Ending the long back pain saga with ... spinal stenosis surgery (and CrossFit)

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.

Exercise and sanity in the time of you-know-what

Fellow exercise addicts -- let's examine our options...

1. Trail, road, gravel biking. Extreme aerosol diffusion. Antiviral ultraviolet radiation built in. Social distance built in. Definite good. Buy your gravel bike now before they're all gone, but any road bike will do. Start commuting by bike.
2. Mountain biking. Same, but different bike.
3. Running. Hard to be less social. Trail runs nicer. For St Paul MN -- Battle Creek!
4. Garage Gym. Get that car out of there. Who cares about cars anyway? Bench, bar, weights, programming from your local CrossFit franchise. Get some friends together at a distance (byob).
5. Your local CrossFit ... class sizes will be smallish. Open the big doors and spread outside where the air flow is amazing. Dress for the occasion. Learn to love open air deadlift and those $!$^@ runs and rows and such.
6. Golf. Chase (Tim) wants this. Lots of social distance! Don't share clubs :-).
7. Lake swimming. Cold in MN March, but eventually ...
8. Inline Skating! Time for a comeback. Get those blades out of the attic. Airflow, etc. Join the Facebook Minnesota Inline Skate Club Group.
9. Hiking. Slow trail running for the win.
10. Rock climbing outdoors. Sweat and blood do not transmit. Maybe don't spit on the rope?
11. Paddling! Canoe, Kayak -- air flow, social distancing, perfect.
12. Fishing -- not much exercise, but good for sanity.
13. Tennis -- don't spit on the ball.

Things governments should do to help morale:

1. Free fishing licenses!
2. Waive state park fees.

The rules change

On the 9th of August 2009 I wrote a post on at the start of my 51st year. It included an estimate that I was at "70% lifetime strength”. That was an improvement over June of 2008.

I figured it was downhill from there.

I was wrong though. Four years later, in April of 2013, I started doing CrossFit. It’s enlightening to look back at what I wrote then:

… I now do CrossFit twice a week; that's about as much as I have been able to safely handle. I currently need 3 days to heal between each session. Between sessions I do my usual 2 hours of bike commuting one day a week...

...After five months, despite my back strain injury, St Paul CrossFit has worked well for me. I haven't developed much visible muscle, but I'm significantly stronger and I can handle more exertion. My weight didn't decrease until about month 4, since then I dropped 8 lbs and am close to my optimal weight.

The net effect is that physically I perform and feel more like I did at 44 than at 54. That's a big difference; if I feel at 62 the way I was at 52 I'll be content.

I'm not as keen on CrossFit as some but I enjoy the people, the exercise, and the game of staying within my limits … I'll probably go to three times a week when ice and snow stop my bicycle commute...

… At 54 I'm into managed-decline rather than improvement, but at 34 I'd have been tempted. CrossFit workouts are intense -- and I'm not sure five or even four workouts a week makes sense for most 35+ bodies…

Six years later I would frequently do CrossFit five times a week, and I usually managed four times a week. At age 59, six years after starting, I amazed myself by surviving a 300 lb deadlift. That’s warmup weight for a strong middle-aged man, but it was a lot for me.

I got my dubs last year.

I've had several weight lifting and gymnastic personal records in the past two years. “Managed decline” didn’t happen at 54 after all -- despite being hit by the familial arthritis train at age 56. In retrospect, while my physiologic maximums had been declining for decades, there was more head room than I’d expected. I just started living closer to that maximum performance level.

But we know how the story ends. We know what 85 looks like. There’s a steep descent ahead.

I think I’ve started that run. Over the past few months I’ve been more fragile, prone to old injury patterns, healing more slowly. I didn’t make my 8/1/ Bar Muscle Up goal (still training though).

My peak performance has met my downward trending physiologic limit.

They probably met in May of 2019 - 3 months ago, but I only got the message last week when a minor back strain passed all my usual fitness tests — and got suddenly worse on a warmup lift. The rules changed.

I greeted this understanding with the mature wisdom of an Old person.

