Tuesday, March 13, 2012

Physical Therapy--Second Visit

There was good news and bad news out of my second visit this morning with Cathy, my physical therapist at Boulder Center for Sports Medicine.

The Bad News

1) I'm still exercising too much. Last week I went to spin class or rode my bike every day but Sunday. After yesterday's spin class, my back had had enough and went into full spasm. Getting out of bed and into my clothes was actually difficult this morning, so I skipped spin, but still did thirty minutes on the recumbent bike before going to physical therapy. Recumbent bikes look like this (though the one at my rec center is older and clunkier):

I told Cathy all of this, and she gave me a new exercise prescription. I didn't cry this time because I was expecting it--I knew my back wasn't liking the past week's workload. I am to do ONLY the recumbent bike for ONLY 30 minutes at a time and ONLY every other day. I am also still OK to do upper body weight training and the three exercises she gave me today (see Bad News #2).

2) Cathy ran me through a quick series of tests to see if I'm using the correct muscles for certain movements. The answer was, bluntly, NO. When I do side leg lifts, I'm using my quadratus lumborum (QL) muscle instead of my glutes, which are the ones I should be using. Here's a picture of the QL, and yeah, when she manipulated it, it hurt:

And when she had me lie on my back with bent knees and attempt to lift one leg at a time, I could NOT for the life of me use my abs. Instead, I was arching my poor back and using the QL and other muscles in that vicinity. Basically, my brain has forgotten how to call on the correct muscles for these movements.

Running, as you know, involves a lot of glute action because you're lifting your legs up and down, up and down. And it also requires a lot of stabilization that should come from those abs. I've been using the wrong muscles for these key running movements for five years. Cathy put it this way: "You can't be running marathons right now."

My homework for this is three very basic (as Cathy put it, "piddly") exercises: side leg lifts (NOT using my QL), clams (also not using my QL--I was better at these) and the leg pickups, monitoring my lower back lift with my hands. My goal for the latter? To lift my legs without arching my back at all. It's going to be hard given that right now I cannot do it.

The Good News

1) Over the course of the week between last Tuesday's visit with Cathy and today's, my SI joint stayed in place. When she checked it today, it wasn't out of whack as it had been before she popped it back in. So my belt (which I'm in full-time for at least another week) is doing its job, and I didn't mess that up by overdoing it on the biking. This is a good thing because it means that so far I'm not in the vicious cycle of having her put it back in place only to have it come out again over and over and over.

2) Dry needling: it's not so bad! After she showed me the ab exercises, she broke out the needles. I had about eight of them in various spots on my QL and my glutes (she left the sacral area alone--I later got a cortisone patch for that). Here's a video of Cathy herself doing the needling on someone else (a shoulder instead of a back, but it will give you the idea--think of it as a massage, but at the source of the soreness and with a needle).

What did it feel like? Well, it felt weird. The insertion of the tiny thin needle I barely felt, but when she started moving it around, looking for the trigger point, and especially when she found the trigger point, I could feel the muscle twinge, rebound, constrict--and because these muscles are already sore, it wasn't what I'd call pleasant. But it also wasn't painful. I'm sore now, in exactly the same way I've been sore after deep sports massages.

After it was over, she had me rest for 10 minutes with heat on the spots. I'm now supposed to ice the area fairly frequently. Her advice was to stick a package of peas down my pants and leave it there for 10 minutes a few times a day. She also wants me to take 1200 milligrams of Advil every day for four days to kick the inflammation.

3) I'm going to see Kate for a massage tomorrow. Cathy says dry needling one day followed by massage the next is pretty much ideal.

My Reaction

1) I don't like not being able to exercise, but even my Eager Mind is conceding that my Exhausted Back deserves the upper hand right now.

2) My task for the next few weeks (aside from doing exactly what Cathy says) will be to watch my weight. This I am nervous about. A week ago, I weighed in at 129.4. That's satisfactory. Yesterday after spin class, however, the same scale, same time of day, read 134.6. That's not satisfactory.

I don't like to be obsessive about the scale, and when I'm running I don't really have to be. I weigh myself once a week. But with the exercise cut so drastically, I'm going to weigh in every day. Today's weight was 132.4. Better....but anything above 130 is an alarm bell that we've moved in the wrong direction. I may even check out the plan in Racing Weight again. I don't care if I get down to what I suspect is my actual racing weight, but I want to come out of this process still safely below 130.

