in the middle of the day to be able to sneak a workout in. I wasn't able to wait until the end of my work day because I had plans for dinner with my wife and some family and had already extended my typical hours to accommodate a patient. So if I wanted to get any physical activity in for the day, I was going to have to make this 45-minute gap work.
Typically, I would incorporate anywhere from 5-15 minutes of some form of movement preparation/dynamic warm-up/athletic development prior to starting my predominantly weight training-based workout for the day. But due to my limited time, I figured I would skip it altogether and just keep it to a moderate intensity day.
To be as efficient with my time as possible while also adding a little complexity to my movements to get maximize the benefit out of a day that I am not pushing heavy weights, I decided to write a workout revolving around different landmine variations. This is what the workout looked like (if my memory is strong, which it is not):
A1 . Landmine Single Leg RDLs 4 x 10-12 each
A2 . KB Arm Bars 4x 6-8 each
B1 . Split Stance Landmine Press 3x10-12 each
B2 . Landmine Trunk Rotations 3x10 each (maybe some people call these something different? I don't know. I make up names of exercises all the time)
C1 . Stagger Stance Bent Single Arm Landmine Row 3x10-12 each
C2 . Split Stance Rotational MB Slams 3x 8-10 each
D1 (time permitted). Alternating 45's 0:45 on /0:45 off x 3-4
(For anyone who does not understand how to read programming like this, exercises with the same letter associated with it (ex: A1, A2) are done one after another, for the given number of sets, before moving on to the next set of movements.)
Okay, great. I get to prove my brilliance by incorporating unilateral exercises with rotational components and getting a solid amount of volume in a limited window to get a training effect (sweat and not be fat) while working on some movement deficiencies of mine. Well here is where the shit hit the fan:
During the second (maybe the third) set of landmine single leg RDLs (left leg), I remember feeling a general pulling sensation in my low back near my sacrum. Nothing too significant and nothing that anyone who works out regularly has never felt and just shrugged off and moved on. So I continued my workout with a subtle tension in my left SI joint/low back. I made it through "C2" when I decided to cut it early to change and prepare for my next patient. Over the next few hours of work, I felt my back slowly tightening up to the point where I couldn't fully demonstrate certain exercises for my patients and I started to walk a little hunched over.
When the day ended, I went out to my car to leave and I could barely maneuver my way into the driver's seat. I had to keep the seat reclined and throw on the heated seats, pressing my low back into the seat the entire way home attempting to find any short-term relief.
When I got home, I needed to shower and get dressed fairly quickly so we weren't late to our dinner reservation. Getting into the car to drive to dinner was even harder than before. I had sharp pain the entire ride and needed to use the handles on the side of the door to pull myself out of the car when we got to the restaurant. We greeted my brother and sister-in-law in the parking lot and they remarked that I was leaning hard to my right side and looked ridiculous. As I attempted to start walking into the restaurant, I could barely put one foot in front of the other. It was starting to even get difficult to breath every time I would land on my left leg when walking.
Somehow I got to our seat. We had a phenomenal dinner (shoutout to 618 in Freehold, NJ). When it was time to leave, it felt like it took an eternity to get out of my chair. My wife and family thought I was exaggerating my limitations, but when I was standing motionless in the middle of the restaurant, they realized I was not joking. I needed to wrap my arm around my wife's shoulder in order to get back to the car. There is no doubt that the entire restaurant thought that I was being carried to the car because I was belligerently drunk.
When we got back home, getting in bed was an even more complex endeavor than getting in and out of the car. Laying down did absolutely nothing to alleviate my pain and transitions (rolling from my back to my side or vice versa) were even more excruciating. We even attempted to manipulate the adjustable base to our bed but, bringing my legs up, again, made little to no change in my symptoms.
I woke up Saturday morning afraid to move. I had just got 6 hours of broken sleep with intermittent sharp pains waking me up. I was nervous about turning to my side, attempting to sit up and even more so of standing up (this is the transition we learn in PT school to assist with bed mobility). I held my breath and moved through it slowly, but the sharp pain was worse than the night before. When I stood up, I was bent at about a 45 degree angle at the hip towards my right side and I couldn't put weight on my left foot without feeling like someone was putting a Valyrian steel sword through my left SI joint.
