Over the years I've done periodic personal medical and exercise posts. It's mostly a way for me to take stock and think, but I'm a (retired) GP doc and I think there's value in seeing these things from both a medical and personal perspective.
I'm 66 now so I expect to do these less -- unless there's something to share that might be useful to others. Why less? Because most don't need to know what oldness is like.
This 2025 update will more-or-less conclude two related things I've written about over 20 years or so -- back issues and CrossFit/exercise.
I have shared my back journey over past decades through several posts, but the history predates the internet. It began, very clearly, with hyperextension of my lower back when body surfing on Huntington Beach Los Angeles. I didn't have neurologic problems, and over weeks the acute pain went away, but after that and for the next 40 years I'd run into periodic back pain episodes that I managed with early activity and exercise. Some, I can honestly say, were very painful. I learned a lot about the sequence of cold packs, early mobilization and the typical 1 week recovery cycle.
Most of the time, as long as I kept up with exercise [6], the back pain wasn't a big factor in my life - but the frequency was increasing from "every 8 months for 3-5 days to every 4 months lasting 14-21 days"
I assumed, as was common in those days in the absence of neurologic signs, that the root cause was soft tissue injury. In 2025 I learned otherwise.
In July of 2008 I traveled home from a family trip lying on the floor or our van after my one and only ambulance to ED back pain episode. It was time to actually see a physician about the problem. My next step was an intense strengthening program pioneered by Minnesota's Physician's Back and Neck Clinic [7]
That program worked great when I kept up with it on their machines, but motivation was a challenge. By 2013 my acute pain episode routine was getting pretty extreme. I needed to do something different to maintain strength.
So ... in 2013 I started CrossFit Saint Paul. CrossFit was still relatively new then, CFSP had only launched a few years before. Gray hair was rare and a 54yo was still a bit of a novelty. I remember lots of young big strong people and very rude music lyrics. I'm still at it 13 years later [1]; there are now many 50+ and the music seems mellower.
That began a second interval of relative back peace. The first was 5y from 2008 to 2013, this interval went from 2013 to about 2024, though as I aged further my strength more or less peaked about 2019 (age 59-60) and I put together my 30y plan to exit [2]. My peculiarly aggressive familial osteoarthritis was manifesting.
Even back in 2015 though I was having periodic acute pain episodes after doing deadlifts. I managed these with Roman Chair back extensions and "Romanian Deadlifts". My posterior chain got real strong -- and I did lighter deadlifts. Also in 2015 I was having a "butt ache" that I treated as piriformis syndrome (it was discogenic).
And so it continued - generally pretty well with setbacks and recoveries. In 2020 I had what felt like an L5/S1 prophylaxis with a mild foot drop that slowly resolved over 6-8 months. (I actually forgot about this until rereading an old post.) By 2021 my prophylactic back exercise routine had reached another level of (successful) extreme.
In retrospect I was coming to the end of this phase of the spine story. I was relying more and more on my muscles to keep my lower spine motion limited. At one point I had an acute exacerbation episode picking up a 10lb weight, even as my back squat was in the mid 200s [3].
In the winter of 2023 I hit the wall. In the space of a few months I was unable to stand upright -- even as I rearranged my left knee in a snow bike episode at night over a frozen creek. I developed 'pins and needles' in my feet. I had my first MRI, it was so awful my primary care doc sent me a condolence email.
I was unable to do even basic PT. Spinal steroid injections had no effect. I attended my daughter's college grad riding my mountain bike because, although I couldn't walk, I could still ride [5]. My ortho team physiatrist predicted a fusion. I walked into my surgical consultation bent over for stenosis relief.
My surgeon took one look and told me spinal stenosis surgery was coming. In June of 2024 my orthopedic surgeon did the following:
1. Right L3-4 and L4-5 laminotomy.
2. Bilateral L3-4 and L4-5 medial facetectomies and bilateral lateral recess decompression.
3. Right L3-4 partial discectomy.
4. Bilateral L3, L4 and L5 foraminotomies.
I had come to the end of a long road. I went into surgery hoping to be able to walk again. A surgery that took hours longer than expected because there was stuff in there so old the MRI didn't show it.