Hah, hah. Not really. I wanted to cry. I was crying on the inside. For a day or two anyway.

Now I have to figure out the new rules. I’m off CrossFit until after my early September Maah Daah Hey mountain bike trail ride — I need to be as rehabbed as possible until I’ve done that trip. So I’m doing my training rides, my rehab weight lifting (my strict pull-ups are 50% improved, also working on a new bench PR!), started swimming again, picking up more inline skating.

I’m studying my Supple Leopard book.

When I return to CrossFit (9/9/2019 is the plan) I can max on the cardio and the body weight reps and I can keep training for my maybe-never-bar-muscle-up, but it will be months before I let myself do serious weights. I have to figure out the new rules.

Maybe next year I’ll do my first triathlon.

Update 12/6/2019

So this week I set new lifetime best weight lifts in clean & snatch, front squat (17 lb increase!) and back squat. More than I’ve ever done before. I was also just 5lbs short of my PR for bench press. Aced every 1 rep max test over 5 consecutive days.

The back? After 6 weeks it was 80% better, after 10 weeks 100%. I think it was a posterior L5/S1 disk — that resolved.

The bar muscle up? No, not quite. But today I was agonizingly close. If I’d piked forward I’d have made it. By far the best ever.

I do not understand all this.

Update 2/3/202

I got my bar muscle up.

My exercise program towards the end of year 60

Current exercise guidelines are more demanding that the “12 minutes a day, 3 times a week” standard of my youth ...

For substantial health benefits, adults should do at least 150 minutes ... to 300 minutes ... a week of moderate-intensity, or 75 minutes ... to 150 minutes ... a week of vigorous-intensity aerobic physical activity...

… Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes of moderate-intensity physical activity a week.

… Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week

I’ll be 60 in 10 weeks. This is how, as a genetically ungifted athlete, I approach those recommendations between May and October

Sunday: 3-4 hour road bike ride, not counting lunch. If weather is bad then CrossFit St Paul. I’ve been enjoying CFSP for more than 6 years now. Often 9 holes of walking golf with #1 son.

Monday: CrossFit, usually with my teen daughter, followed by sets of sit-ups and dubs (120 and 80+)

Tuesday:  Mountain biking 1 hr at Battle Creek, River Bottoms, Leb or Carver. St Paul JCC with Emily and #2 son, weights and running — whatever I’m not doing at CrossFit. Usually Bench, SLR, and working on components of a Bar Muscle Up.

Wednesday: CrossFit, with the daughter, sit-ups and dubs.

Thursday: CrossFit (daughter) and the J with Emily and #2 son. Some light weights and sauna.

Friday: CrossFit, sit-ups and dubs.

Saturday: Rest day! Nothing scheduled but often kinetic anyway.

From October-April I do JMS Hockey on Friday nights, CrossFit on Sunday, and Nordic skiing when conditions allow. This year I’m planning to add winter mountain bike trail rides.

Because I once had a quite bad back I do a set of 9 stretches every morning and 20 weighted roman chair reps each night — but those go fast. I do dumbbell curls during phone meetings and before bed because of that muscle-up project.

I’d love to be able to also bike commute to work, but my current job is a remarkably bad fit for bike commuting.

On a good week I do at least 600 minutes of moderate to high intensity exercise. It keeps me more or less balanced and able to work. I didn’t start out doing 600 minutes a week, it just built gradually over the years. The older I get the more important exercise is, and the more time I need to spend on it. It helps that I’m quite good at amateur injury rehab.

Current medical wisdom is that exercise won’t control weight, but I think that depends on how much exercise one does. In the winter I am more careful, but in the summer I sometimes need to add extra food to maintain my weight.

Life goal #2 - The CrossFit Kipping Bar Muscle-Up

In 2018 I met one of my two CrossFit Life Goals (tm) - 10 consecutive dubs (hit 42 in a wild fluke the other day). Only took me five times as long as anyone else I know.