3) Between daylight savings time and a week of getting up early, I'm really tired. The recumbent bike, for all its drawbacks, is always there. I don't plan to set the alarm again for a while.

37 comments:

  1. Fleurg, that dry needling video looks way worse than it probably is! I'm glad it isn't as bad as it looks!

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  2. I know this time is very hard but you can do this!  I went through the same thing and I have come out on the other side.  Just remember that is temporary.

    I am pulling for ya!

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  3. Best of luck in your recovery efforts. It sounds like you are in really good hands. You'll come out of it stronger in the end both mentally and physically.

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  4. Very interesting stuff.  Just keep remembering that you will be so much stronger and ready to tackle hard training when the rehab is finished - you'll have to come up with a mantra to repeat to remind yourself!  The exercises are probably good for all of us to do regularly.  I like hearing about the dry needling - I will file it away in my mind for future reference.  As for the weight thing - I feel your fear!  Being able to run or ride as much as we want is a way to CONTROL things, ie:weight!  And when we can't or aren't allowed to do what we want (need!) - run, ride, etc - we lose control.  Eeeks - I hate that!  Hang in there - you will regain control of your body in the not-so-distant-future!   Maybe you are just a little bloated on the heavier days....... We've got to just laugh about it all!  :-)

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  5. I'm glad the dry needling wasn't so bad!  It sounds and looks not fun!  I hope the time off allows your back to recover.

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  6. Ugh. I'm sorry you're going through this. I totally relate to that awful feeling of not being able to exercise. And to worry about the weight gain. I definitely put some on during my long lay off from running and am still working to get it off. But it's really ok in the grand scheme of things--all temporary, even though it seems permanent at the time. 

    Glutes that don't fire are so common among runners and it's something we all need to work on. Eric Orton has a great article on his web site on this as it relates to ITB, btw. 

    Good luck with it all. Just focus on any progress you make and use the to lift your spirits!

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  7. I am sorry you have to face this. I agree with Amanda...focus on the progress you are making each day.  Just one day at the time.  Try not to look too far ahead.  You can do this. 

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  8. BostonboundbrunetteMarch 13, 2012 at 12:05 PM

    Boy are we in the same situation.  i was just looking at the scale today and I have put on a few pounds as well.  I normally weigh in once a week too but I have been doing it more often lately.  It is a temporary problem that can be fixed once you are 100% so we hang in there.  

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  9. Sounds like you are doing all the right things and following the plan to the tee.  Hang in there! Dry needling freaks me out :) But I know it does amazing things for people.  

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  10. Oh Terzah!!!! I'm soo sorry! But it sounds like once you get through all this you are going to be a much better runner and this is a good thing.

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  11. Argh, more frustrating news! I'm so sorry... I'm struggling too with wondering if all my spinning is not allowing my ankle to recover, as it's still somewhat swollen at night.  Do what you're allowed to do, and try not to stress too much about weight... eat when you're hungry, stop when you're full... you'll be able to maintain! I'm glad there was some good news, and overall, I'm impressed that you're still sounding so positive!

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  12. those pesky glutes...apparently not using my glutes caused my injury. 

    My PT told me to bang my fist against my gluteus medius & maximus while running to order to remind them to fire.  I've taken to carrying a golf ball and bang it periodically on those muscles - kinda looks liking i'm spanking myself to run faster.  I know - what  a dork, but I don't care how I look as long as I use the right muscles.

    hang in there!

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  13. Do what they tell you to do :-)
    Just my 2 cents.
    It seems like when I don't listen to the "officials", I always end up regretting it.

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  14. Not to say it, but didn't I................... Just kidding, stop using your quadratus lumborum so much, you'll wear it out! HA

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  15. Grrrrr!!  I'm sorry for the bad part of the news; hoping that this new series of exercises and the lay-off from so much biking will be the ticket to a happier back soon!!

    When I go to Pilates, she always says to keep the back flat on the floor as this engages your core better.  Some exercises are really hard to do like that but when I am able to get the back flat, wow, what a difference it makes. 

    I know the weight thing will bug ya (there with ya, girl) but try not to obsess too much.  You don't need to be at racing weight RIGHT NOW.  Your body just wants to be a few pounds up and I think you'll recover quicker if it is.  I'm not talking 15 lbs like I am - ha - but a few lbs to help the body heal would help.  You seem to easily lose it (unlike me :( ) so you can quickly get the weight below 130 when it's time to race!  Just my 2 cents.

