Acute back strain management - one anecdote

After the 2008 vacation ambulance ride and the supine drive home I decided I needed to see a doctor other than myself. Twenty-five years of increasingly severe and transiently disabling back pain was enough. So I did, and I got better.

 

Which nobody wants to hear about. There's nothing more boring than back pain stories. Heck, when I first saw my back doc he cut me off at the start of my epic. He'd heard it all before. 

 

So nobody wants to hear my stories, but, honestly, if you have back pain you should read 'em [1]. I got anecdote, I got training, I got experience, and my current approach is consistent with PNBC's evidence-based back strength boot camp. By contrast much physician management of acute back strain is pretty weak.

 

This particular story is a bit different. In the past I'd sneeze or tie my shoes funny and be laid out for days. [2]. This time I was at the end of four sets of CrossFit front squats, lifting about 125 lbs. when I shifted forward a bit, tried to correct and felt my back tear (or whatever it's doing - we don't know). I dropped the bar and lay (grammar?) down on an ice pack. 

 

This is what I did for immediate post-injury recovery. This time I didn't need my old canes, and two doses of Motrin was plenty. I don't know if that's because I'm stronger than I once was or because this was a relatively minor injury.

• Sunday (injury day): neoprene waist band and doubled cold pack. Walking and modified version of my usual morning stretch [4]. Inline skating in pm - that's often helpful for me [5]. Sleeping was difficult, though I've had much worse. Motrin 800mg midnight.
• Monday: I am able to stand. Fear level diminishes.  Able to do most of stretch [4]. Continued ice. Evening skate with my son and the Minnesota Inline Skate Club. Start using Roman Chair for extension exercises, with arm assist. Motrin 600mg before bed.
• Tuesday: I am able to do 85% of my usual stretch. Minimal ice. Two hour high speed bike ride from home to Minnehaha trail to Lake Harriet around and back. Roman Chair with minimal arm assist. No meds, sleep a bit sore.
• Wednesday:  AM full stretch routine. 16yo and I go to weight room at JCC. There I can do arm workout, resisted back extension, abdominals with controlled equipment (not free weight). Full Roman Chair. In evening I'd scheduled a swim, but couldn't fit it in. PM stretch. Sleep good.
• Thursday: AM stretch, otherwise day spent on chores and family duties. Full set of situps and Roman Chair. PM stretch.
• Friday: AM stretch, AM CrossFit Yoga - extreme stretches. No pain. Two hour bike ride in evening with 16yo. Roman Chair and Situps. PM stretch. Back isn't normal, but it's pretty good.
• Saturday (plan): Try running to barber shop in AM. PM family bike ride -- lots of lifting bikes, moving car seats. Good functional back test. 
• Sunday (plan): Regular CrossFit -- will keep weights under 50 pounds (women's 18 or 33 lb bar).

As a rule a soft tissue injury at my age will take at least six weeks to heal. In addition it's clear that my back is going to need to get stronger before I go back over 100 lbs [6]. So my go forward recovery plan is:

• Maximal weight 90lbs until my extension and abdominals are much stronger.
• Ensure I have at least 3 days between my full CrossFit workouts. They are intense and I need that much time to recover; when I was hurt I had a 1 day gap. In between I do my bike rides, inline skating, and, now, gym weights.
• More aggressive Roman Chair and situp training.
• Add 1 day/week of workout in conventional gym with controlled equipment. I will establish my current baseline max for 6 rep extension and abdominal. I need to increase that by 30% before I go up again on free weight.
• Consider adding a routine CrossFit Yoga session -- if I can find the time I think that would be a good complement in a couple of ways.

- fn -

 

[1] For example ...

• The summer of 2008: ED treatment of acute back pain — what's missing and why (6/2008), How to construct an emergency custom back support car seat for under $20 (7/2008), and Bad back better (8/2008-onwards).
• Innovations in back pain management: cold and colder packs 5/2007 - how to make a safe cold pack that lasts
• The neoprene back wrap and other parts of John's acute back pain recipe 11/2005 - an older approach, my current management is even more aggressive, and Motrin/tylenol only

[2] One of the little ironies of mortal life is that nature routinely does stuff to us that, when we do it to one another, could be considered a war crime.

[3] Why is CrossFit, and why am I doing this when I'm older than the moon? I've got a post pending on that.

[4] Every morning, 5 reps each for past five years: Knee to chest r/l, knee lateral hip rotation r/l, straight leg, two leg to chest, elbow press back extension, full arm back extension, cat stretch, sit rotate, hamstring stretch, quad stretch.

[5] Sounds bizarre, but when I've hurt my back it's a lot easier for me to skate than to walk. I'm a good skater. It also forces me past the fear that accompanies this kind of injury, especially for those of us with memories.

[6] My classes are about half female, and, prior to my injury, I lifted an average or above average amount for the female group. Bottom of the male group of course.

Update 3/19/2016

Despite developing an inflammatory osteoarthritis (yay) my back has done quite well over the past 3 years of CrossFit. I had another strain with deadlift in Jan of 2016 but it healed well. I think I took 1-2 weeks off CrossFit to do cyber-type weights at a different gym before returning to CrossFit. Year 8 post my great PNBC experience and 3 years of CrossFit St Paul my back is healthier than most people my age.