Second back flareup

I had a flare up last night….again while laying down. Relief: laying on the floor with my legs up and bent like this helped. This is a screen shot from this outstanding video by Dr. Andrea Furlan. It is really the best one I’ve seen; lots of outstanding advice here.

The flare ups started last Thursday and are always associated with lying down. I also note they started after I switched to walking before doing pull ups, and I’ve noticed some radiating pain (not severe) a few sets into pull ups. I think I know why: I appear to be arching my back on the way up, and that is never good.

I’ll start doing few pull ups, with legs in front and if I need to 1-2-3 at a time (if that), that’s what I’ll do. I might even do some with the assist machine to train the muscles the right way.

I’ve noticed occasional pain when doing the crawl stroke, pull ups, sometimes with the bench press (after I torched it with pull ups) and toward the end of walking on a hilly course.
Oddly: deadlifts (ok, with the trap bar and light weights I use) are painless, as are push ups, back stroke, side stroke, or swimming as fast as I can.

Walking slowly (15 mpm or slower) starts to get slightly uncomfortable ..walking under 13 minutes a mile feels good.

(for those reading my blog for the first time: I suffer from neurogenic claudication brought on by femoral spinal stenosis which results from isthmic spondylolistheis. the TL:DR version: my L5 vertebra is slipped forward due to a chronic stress fracture in my pars (back of the spine) and this slippage impinges my L5 nerve root.

Today’s workout: I had some trepidation. But walking to work and back home were fine; I added distance to ensure 1.1 out, 1.03 back. No trouble at all. Work was fine too. I also did PT and a morning swim…very gingerly as the back ached while crawling; I made an effort to keep a flat back and not arch.

1000 with 4 side stroke 100’s, 4 back stroke 100’s, 1 fin segment (50 crawl, 50 back) and 1 no fin segment (50 crawl, 50 back)

5 x 100 drill/swim (4 kick on the sides/swim, 1 kick front, swim

6 x 50 on the 1:30. all but 1 were 0:57, one was 56 (swimming scared..kept a lot on the tank)

200 in 4:00 (again, swimming scared)

Then I had my two lunch walks.

So back to this injury: it is sort of crazy. I’ve got walking back, I can swim (provided I mix strokes and don’t over extend my crawl) and I can lift..with in reason.

The new worrisome symptom is the lay-down flare up. But my work life and walking are 90 percent better!

I am not ready for the knife yet, but I do have to manage my activities carefully and constantly checking for what might not be working.

Minor flare ups

I’ve reached a point where I am getting minor flare ups from time to time, but not while walking.

I feel it some just after pull ups (have to work on keeping the back straight; maybe use a belt?), bench (couldn’t quite get the back comfortable) and on rolling on my side from a prone position. I seem to be sensitive to arching; wondering if:

  1. Not doing the press ups
  2. too much sitting; just ordered a lumbar cushion
  3. Walking: how is the volume..it seems ok..the old pain while walking has gone down greatly.

I was worried about work, but no problems…even walked an extra mile home. But I didn’t do high incline presses.

PT, 1 mile walk, weights. Then a lunch walk

weights: pull ups 2 sets of 15 singles, then sets of 5. push ups: 3 sets 35, 30, 25 incline, 10 flat

bench: 10 x 134, 10 x 139, 10 x 139 feet up

curls: 3 sets of 10

Baseball:

The weather didn’t want to cooperate at first, but eventually we got a 4-3 Chiefs win. It was 4-1 in the top of the 9’th, when the visitors got a double and a home run. But that is where it stopped.

The crowd was pretty good, especially considering the weather delay.

Step achieved

Back in June 2021, I started physical therapy for my shoulder and what I thought was a piriformis injury. I got to walking up to 1 mile segments at a time; in the fall I did 3 miles usually in 1, .6, .6, .5, .3 segments or the like.

