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.