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  16. SORRY about the bad news but so glad this is all getting taken care of and it sounds like you are in AWESOME hands. Hang in there... it will be very worth it when you feel like a new woman. :)

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  17. I would have a hard time not exercising too much too.  I don't know if I could handle that dry needling, needles freak me out when they are coming at me.  Hope you get back to running soon!  

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  18. I think there are probably a lot of us who aren't using the right muscles for things but didn't have that exacerbated by carrying twins. I'm glad you have such knowledgeable people working with you. Hopefully the combination of rest and treatment get you healthy!

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  19. You can do this - and how about sleeping in!!!Go easy on yourself about the weight! Put that energy into yummy, healthy treats for you and the family! I'm glad to hear that the dry needling wasn't so bad - the idea still gives me the willies! 
    Hee hee - you've got pees in your pants!!  ;)

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  20. Thanks, Allison! I hope you're right.

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  21. Thanks, Mandy! That's my hope too.

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  22. Thanks, Amanda! I will go check out that article. This whole thing sort of feels comparable to when my twins were babies/toddlers. Eight weeks was a forever time--but that passed and I know (with my head) that this will too. I really appreciate veteran runners like yourself who have been through this sort of thing and are thriving on the other end.

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  23. Hopefully we'll always be in the same situation...but that situation will change to "buying tickets to Boston." ;^)

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  24. Thanks, Carrie! And don't fear the needles if it ever has to happen for you. I promise it's not that bad. Just weird.

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  25. This CRACKED ME UP. I thought I looked foolish driving on the Diagonal with a tennis ball under my behind!

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  26. I think I already wore it out....

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  27. I don't think I could handle the dry needling. Don't worry about your weight so much while your body is healing. As long as you don't eat dozens of brownies each day, it will regulate and calibrate itself. Good luck!

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  28. Terzah, are those peas in your pants or are you just happy to see me?  I can't believe you have to put peas down your pants you poor thing!  And the recumbent bike...oh so sorry!!!  Maybe instead of meeting for a run I should take you out for a strong drink!  Hang in there and I hope the improvements keep coming!

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  29. Hey Kaitlyn! It's not that I'm not capable of eating dozens of brownies a day, but I think that in this situation I'll be much less tempted. Thanks very much!

    I just signed up to follow your blog--that picture you have across the top is gorgeous.

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  30. Oh the lazy glute! SO common in runners Terzah! SOunds like you are in excellent hands with Kathy and the therapy will work wonders. I still do all my glute exercises (and lots more lower body strengthening stuff) since my hip fiasco last fall. I know it's hard not to be running, or even working out as much but this will get better, I promise. 

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  31. Hopefully soon the good will out weight all the bad!
    Stuff like this freaks me out as I know I don't use some of my muscles properly and am overcompensating with the others.  Bad and just an injury waiting to happen. 

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  32. Awww, girl, that sucks, but at the same time, this is a good thing because now you know why that sucker keeps coming out.  It sounds like the same issues as I was having, not engaging/having strong glutes!  Those damn butt muscles!  What a pain.   It also sounds like she is having you do the same leg lifts as my PT had me do.  Pretty soon you'll graduate to more difficult moves and then your booty will really be sore and strong.  
    Hang in there, you'll be back at it once you take care of the root of the problem. I didn't take care of the problem and it caused piriformis and ITB issues and then the ITB issues caused a huge cyst, which finally resulted in surgery.  UGH, i am glad I am over all that now!  

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  33. Looks like you have a different back issue than I did, but I could talk to you for a while about my lower back problems.  I eventually figured out what exercises I needed to do to keep my back at bay.  The one thing I'll mention is that I was surprised at how much doing lunges helped my lower back.  I don't know if that could apply to your QL situation

    I'm also a bit obsessed with the scale.  I've found a few pounds can make a difference between a good workout and a great one.  Not to mention my body can take more running abuse when it's lighter.

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  34. I hear ya on the weight issues -- it is getting to me too.  Sorry that you have to exercise less and less but happy everything is staying in place!!  Hang in there!

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  35. I hope you solve your problem very soon. Please don't do as I did, take your time and be careful. Better one day (or week) more with no runs.
    All the best!

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  36. we all are your well wishers there , hope everything will good for you.
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    nj physical
    therapy

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