The other goal is the Kipping Bar Muscle-Up. So that’s on the list for 2019. I’m also planning an IMBA “Epic” mountain bike trek — the Maah Daah Hey, but that’s mostly about showing up and moving my feet. The Bar Muscle-Up may be impossible, so it’s more interesting. (Watching Paoli video I should be able to do it now [1], but that’s now what I’m feeling!)

I’m putting my training notes and references on this page.

Examples

• CrossFit demonstration video 
• Carl Paoli Bar Muscle Up progression (3/2017)
• Extended tutorial
• WODPrep step-by-step and WodPrep Ultimate Guide (course)
• Invictus — knees up

Movement notes

Some of the best tips came from a post in the CrossFit Physicians Facebook group.

• Hands a bit wider than shoulder, but narrower than bench
• From beneath the bar jump up and back to a big arch then fall forward into extension position — gets good start there
• Drive hips to bar from top of “hollow” position, while “push down on bar with straight arms”. There should be a bend at hips so can “pop” the hips and pull, row bar into chest/navel (pop/pull is the trick - need timing). The pull should be very hard and fast
• Grip. Begin with the end in mind. You want to think about the position the hands and wrists need to be in when you're on top of the bar and doing the dip portion of the BMU. A lot of people struggle because they grab the bar from directly underneath and don't really wrap their hands over the bar. Instead of doing that, wrap your hands as far over the bar as possible. It's basically a 'false grip' maneuver that you've probably seen on the rings, just on the bar. The idea is to have to turn your hands/wrists over as little as possible. The-two word actionable cue for this is "meaty grip".
• In the kip swing, think about getting your body as loooooong as possible in as you move in front of the bar into the extreme of the arch position. Maximize the full range of motion of your shoulders, keep knees as straight as possible, and point your toes. Your body is a sling shot. Two word cue: "get long". 

• For the pull up & over the bar. Pick a spot on the floor in front of you. Your goal is to stare at that spot all through the first part of the kip and the initiation of the transition into the hollow position & first part of the pull. At some point, as you pull your hips up to the bar, you're going to lose that spot from your vision (it's unavoidable - the head tilts backwards), but your goal is to see that spot again as soon as possible. The instant you don't see the spot anymore, your sole focus is to find it again. This will help you with the speed necessary to execute the transition. Actionable cue: "find the spot". 

Training programs

Some of these are for the (ring) muscle-up, the bar muscle-up is considered to be harder

• Virtuosity with Dusty Hyland: The Entire 8-Part Muscle-Up Series
• Proper Foundations: A 5 Step Progression to the Bar Muscle Up
• … five to ten strict pull ups, and around ten or more unbroken kipping pull ups … some weighted pull ups … Once the athlete can get the bar to the xiphoid process, that is when he or she is ready to move on into the next phase. I recommend the athlete have the ability to hit the xiphoid process regularly while using a regular kip. This means the athlete should have a solid kip, but also have pull strength…
• Bar Muscle Up Assistance Drills - The Barbell Physio
• Bar Muscle Up: $25 program (I might try this)
• Bar muscle up 4 week program building strength
• 12 Weeks to a Muscle-Up! This is a detailed strength program, gymnastic rather than CF, requires more strength
• Tip: How To Do a Bar Muscle-Up | T Nation
• Tips For Getting Your First Bar Muscle Up!
• CrossFit Muscle Up Progression Program - Muscle Up (ring)

Training exercises

• Strict pull-up
• Kipping chest-to-bar with elbows behind the back
• Lat Pull-downs
• Use gym machine with pulley’s ropes to emulate the curious straight arm downward push-pull (see still below).
• Back extension and arching
• Shoulder range of motion, esp. internal rotation
• Band-assist Muscle-Up with gradually diminishing bands
• Box jump muscle-up with gradually smaller box
• The glide kip drill - stand on 1-2 bench, bar a bit above eyes, arms and back in line with hip flex to big hollow, hop up, glide out with feet just above bench and extend to small hollow, then reverse on return.
• Paradiso progression
• 3 sets of 5 high back kip swings
• Hip to bar pull up (20 repeat 1 rep) - kip swing with hip snap
• Transition (atop box, etc) - 20 to 30 reps of jumping box muc
• Hip-to-bar progression with a slight arm-pull, hip drive from the hollow (I can’t get my hips to the bar yet), note in this still from Paoli video his elbows are bent, but he’s mostly pushing the bar down towards his hips and lower abdomen. Feet are below hips. Trapezius muscle here. I have to figure out how to build something like this.
  
  and note he’s actually hitting bar around navel at this point (not hips), feet are still in front as he transitions.
  