And ... it worked. The surgery actually worked. I could stand and walk immediately. I'd purchased walkers and toilets lifts and canes in anticipation of a painful recovery - I used one tylenol (I didn't really need it) and returned all the equipment unopened. As soon as I was permitted I was walking 5-10 miles a day. Then I was allowed to bicycle. And ... I was permitted to return to CrossFit 3 months post surgery, albeit without deadlifts [4].
It's been over a year since that surgery. I still lift 10lb weights the way I lift 100lb weights, but I'm not sure that's necessary now. I don't do my 2021 extreme prophylactic exercises, I do only "normal" posterior chain work. I don't do deadlifts or even RDLs, I use a hex bar and do squat-deadlifts that are much more like front squats than deadlifts (limited hinge). My one rep max are all down about 10-15% but they are slowly going up. Since resuming CrossFit I've recapitulated my early history there -- starting out dropping 10-14 lbs then very slowly building back up. (I'm 66. The muscle mitochrondria are half dead. Slow.)
My corrosive familial osteoarthritis continues. I am now being evaluated for cervical spine compression despite never having any history of neck issues (the MRI is awful of course). I suspect I have another, even scarier, spine surgery ahead - preferably years ahead but it might be sooner. This time I'm entering the surgical pathway earlier, my one regret of my back surgery is that it was delayed while I had to walk through the insurance mandated pre-surgical protocols. I wonder if I'd have less residual neuropathy if that delay had been less.
What lessons could I share if someone were to ask (nobody does) about this journey? I'd summarize them as ...
- Surgery has improved over time. Sometimes it's technology driven (laparoscopy, imaging, robotic surgery), sometimes it's learning what works and doesn't, sometimes it's small incremental improvements. For many surgeries the first shot is the best shot - so make it a good one. There's benefit from delaying surgery -- in my case for 45 years.
- The spine is weird. The surgical/nonsurgical physical exam techniques I was taught 40y ago are not very reliable. In retrospect I would have benefited from 2024 surgery in 1981 -- but the surgery of 1981 was relatively crude. I'm glad I avoided it.
- A strong posterior chain and good technique can compensate for big anatomic problems for a surprisingly long time.
- If you do have a 'surgical back' in America you are going to have to jump through some hoops before insurance will pay. It's best to get into a system early so the clock starts ticking - even if surgery may be delayed for months or (ideally) years.
- If you need back surgery it really helps to be in very good physical condition. I lost a lot of strength from November 2023 to June 2024 but I was still probably the fittest old patient my surgeon had.
If I do get to neck surgery I'll probably do a post on what happens then. I also expect to run into new lumber problems as the bones continue their journey to the grave. I am a bit bored with the topic though, so probably not a lot of blog posts. This one will have to do for a while.
PS. I mentioned that even as the spinal stenosis was manifesting I also deranged my knee in a snow bike accident. For a while I thought that was the bigger problem, though it soon became incidental. I tore everything but the lateral collateral but, given age and the fact that I looked like I was going to die soon, the surgeon did not recommend surgery. I think being unable to do anything but bicycle for 6 months was quite good for that knee. My tibia is now loosely connected to my femus but I can still do my usual things including full squats. Happily I'm not a basketball player! Once again, all those leg exercises came in handy.
- fn -
[1] From 2013: "Will I still be doing CrossFit at 64? It seems unlikely, but it's not impossible. I'll let you know." That choice of age was prescient. It's a year-to-year thing now.
[2] I wrote that in 2014 and, damn, it has been pretty accurate.
[3] That's nothing for a power lifter, but for non-comp CrossFit it's not bad for my age.
[4] Did my surgeon understand what he was permitting? I kind of doubt it honestly.
[5] In order to sustain my reputation for bloody mindedness I did our annual mountain bike trek to Bentonville Arkansas 3 months before my spine surgery -- even though I could not walk. I did avoid the black trails.
[6] In 2009 the role of exercise in managing back pain was still somewhat novel, in 2004 back pain was described as untreatable.
[7] I don't think there's anything quite like PNBC any more. They were profiled in the New Yorker back in 2002.