Early this year, it took a turn of the worse; I got medical attention for …my back. I brought back walks; 3 short ones at first. It was my dream to get to 5K.

In May, I got my “long” walk to 2 miles; 1.2-1.7 was more typical.

Finally, 2 miles is typical and I got a 3 today. That is 1 mile in 2.5 months…though the pace is much, much faster than it was then.

What I did:

PT inside.

Pull ups; did 2 sets of 5-5-5 (first one: 30 seconds rest between sets, second was “5 on the 1 minute”, then 2 sets of 10, and banded walks.

Then the 5K walk maintained a decent pace.

2 more sets of 5 mixed pull ups

push ups: 30 incline, 30 incline, 20 regular 20 regular

Walk 2 (1 mile)

Rest/stretch

Downstairs: bench press (legs in the air)

3 x 150, 3 x 155, 3 x 160, 3 x 165 (hard), 2 x 170, 1 x 175, 9 x 145 (every 3 minutes)

High incline: 3 sets of 10 x 94 (105 was too much for full ROM)

Curls: 3 sets of 10 x 50

Of course, this is like when I first made 2 miles: this is my max, not my daily. Pace was fine, though my right knee kind of buckles.

The improvement is definite. But I am NOT healed by any stretch.

Next goal: average 3 miles a day, then 3 miles a walk. I am at 2 miles per walk (average). That will take time…several months.

Snapping out of it..

I am seeing more progress.

  1. Walks: are now starting with “I wonder what I can do today” instead of with dread. No, I am NOT up to 5K yet..still got a ways to go, but I am doing a lot of 1-2 milers and am at about 18 miles a week. YES, I know, in 2019 I could walk a marathon, but this isn’t 2019.
  2. Weights: I seem to have a good idea as to what hurts me and what doesn’t. I do have to be careful with the trap bar deadlifts and the “let’s see what I can do for 1-3 reps” days are probably over. I am not that far away from 10 reps with 300 lb (8 inch handles) though. I have to bear down on my form.
  3. Swims: most progress here. Again, where I am is laughably bad from where a good swimmer is and from where I once was (I was never good). But I think this is my best physical activity right now. This is where I restarted.
  4. Physical Therapy Routine: I think I have it down; I do these and add some of the Williams set.

It will be good to reach a point where I am no longer constantly whining about my back. It has been a long 2 years.

What went down today:

PT, included shoulders.

1.5 mile walk; a little tighter than I’d like but I probably wasn’t focused endough.

2000 meter swim, straight crawl (longest crawl set in forever). Great: well, no, but much, much, much better than were I was even in early July.

500 splits: 11:41, 22:50, 33:59, 45:04 (11:41, 11:09, 11:09, 11:05)

Miles: 9:25, 18:30, 27:20, 36:13 (final mile: 35:40)

Yes, I know; in 2001 I averaged 33 minute miles for a 5K swim; in 2008 I averaged 31 minute miles. But I am early in my training; I need to progress slowly. And I am well beyond where I was here (12:52 for 500, 11:44 for 500) and here. (11:14 after warm up, 10:52)

Afterward, a short hike ..and ONE stop (to take a photo..no stretching..though I did have to scramble under a fallen tree and that helped a bit. The hike was “easy effort” and in line with my other hikes on this course.

July 4 2022

Part I: the YMCA pool was open so I drove there and..well, evidently the swim team started at 6. So I was shunted into another lane and even we ended up circle swimming. I ended up beating up my hand on the lane line..it was a bit disconcerting to see so many next to me (yes, they were faster; a lot faster)

I made the best of it..and glad I didn’t know in advance else I wouldn’t have gone.

200 warm up (side, 50 back, 50 easy free)

200 of 50 kick, 50 swim with fins.