I immediately texted two of my good friends who also happen to be Physical Therapists, Mike Camporini and Iordan Krouchev (much appreciation to both of them).
Through our discussions, we attempted to work together to both find a position that would help abate the symptoms, which originally was lying on my stomach with a pillow under my belly button, and then try to reintroduce movements my body wasn't able to coordinate without significant compensation. We cheated a little bit here because we had a good understanding of what my movement biases were prior to the injury so we skipped some steps and jumped right to what we thought we already knew about me.
I already know what majority of people are thinking: "Well, what actually happened?" "What do you think was wrong with your back?"
And my answer, in the least snobby way possible, is "I don't care."
I don't care because, even though the pain was terrible, I did not have any "alarming" symptoms like severe numbness, unrelenting tingling or weakness (beyond perceived weakness related to the pain). These would all be symptoms indicating that a nerve is affected in someway. Although it was painful, I was capable of bearing weight and putting direct pressure on the area, so my brain never even entertained the idea of a fracture. So I was left with what us in the medical world like to call "low back pain."
So we attacked my pain from a movement perspective.
My homework was 2 exercises. The first exercise was a modified bridge variation in a hook-lying position (lying on my back with my knees bent).
The goal of this exercise was to ultimately feel the proximal (closer to the butt) end of my hamstrings contract. I even threw in a little modification to try to isolate out the left side a little more. It is not uncommon to feel a cramping sensation, especially for those who would really benefit from this activity.
The second exercise was a left side-lying position shifting my right knee forward relative to my left knee.
Side-lying Hip Shift
There were multiple goals to this exercise. First, I wanted to be able to maintain heel contact in the wall. Then I want to make a small adjustment to better feel the outside of my left hip on the ground. Believe it or not, in a resting position, all I was able to feel was the outside of my left thigh on the ground. The adjustment I needed to make was to raise my left foot higher off the ground. Next, I wanted to simultaneously shift my right knee forward while pulling my left knee back as if I was trying to spin the ball between my knees. If done correctly, if I inhale while I perform the hip shift, I would feel a pretty substantial stretching sensation directly at the base of my spine and near my left SI joint.
On Saturday, I worked on these two exercises for about 5-6 hours. I laid on the ground in my family room just under my television and repeated sets of 10-20 breaths of each exercises with breaks, when needed. The first time I tried to get off the ground, it took me about 7 minutes to get up, so I decided to create a workspace by pulling multiple couch pillows over on the ground and set up shop for the weekend right on the floor. Every once in a while my 1-year old bernedoodle named Talula would come by to make sure I was alive and lay next to me.
The first day was an utter disaster. There wasn't a single rep that I was able to feel hamstrings with the first exercise and the second exercise was so uncomfortable to even get in the position that I was not seeing significant change with it. But, because I trusted the plan in place and also understood how the acute nature of my condition could otherwise explain my slow progress, I stayed consistent.
I laid on the ground all day Saturday other than when I needed to use the bathroom or eat food. Didn't quite hit 10,000 steps, but that was a sacrifice that my body was just going to have to deal with. My wife helped me put my socks on and took care of walking my dog when we would otherwise trade off responsibility. She was a real trooper the whole weekend.
I am not one to reach for pills for any purpose, but I decided to take Advil PM to help sleep that night. It was a terrible night of sleep. I wedged pillows under my legs, between my knees and elevated the foot of the bed, but I still woke up multiple times throughout the night with sharp pain from shifting positions in my sleep.
Sunday I woke up with little change. But I went downstairs to my station of pillows in the family room and went back to work. Repeatedly alternating between the two exercises for another 5-6 hours while watching football in the background.
I still didn't feel hamstring with a single rep, but was able to feel a very strong sensation in my left SI jt with the side-lying activity. I decided to commit to the second exercise for a higher frequency.
The process of getting up and down off the ground was miserable. Rolling onto my side and then up into a kneeling position consistently led to sharp, stabbing pain. Then I would use our coffee table to support me as I muscled my way to my feet using my upper body. Halfway through Sunday I decided there was no way I would be able to work on Monday. I contacted all my patients who were scheduled for the next day and rescheduled them for later in the week (sorry guys).