[1] Well, not now exactly. My left biceps is strained, so I have to rehab that first.

Update 2/3/2020

I posted the first version of this on Dec 27, 2018 and I succeeded on Feb 3, 2020.

It took me over 13 months. At one point, probably June 2018, I bet my 17yo daughter I’d get it done by my 60th birthday on Aug 1 2018. If I’d succeeded she owed my $10. If I failed, I would pay her college. 

Emily and I are paying her college. 

In August 2018 I was feeling kind of bleh and this looked impossible. To my surprise I started to recover in October and have been getting stronger over the past 5-6 months. Maybe the protein and creatine shakes helped. I also started doing more CrossFit for weird (but good) family reasons — 4-6 a week instead of 3-4 a week.

I didn’t end up following any of the programs above. I just worked on pull-ups whenever I could and I practiced with bands. I could do BMUs with a “green and blue” (green is BIG), then the sequence went like this (typically 3 at a time, the first is usually hardest):

- 1/9/2020: single black band 3 consecutive
- 1/20/20: red and blue then thin red, orange, blue
- 1/22: blue+thin red+orange
- 1/29: blue and 1 orange
- 2/3/20: During a “max MU in 4 minutes” WOD I started with blue, red, and orange bands and in about 4 sets of 3 I dropped bands until I did 3 with two thin orange bands and then one with no bands. When I actually succeeded it didn’t seem that hard. Timing is key.

The most useful advice I was given was "wrap your hands as far over the bar as possible. It's basically a 'false grip' maneuver that you've probably seen on the rings, just on the bar.” I didn’t really understand it at first, but it means having wrists above the bar when you start. I had note understood how hard I had to grip the bar and lever myself up.

I hope I do more, but in terms of my goal I only had to do one.

Dubs

Ten. Consecutive. Dubs.

It’s not too much to ask, is it?

Oh, and one muscle-up. Or bar muscle-up. I’m not picky.

Dubs aren’t that hard. Most CrossFit newcomers figure it out in a few months, maybe a year. I don’t know anyone who has failed as persistently as I have.

A few months ago I got 8. It was a bit of a fluke. I’ve gotten 5 or more several times. I looked like a meth-addled feeding frenzy but, like I said, not picky.

Then I started to get worse. Finally I couldn’t get any at all.

I think I’ve figured out what happened. My technique got better. Instead of swinging my forearms I learned to do singles with my wrists — like you’re supposed to. Turns out my wrists can’t move the rope fast enough. I don’t have anywhere near the coordination. This isn’t only being Old, I’ve had horrible coordination all my life. Old isn’t helpful though.

Once I thought of this I went back to the arm swinging feeding frenzy and I can do a few again. So I’ll practice that for a while. Preferably somewhere nobody can see me. Which means not my gym, where sympathetic looks of sorrow and helpless frustration are hard to bear.

Meanwhile, I can work on those lat pulldowns.

8/6/2018: I0. Also, in that set, some 7s, 8s and a 9. #lifegoal

8/12/2018: 14

12/19/2018: 42 consecutive.

CrossFit 58

I’ve had a habit around each birthday to review where I’m at with my exercise addiction. This past week was the 58th. I bought myself a Canon SL2 and Emily made me a fabulous Black Forest cake. So time for an update.

I started on the hard stuff at 53. I’d done some exercise before that - mostly road biking, nordic skiing, inline skating and other soft stuff. At 53 though, I fell into CrossFit. Actually, I was pushed. By a friend.

