Saturday, January 14, 2012

rehabbing the lower back

Rehabilitating the Lower Back

by Bill Starr
rehabbing the lower back

The sky was ash-gray with all the signs of an incoming storm straight off the Gulf. The air was muggy and still. I found a place on the screened porch that always catches a bit of breeze, regardless of the weather, and turned by attention to Michelangelo’s epic confrontation with Pope Julius as recorded by Irving Stone in The Agony and the Ecstasy. I was at the point of the story where the Pope was trying to convince Michelangelo to paint the ceiling of the Sistine Chapel, a task the strong-willed artist was resisting with all his body and soul.

This is one of my favorite times of the day. Indulging myself in that first cup of coffee and enjoying a well-written novel. Tinker, my worthless black puppy, was napping in a chair next to mine so that he could receive an occasional scratch, the breeze was flowing gently on my back and all was quiet in the country. But my solitary relaxation was to be short-lived this day. All four dogs broke into a barking frenzy as they spotted the green pickup coming down the lane.

It was Ed, and as I attempted to quiet the mutts, I noticed that he was walking with a hobbled gait.

“Looks like you’re hurting,” I said as I opened the screen door for him.

“Yea, I am. I need to talk to you. Got a minute?”

“For you, sure. What’s up?”

“I need some help. This back of mine is giving me fits. I just can’t seem to get it well. It’s been out of whack for over three months now.”

“Where is it hurt?”

“It’s my lower back. I did it deadlifting in the Galveston meet. Sometimes I can’t even get out of bed in the morning. The pain runs down my left leg and I’m barely able to hobble around.”

“Have you been to a doctor?”

“Yea, two or three. They give me pain pills, muscle relaxants, and one gave me a cortisone-type pill which helps for a while, but then the pain comes back and I know the problem is still there. I just came from a chiropractor. He helps the most. I feel good for a few days after he adjusts me, but then it comes back again.”

“Have you been exercising it?”

“Well, I’ve been trying to train my upper body so as not to let my shoulder strength get too far behind, but I’m afraid to work my back. I’m almost crippled now.”

My friend was obviously in great discomfort. He gingerly lowered himself into the chair next to me. He had to use both hands to extend his right leg. Blondie came over to coax a few pets from the visitor.

“What should I do?”

“Ed, the back is one of the most difficult areas of the body to deal with as there can be so many things out of sync that cannot be discovered though X-rays or such. You tell me that it feels much better after each adjustment and this is a most positive sign. What you need to do is strengthen the muscles that support the lower back so that when the chiropractor sets you into a proper alignment, the muscles will be strong enough to keep your vertebrae in the proper line.”

“Frankly, I’m a bit afraid to exercise my lower back at all. What if I blow it out completely?”

“I understand your apprehension. I suffered with the same problem for almost three years. I couldn’t break a bar off the floor without pain. That’s when I came up with this little program I’m going to show you. Think on this. There are two ways for you to go. You can continue on your present course and hope for the best. A small miracle maybe. But I can tell you from experience that the muscles of the lower back, hips and legs will just get progressively weaker if they are not exercised. That is a physical law. And I can almost guarantee you that your back pain will not only continue, it will get worse.

“The other course is for you to start on an exercise program designed to strengthen the weakened muscles of the lumbar region. It’s that simple.”

Ed was busy scratching Blondie’s chubby yellow back while he listened intently.

“What kind of exercises are you thinking of me doing?”

When anyone asks that question, I know I’ve got him headed in the right direction.

“I have two favorite exercises for the lower back: the good morning and the halting deadlift.”

I watched Ed’s face lose all of its color.

“Deadlifts? I don’t think you’re listening. I can’t stand upright without pain, how am I going to deadlift:”

“Very lightly,” I replied.

He studied me for a moment to see if I was joking. I wasn’t.

He was now busy massaging Blondie’s ears.

“I have to admit that I don’t want to continue like this. I’ll try anything. When can you show me how to do the exercises?”