I still wasn't able to stand up straight, but I also wasn't able to sit without significant pain. So the only position I was able to maintain for any length of time was partially leaning on a bar stool in our eat-in-kitchen. That sucked. Every try kind of standing for a whole weekend?
Second consecutive night of Advil PM, but no significant change in sleep quality.
Monday rolls around. Same pain. Same process.
At 8:00PM (!), after working on the same two exercises for about 15 hours or so over a 3 day period, I finally felt hamstrings (but lower towards the knee, so not perfectly executed) for the first time. I turned onto my side and performed exercise #2. Both hit the areas I wanted. I apprehensively came up into a side sit position, then to quadruped, then to half kneeling and finally to standing (expecting to feel pain at each point) and was ecstatic to feel very little limitation. I quickly sat at the kitchen counter to do a little work on my laptop, stood up a couple minutes later and BAM, locked up again. But now there was a light at the end of the tunnel!
At that point, the two exercises became my "get out of jail free card" that would give me an increasingly bigger window of relative pain-free movement. I decided to go into work the next day even though I was still hunched over, looking like an idiot. When I had a gap in my schedule, I would lay on the ground and do my two exercises. During lunch time, I would sneak a couple more sets in. I worked 10 hours on Tuesday and left relatively unscathed.
There is a reason I decided to give as much detail of my experience as I have. Let's say I wasn't a physical therapist. Let's say I didn't have (good) physical therapist friends. Let's say I didn't understand my body and my movement. How could these events have been different for someone who doesn't live in the rehab world?
This is likely how things would have gone for that person:
They would experience the pain that I was in and likely would have rushed to an Emergency Room after dinner. In the ER, they would have had an X-ray and likely given muscle relaxers and pain-killers. Then the ER would recommend to follow-up with a specialist. The specialist may order an MRI. That MRI may or may not have shown findings such as a herniated disc or inflammation. Let's say, for the sake of making an example, that it showed a herniated disc. That specialist would then make a recommendation on treatment strategy based on that MRI finding. Absolute worst-case scenario, some specialist thinks it is a surgical candidate due to the severity of pain combined with the MRI findings. NONE of these treatments are identifying why this particular incident occurred, which means none of them would ultimately be effective. But that is the American healthcare process at its finest, unfortunately. Unless you know better.
I woke up on Wednesday and was able to roll out of bed with absolutely no hesitation. On Wednesday, 5 days after the initial incident occurred, I was back in the gym and able to get a full workout in. I dramatically modified my workout to prevent exacerbation of symptoms, but I was able to work hard enough that I got a sweat going and felt great physically and mentally. All that progress utilizing nothing but precisely prescribed movement and breathing (and Advil PM for 2 nights).
The process is still not over. Do I feel significantly better? Yes. Can I do more than I was able to over the weekend? For sure. Does this mean I should stop working on everything that got me to this point just because my pain decreased? Absolutely not.
My condition was acute. It took time. I spent over 15 hours working on it in 3 days! It was the weekend, so I had the time. And I would not be able to function if I did not commit to getting my symptoms under control. I was working on exercises that I have done thousands of times in the past and coached hundreds of patients/clients on how to perform them and it still took me 3 full days to even slightly feel what I was suppose to feel. And I spent significantly more time working on those exercises than most patients ever would AND more time than most physical therapists would ever dream of prescribing.
This is a reminder to everyone that there are no magic fixes. Every rehab process is different. It will always be a process. How much are you willing to commit to the process? How much are you willing to be educated on what needs to be done? Are you willing to do what needs to be done or are you only willing to commit to what is convenient for you? Just because things do not change immediately does not mean to abandon the plan. You just need to make sure you are working with a clinician with whom you trust is devising the right plan for you.
Movement is a powerful thing.
I hope my story helps you feel more hopeful about your own experience. If you are someone who has dealt with significant pain in the past and you were put through "the system" and saw minimal or no improvement, contact me at firstname.lastname@example.org or 732-740-5384 and I would be happy to help guide you in the right direction.