Four and a half years later I’m 58 and I’m still a regular at CrossFit St Paul. I average 3-4 CF workouts a week, mountain bike 1-2 times a week, and do 1-2 days a week of recovery weights or road biking or ice hockey or nordic skiing.

I’ve had soft tissue strains and pains from all of those things, but by now I’m good at rehab. I have a suite that covers hamstring/gluteal/“piriformis”, lower back strain, shoulder things, achilles stuff, chondromalacia patellae and more. “More” includes a familial arthritis syndrome affecting my hands and knees. Sooner or later that will do me in, but hydroxychloroquine seems to slow the progression. When it was diagnosed 2 years ago I figured I’d be out of CF by now, but the arthritis hasn't been a big deal yet.

I work the rehab into my workouts. It’s all one thing. Mostly I’m pretty good.

Over time I lost about 20 lbs of fat and gained about 5 lbs of muscle. Alas, at 58 I have no more muscle stem cells — those seem to go away in the 30s. I may yet get a bit stronger with practice, but not a lot. I’ve bumped up some of my weightlifting records, but recently my overhead squat and snatch have sucked. Seems the small amount of muscle I added to my shoulders came along with decreased range of shoulder motion. Gives me something else to work on.

I still can’t do consecutive double-unders, I have to mix singles and dubs. I may set a record for longest time practicing without success. It’s a coordination thing — I’ve always been clumsy but age sucks. I’ll try a fourth jump rope; some say a slower, heavier rope works better for the old. I have a rope for every occasion now.

I haven’t been able to do a muscle-up - neither bar nor ring. I work on it. Maybe someday.

I got into this to keep my formerly bad back better and because the only things that seem to slow dementia onset are sleep and exercise. I need to slow the dementia - family circumstances mean my brain has to work until about 85, when I can finally keel over and die. It’s too early to tell if it works for the dementia, but my back is pretty good.

Happily I enjoy CrossFit. I travel for work and always drop in on a CF gym — they are almost everywhere (not Hot Springs South Dakota though). I’m almost resigned to being the slowest and weakest person in the box.

It’s a living.

Moving the body - how much is too much?

I’ve read that our national dumpster fire believes exercise is unwise. That’s not a surprise.

It does remind me though of an open medical question — what is the optimal amount of physical activity?

We know the optimal amount of activity is far more than most Americans do. We suspect there are limits though. Most people should not try to deadlift 400 lbs without a lot of training and some helpful genetics. Likewise few bodies will do well running a marathon every other week.

That’s a pretty wide range though. It would help to have a guide for various ages. For example, I’ve found I run into trouble if I do full CrossFit workouts more than 3-4 times a week, but I bet 30 years ago I’d have been ok at 5-6 times a week. Once I’d have done well mountain biking daily, now my arthritic knees prefer 2-3 times a week.

When our stem cells are happy we don’t wear out like a camera shutter. When they’re depleted we may truly have a limited number of clicks. On the other hand, sometimes a set of heavy back squats puts my knees right for a week or more. That’s just weird.

There’s quite a bit of research on this question. It’s worth following …

Physiology in action - water loss on low carb diets

I love carbs. Bread especially. Ok, pastries even more.

I liked the days when diets were supposed to be low in fat, and even low in protein. (For every appetite there is a historic “best diet” recommendation.) 

Alas, carbs are somewhat out of fashion these day [1]. So when I am home, and being good, I control carbs. I also do a relatively extreme amount of exercise. When I am away I sin with carbs and exercise less — and my weight jumps 3-5 lbs very quickly. [2]. When I reform I “diurese”, which is a medically polite way of saying I pee a lot and drop the weight.

What’s up with that? I think it’s this …

Low-Carbohydrate Diets - American Family Physician

 …low-carbohydrate diets also initially induce significant water diuresis. The majority of this diuresis is likely the result of glycogenolysis from increased protein consumption. Glycogen binds water at a rate of 2 to 4 g of water per gram of glycogen. As glycogen stores are consumed for energy, two to four times that weight in water is shed through urine. Thus, a portion of the early weight loss in these diets is water weight.