500 in 11:14 (zoo)

200 of 50 kick, 50 swim with fins)

100 (interrupted as someone wanted to circle…it was that kind of day

500 in 10:52

200 fins (some kick)

100 in 2:05 (damn, the 50 meter pool is long)

Then most of my PT, including shoulders

Then a hike: first part was on the single track wooded trail, second half had some asphalt, mostly single track woodchip/ grass

The single track: I did have to do some very quick stretches (20-30 seconds) but things cleared up when I was on flat asphalt or gravel. The back is better; that is undeniable. But the reality is that there will be a lot of “activity management.”

Swim: went very well, in terms of body and pain (shoulder and back).

Note: the swim itself went much better than a month ago; I have improved in swimming. But I thought I’d try for a mile straight..just not ready for that yet. I’d get chopped up at Barton Springs.

Not rainbows and unicorns

10 days after the injection:

  1. Night tingles reduced.
  2. Day to day “small stuff” pain greatly diminished.
  3. Swim pain (glute) mostly gone
  4. Ok, walking: 2 miles kind of feels like 1.5 used to and there is far less “after the fact” glute pain. But there are still tingles and duller pain..pretty dulled but still there. I also think that I get more “pop” out of my leg.
  5. Trying to learn how to squat: that still sucks.

Today: most of my PT

2 mile walk (slower)

Two months ago, this would have been exciting. Today is is “meh” due to the gorgeous weather.

More PT then 2000 yd swim:

600 of side/back

200 of 25 front balance kick, 25 free

50 alternating free/back recovery free (49, 48)

100 free, 50 back (1:41, 1:42)

100 back

100 of 25 free, 25 front kick

Then 500 of: 100 pull, 150 swim, 150 pull, 100 swim (9:36)

203.8 after swimming.

On one hand, this swim is nothing compared to what I once did. On the other hand, it is a major improvement from when I started (restarted swimming)

And the shoulder feels great.

Testing it out.

Ok, there was some mild disappointment with my walk. I did most of my PT first, stretched and decided to do 2 miles all at once.
Ok, it was painless BUT there were some tingles and some post walk “almost pain” (similar to what I used to get with “heavy” deadlifts..after the fact) Pace was not that bad (13:21 for 2 miles) but I suppose I expected rainbows, unicorns..and to be able to 10 miles without any sensation at all

It was my best walk in over 18 months, but…expectations were unrealistic.

I finished PT and ended up with a very long workout: 2:40 or so total?

pull ups: 10, 10, 5-5, 5-5, 5 chin, 5 wide, 5 mixed, 5 mixed

push ups: incline: 20, 30, then 5 sets of 10 with a banded walk, 10 on a step.

bench press: 10 x 145, 10 x 145, 7 x 150 (tired)

deadlifts: 10 x 134, 10 x 184, 10 x 260 (8 inch); very sloppy (too fatigued ..need to do this set rested)

incline press: 10 x 94, 10 x 94, 7 x 94 (lost the grip)

curls: 3 sets of 10 x 50

then the belt squat: 3 awful sets of 10 with a joke weight (22 lb) trying to learn the lift. I might try with a plate under my heels; limited mobility (too stripper like)

Reading this, I am surprised the workout took as long as it did, but I did get kind of tired at times.

Cautiously optimistic

Well, the epidural injection was Friday morning: single level; 1 mg of dexamethasone sodium phosphate, a very strong steroid. The instructions said that I might feel the steroid’s effect in 3-5 days: so today would be about right (day 4).

And…and…..well, my walks, while 1 mile…have been pain free, and the after the fact: less pain; some stiffness here and there. The neurogenic claudication symptoms feel ..less. But..I haven’t challenged myself.

But…just weightless squats feel a LOT stronger, walking pace is picking up, and less soreness after the walk.

Warning signs: I did feel foot tingles last night around bed time, but some forward bends took care of it.

Side note: my belt squat belt and loading pin are here. I can do belt squats using weight plates as a platform..my step stools should be here soon.

