Saturday, November 07, 2009

Bad back better

It makes for a good family story, but really nobody was very happy with me. After a nearly 30 year run my strategy of ignoring my back pain wasn't working. I'd gotten pretty good with ice packs, advil, canes and early inline skating, but I'd advanced from an every 8 months problem lasting 3-5 days to every 4 months lasting 14-21 days.

Every doc knows where that story goes. So I bit the bullet, and I saw a doctor (other than myself and my wife that is). Specifically, I signed up with the marines of back rehab - Minnesota's Physicians Back and Neck Clinic (PNBC).

It worked. My back is better now than it's been for at least twenty years. That was probably the last time I went this long without a 'stuck to the floor' acute exacerbation.

It's been long enough now that I know they did right by me. My doc was a bit crispy after decades of doing bad back work, and I was a bit surprised he didn't even bother with a plain film (these guys do very little imaging), but the program he and his buddies established worked. I did about 2 months of PT driven core muscle training and eternal daily stretching routines. I'm still religious about the 10 minute daily stretching regimen. As per my colleague BF's husband, I do them before I get out of bed.

I haven't been as diligent with the maintenance Roman Chair back extensions they prescribe, so I know what I'll have to change if my pain returns. That's my problem though, not a problem with the PBNC program.

Yeah, it's n of 1, but these guys are pretty much smack in the center of evidence-based back pain management -- they're just meaner about it. For n of 2 I'll mention that my buddy ZH was facing grim cervical spine surgery when he went there. They fixed him good - no surgery, full activity, he's a fan.

It's perhaps not for everyone, but if you're in MN, and you've got a really bad back or neck problem, chronic or acute, this is the team to see. Just remember when they want 10 more reps - "Pain is weakness leaving the body".

See also:
Update 11/21/09: Something I'd forgotten when I wrote this post. For the first few months after treatment began my back often ached. I felt as though I'd spread the severe pain over time, as though the total had not changed but the distribution had improved. I was fine with that, it didn't stop me doing anything. It is only now that I realize that my tolerable legacy symptoms, slowly and without my notice, went away.

Update 7/3/2013 - six years after my summer 2007 injury

Around 2010 I had another episode of reasonably severe back pain and I returned to PNBC for another rehab session. In retrospect that was probably unnecessary, but it proved I'd done a bad job of maintaining my muscle tone.

I have been utterly reliable at my morning stretching exercises, which I credit for 60% of my prolonged remission. The rest is core muscle; I've done better at maintaining that, but it is possible to have too much of a good thing.  In June of 2013, while engaged in an arguably insane level of physical activity for non-elite 54 yo at CrossFit St Paul, I injured my back when I lost form doing my 16th front squat with a 120+ pound bar. (More on CrossFit in a 2013 post I think). Clean and jerk and squats likely voided my PNBC warranty. That pain resolved in about 24 hours, and 48 hours later the discomfort is mild.

It must be noted PNBC's aggressive strengthening program doesn't make one completely invulnerable. (That's a joke.) I'll go easy for the next six weeks, then keep my free weights under 90lbs for the next six months and focus on reps.

After 2009 PNBC was acquired by a local healthcare enterprise; I suspect it's lost a bit of the old intensity. Sadly, their 2009 approach to managing back pain is still radical.

Update 12/24/2015 - 8+ years later.

Over the past 4 years I've had 2-3 back strains related to pushing the envelope while weight lifting, most recently on the dead lift. I don't think one can complain about this sort of thing! So far they've all resolved fairly quickly with nothing like the severe pain I once new. So far :-).

Further notes:

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