I think my body is “good” at building glycogen stores, and not bad at using them when I reform.

 - fn -

[1] The Mediterranean diet has been fashionable for at least a decade (carbs as grains), though if the AIs ever figure out proteinomic-microbiomic networks we will probably have custom diets that may be quite different.

[2] I’m being circumspect, because I think my weight makes these sudden jumps after I quit sinning, decrease carbs, and increase exercise. If this impression is correct I might hypothesize that my body responds to the double hit of more exercise and fewer carbs by stuffing what carbs and fat I get into water rich stores. These then have to be depleted.

Fixing a painful wrist with high frequency weightlifting and wrist hyperextension. WTF.

In the spirit of my medical anecdotes, I present my left wrist.

Late Monday afternoon, while typing, I developed sharp pains in my left wrist. It hurt! I couldn’t type, though changing wrist position with a gel pad helped. Maybe, I thought, it was something with some recent mountain biking. Or maybe it was the high intensity CrossFit cleans I was doing. Whatever, it was obnoxious.

So I sort of splinted it with my weightlifting wrist wraps and then I waited to see what it would do.

It kept hurting, but another mountain bike ride didn't make it worse.

Maybe, I think, it’s an inflammatory arthritis of some kind. I’ve a family history and some intermittent personal history to worry about. Who knows.

I go to my morning CrossFit anyway. (Hmm. I wrote that one at 54. Now I’m 56…) Today the workout is muscle cleans and push press — about 180 of em. Great. That’s gonna hurt. I do the first 80-90 with a straight wrist, which is extra work. Then, between sets, I realize my wrist isn’t hurting any more. I do the next 90 with the usual wrist extension.

There’s some mild aching as the endorphins fade, but then nothing. Twelve hours later it’s slightly sore with unusual motions. [1]

If a patient came into my office with wrist pain back in the 90s I might have recommended ice, a splint at night, and some gentle range of motion exercises. Today somebody smarter might suggest something like the Dynaflex Pro. I don’t think anyone would recommend high intensity high repetition wrist extension weightlifting.

That’s what helped though.

I do not understand my increasingly aged body, and I don’t think I’m the only mystery. I suspect nobody really understands joints and backs. Once upon a time we recommended bed rest for sore backs, then we recommended activity and exercise;  I personally did well with relatively intense weight and flexibility training. More recently, mountain biking made my anterior knee syndrome slightly worse, but deep squats seemed to have no effect and conventional rehab seems to have helped. Today there’s the wrist.

Pity the poor physician who has to make a recommendation for someone’s sore wrist. It doesn’t work to say “I really have no idea”. It would be nice to know what’s going on though.

[1] I can make up a theory. I have reason to suspect I’m prone to dumping calcium into sore tendons and tissues — a counter-productive response that promotes inflammation. Bad genes I guess. Maybe the vigorous activity promoted clearance of some local calcium deposits. Maybe a stuck tendon sheath loosened up. Maybe the gods had mercy...

Update 5/1/2023: Almost 8 years later I can see this was probably the start of wrist involvement in my mixed-type arthritis. It became an on and off problem over the next 8 years. I'm on HCQ to slow progression and the symptoms seem to be dose responsive. It's annoying but not bad. When it's more bothersome I do "true pushups" or ring pushups or more reps at lower weights.

Exercise on the exit ramp - the 30 year plan.

One way to spot an aging control-freak geek: after 55 we count down to the target zone. [1]

One of the things we ponder is how much exercise we can take at which age. CrossFit is great at 55 [2], but it ain’t gonna fly at 80. On the other hand, gotta max out the amyloid clearance while we can. 

So when do we go from CrossFit to things like TRX, or even road biking, swimming, XC skiing, hiking and the like [3]? When do we transition to power-assisted trikes [4]?

These numbers on the 2011 Chicago Triathlon finishing times provide some insight:

: ""

Yeah, this is an elite group, and by the time we get to the 80+ group we’re talking super-duper-elite.