Workout notes

Yesterday: BU was closed so no swimming. Still, full PT and 2 one mile walks: 1 before, 1 after with some POST WALK left hip/IT/glute soreness (similar to post deadlifts in days past) Note: top walk was walk no 2.

Today: indoor PT, walk 1, outdoor PT with pull ups, push ups), walk 2.

Then indoor weights.

Yes, the pace is improving..probably because my legs are finally getting nerve signals.

The weights:

pull ups: 10 singles, 10, 6-4, 5-5, 5 mixed, 5 mixed, 5 wide, 5 chin

push ups: 30 incline, 4 x 10 with banded walks, 30 decline

indoor: bench: 10 x 134, 10 x 145, dead: 10 x 134, 10 x 184 (focus on leg push and straight back), curls 2 sets of 10 x 50, high incline: 2 sets of 10 x 94 Swiss bar.

All in all..sweaty mess and maybe I did myself some good.

Come on now

The following reared its ugly head from the period July 2020 to July 2021. All are chronic and have been symptomatic from: back: 1978, shoulder: 2000, knee: 1978. They all finally became chronic in this period..right after turning 60.

Nevertheless, I still lift 3-4 times a week, walk 4-5 times a week, swim 3-4 times a week…not that I’ll win any athletic awards. But I’ve really had to manage my activities.

Above: my spondylolisthesis at the L5-S1 (L5 is too far forward and my S1 (top of the tail bone) is tilted forward . I’ve had this since the mid 1970s but it finally became a chronic problem in July 2020 or so

See the top of my shoulder (acromiale bone)? That is supposed to be straight. The os segment never fused properly. This has caused me rotator cuff problems off and on, and it came back to haunt me in April 2021

Knees: that right knee has been operated on 4 times: 1978, 1979, 1984, 2010. (left only once in 1984). Well, the wear and tear finally caught up to me in July 2020. When I ran, I could feel the pain go down to the top of my shin bone.

Notices in the flexed position, the spacing is all but gone.

“Back” in business..so to speak.

What happened: in June-July 2020, I started to get glute pain upon walking…it became more and more severe until even 2 miles was enough to bring it on. Weight lifting: it did not appear during workouts, though I grew to understand that certain exercise (heavy deadlifts, arching while bench pressing, arching while shoulder pressing) brought on the referred pain AFTER the fact…not during.

I also had foot tingles/leg tingles at night; sometimes extensive.

As you can see, I am quite bent forward when I walk; I think it was my body’s attempt to take pressure off.

I sought out PT for it in summer of 2021…fall of 2021..even walking from my car to a game was painful. I tried resting from all walking, this stretch, that stretch.

Well, I’ve had this spondylolisthesis for many years; it was first noticed in ..yes, 1978 (summer). I have a pars defect (fracture of the pars; aka spondylolysis) which lead to the L5 vertebra slipping forward, ahead of S1 (top of your tailbone). I’ve had episodes for some time, most lately in 2006, 2011, 2013, 2016 and this time, conservative treatment could not quite clear it up.

Update: I just looked at my records online; in addition to my spondylolisthesis (due to pars defect) I have lumbar spinal stenosis (due to the nerve root impingement) which causes neurogenic claudication. (heaviness and pain in the leg due to the nerve root being impinged

My S1 is tilted forward and the L5 slides down, even when standing straight (shear force).

This leads to a lack of space for my L5 nerve root, hence foot tingles, sometimes shin tingles, and glute pain on my left side at about .8-1.5 miles of walking (warmed up); .4-.6 miles of walking (no warm up).

PT has helped and strengthening my glutes and core has helped. But not enough.

So, after meeting with the non-surgery back doctor, he referred me to a surgeon.

The surgeon explained that the definitive treatment would be spinal fusion, but that while the operation would probably relieve the symptoms, it would probably lead to different problems down the road and start me on the road to more surgery.

So…epidural steroidal injections have a decent success rate and possibly stop the cycle of irritation.

I get mine a week from today.