Still, it’s an interesting story about what happens to the “average” elite. It goes like this:

• 20-44: not much difference at all
• 45-64: bit worse every year, but more of a steady decline
• 65-74: there’s a big drop in mid-60s, but then it stabilizes (of course a lot have dropped out by then)
• 75+: the scythe is being sharpened - nobody escapes

So for me that looks like:

• 55-65: Do CrossFit, Mountain biking, etc until wear and tear adds up. Can do pretty much anything if train for it and stay disciplined about scaling and stopping. [5]
• 65-74: Downshift. Good age for long bike rides, nordic skiing, etc.
• 75+: Functional exercise, balance, walks, swimming, shorter bike rides, nordic skiing, maybe the power trike, tourism.

It’s good to have a plan.

 

- fn -

[1] I figure by the time I’m 80 I’ll be able to hire a “life” coach to ensure I don’t overshoot (Ninja assassin experience a plus). Ok, a Death Coach.

[2] 36 handstand pushups yesterday. Ok, so that was over 9 sets. And, yes, I used more than one ab mat. No, I won’t say how many I used. Still. Yeah, and PR on the back squat — even though the two women in the class beat me by 20 lbs. 

[3] All favorites of mine. Today I can’t afford the time for a 4 hour bike ride, but when I’m 65 the time may be mine.

[4] Mine will have streamers.

[5] I have a PhD in CrossFit scaling.

Exercise and 55 - still CrossFit

When I would lose weight at 35 friends might say I looked well. At 55 friends say nothing, but they look worried. Like they’re wondering who Emily will marry after the cancer gets me. It’s different.

I think the skinniness is the CrossFit though. I’m still doing it, 17 months now, still at CrossFit St Paul. I used to need 3 days to heal after the workouts, but I went to 3 times a week last January. When my bike season ends I’ll go to every other day until spring.

I’m not addicted. Ok, a bit.

Doing this has put an unexpected spin on aging. My hair gets whiter, my brain gets crappier [1], but my body gets stronger and faster. I ran my best lifetime mile a week ago. I finally started doing “double unders” - just took a year and a half of failure. (Ten year old girls do these routinely. I blame it on a 55yo cerebellum and my aspie genes.) I suck at snatchs and handstand pushups, but they don’t scare me any more. I’m doing the chin-ups with the smallest band assist - or none at all.

The pounding music and tattoos have become familiar. You see something every week and pretty soon it’s just background. (I told my daughter if she gets a tattoo I’ll get one too, but I’m bluffing.) Now I see all the levels at CrossFit — on-ramp, newbie, beginner, regular, “Rx”, specialty classes, competitive and beyond. I’m basically somewhere between newbie and regular. Rx, at least Rx for men, is beyond this life.

We have terrific coaches and classmates, times that work no matter my schedule, great location for my commute, no contracts, and great return on time spent exercising. I like the “risky crazy” reputation, though I am positive my bicycle commute is a higher risk for serious injury.

Yeah, it doesn’t go on forever. I know what 80 looks like. Long before that I’ll be doing something gentler, and if I’m lucky I’ll one day be pedaling a electric-assist trike for exercise. Until then, I pay a month at a time.

If you want to try CrossFit and your 40 year warranty has expired I can share what’s worked for me — so far. 

I’m careful. I keep my deadlift under 210 - which is ridiculously low for a guy. I’ve got some history with backs and I respect that. Deadlift aside I aim for 80-90% of “Women’s Rx” on the weight, where Women’s Rx is what a competitive CrossFit woman would do. (Men’s Rx for olympic weights is way beyond me.) When my technique gets poor I slow down — even when time is running out. I like to ride my bike to the gym to loosen up, and a few hours of bicycling on off days is balm for a sore body. In the winter XC skiing works the same way — but this winter I think I’m taking up skate skiing. It’s good for the squats.

There’s some etiquette with being old in a relatively young person’s activity. There’s always something on the body that’s trying to break — don’t whine. It’s just entropy at work.

That’s it. If you want to try I recommend starting twice a week, abandon any idea that you’re stronger or faster than the CrossFit women, respect the body (never push, it will break), be persistent and be patient.

[1] One of the reasons, maybe the main reason, that I started doing CrossFit was that the only damned thing we can do to slow our inevitable brain mushification is to do serious regular physical exercise. If it’s really working for that then I hate to think what my brain would be like otherwise.

Update: This 2012 review of CrossFit is well done.

Exercising hard as an old person - one year of CrossFit

Dave Foley, who is 67 to my 55, describes what it’s like to run hard as a senior citizen …

Silent Sports: Getting along with getting old Part II

… Age tends to level the competitive playing field. Guys who trained fanatically 20 years ago, logging 100 miles a week, may not be able to run 50 miles over a seven day period now. Years of hard running does take a toll.

However, if you put in 40 miles weekly at a comfortable pace in the 1980s, it is quite likely you can still log about the same weekly mileage.

Those tortoises, who routinely got bested by the hares they faced in their youth, may now find themselves shooting past those one-time speedsters. And those newcomers, who didn’t even start running until they were in their 40s, they’ve got fresh legs and may now be racing past the ancient tortoises and hares.

… Stretching is optional, but the first steps of a run must be gentle ones. If timing a run is important, then slowly jog a half mile before clicking the watch on…

… No running at all for the last two or three days before a competition. In this way you actually may arrive at a race site with absolutely no muscle stiffness. Don’t be deceived. No matter what your brain tells you, you are still as old as the Rolling Stones…

… Banish all thoughts of “No woman is gonna beat me” because they can and they will.

… the leg muscles of senior runners fatigue before their lungs. That means that when your aching quads won’t push you any faster, you’re likely still able to easily converse with other runners….

… The race to the finish is no longer a venue for heroic sprints. If you haven’t been practicing sprinting, don’t try or your hamstring is apt to split open like the skin of bratwurst on a hot grill…

… Seconds after crossing the finish line, expect to have a race official hovering next to you saying, “Are you O.K.?” Apparently old guys who race hard look awful….

… we can avoid most injuries by listening to our bodies. And since those daily runs burn up calories, we can eat more than our sedentary peers and still stay trim. Although our bodies may ache a little, most days it feels good to be out running. And if the science is correct, we are going to enjoy longer, healthier lives as runners.

… sone days I feel young and my feet seem to fly down the road. A nine-minute mile on these days feels no different then the sixes I once ran…

I suspect Dave still felt kind of middle-aged at 55. Me, my kids tell me I’m already ancient. Even so, my routine exercise intensity has never been higher. Sure, I’ve been stronger and faster — but even at my most active I didn’t do CrossFit level intensity week after week. Unlike Dave, because I was less active previously,  I can keep setting “personal bests” even as I get older. It’s not that time is running backwards, it’s that I’m getting closer to my biological potential even as it declines. I’ll probably hit the limit this coming year, but  think I can manage that. For now it’s good to be stronger and faster than I was 10 years ago. I’m even learning to run - an activity I avoided in favor of everything else.

I can’t speak for the incredibles who compete in CrossFit Masters (starts at 45, 60+ is all one group), but there are a few rules that I follow to try to stay out of trouble. For exercises that specify “Rx" weights, I aim for 70-80% of the women’s Rx. Years ago I had a bad back, so I’m careful with technique and deadliest; I’ll add reps if I feel too strong. I’m not embarrassed to use the women’s bar when that makes sense, and “no woman is gonna beat me” is laughable. I’m regularly beaten by some women who are themselves over 40.

Most of all I pay attention to what hurts. I’ve been nursing a right medial tendon ache for a couple of months, so I go easy on that one. On chin-ups I’ll “band up” and do more with my left arm - go for more reps with more bands.

There are some things I can’t dodge. I’m lucky to have good knees, but when those go I’ll have to pass on to something else. It’s  hard to do CrossFit without squats (it should be called SquatFit).

Not yet though. Maybe I’ll get another year …