“Now.” We walked from the porch through the kitchen into the Sugg’s Athletic Club. Which is, in real life, a two-car garage with sufficient equipment to train a world champion: Olympic bar, bench, power rack, squat stands, dumbells and about a half-ton of weight. Quaint, and often animated with some two dozen odd cats and kittens coming and going at will, but anyone who really wants to get strong can do so at the S.A.C.

“Before I show you how to do the two movements, let me explain that you are going to do very high reps and be using a very light weight. The workload will be achieved through reps, not the resistance. You will be using this broomstick for resistance and I want you to do 75 reps, if you can.”

“Seventy-five reps! I’ve never done seventy-five reps of anything.”

There was a tattered copy of The Strongest Shall Survive laying on the top of the washer. I flipped through it to page 165 and showed Ed the photos of Ed Frasca demonstrating the good morning. Then I took the broomstick and performed one as I instructed him.

“Place the bar high on your back as you’d do on a ‘high-bar’ or Olympic-style squat. Your feet should be closer than shoulder width, about 12” apart. Your toes are turned slightly inward, in a pigeon-toed stance. Bend the knees slightly and then lean your upper body forward and try to place your chest on your thighs. Eventually, you will be able to touch your nipples to your knees. Round your lower back and do not let your hips go lower once you have set your position. Come up slowly, with the weight on your toes, rather than your heels. Reset for each rep.”

Ed followed my instructions perfectly, going slowly into the bottom-most position. For the first dozen reps he was barely bending forward at all, but steadily he got lower and lower so as he neared the fiftieth rep he was actually touching his chest to his thighs. He got to seventy-five, then quickly went to the bench and laid down. His face assumed the color of chalk and he was breathing like a man who had just run wind sprints.

“Good grief,” he gasped. “I can’t believe that made me so tired.”
”How does it feel, your back I mean?”

He was lying on his back with one arm across his face. He flexed his lower back on the bench.

“I can feel the pump, that’s for sure. I can’t believe working with a broomstick could do that to me.”

“OK, rest a minute or two and do another set.”

He looked up at me from under his forearm and said weakly, “I’m not sure that I can.”

“Yes, you can. One thing that you must learn is that you’re going to have to handle pain. There is simply no other way to rebuild a damaged bodypart without some degree of discomfort. What you need to be able to do is to differentiate between a sharp stabbing-type pain and a dull aching-type of pain. The sharp pain indicates that there is something amiss and you should stop whatever you are doing. The dull ache is a positive pain. It means that you are feeding blood and healing nutrients to the damaged area.”

Ed got up slowly.

“OK, I’ll try another set.”

I coaxed him through fifty reps before his skin took on the tone of milk. He flopped on the bench again.

“Phew, I didn’t know my lower back had gotten so pitifully weak. I’m embarrassed. I was deadlifting 550 before I got hurt.”

‘Your strength will come back quickly once you get over these first few weeks of rehabbing. And if you go about it sensibly, your lower back will be stronger than it was before you got hurt. Now get up, I want to show you one more exercise. I call it the halting deadlift. You only pull the bar to just below the knees. You never come fully erect.”

A bit of color had returned to Ed’s face, but he was still a tad pale.

“I don’t think I can deadlift anything.”

“I don’t expect you to. You’re going to use the broomstick again.”

“Oh no. And high reps?”

“You got it.”

Ed growled and grumbled, rolled off the bench and took the broomstick from me.

“Do this movement just as you would the regular deadlift except I want you to lower the broomstick to the tops of your shoes and only bring it up to the top of your knees.”

He performed seventy-five reps in fine form and was once again totally spent.

“Boy, am I puny.”

“There’s no question about that. Your lower back strength really fell off. How is your back feeling now?”

He stood up, twisted and turned in a variety of positions.

“Hey, pretty good. It’s not hurting now. That’s the first time in over a month it hasn’t hurt without pain pills.”

“Well, don’t be fooled. The lower back is still hurt and you should continue to assume that it’s damaged for some time yet. But you can be happy in the fact that if it feels better after a session such as this, you’re on the right course.”

You should do three sets of both of these exercises at least once every day. Twice a day is even better if you can work it into your schedule. Stay with the broomstick for the next five days and try to run the reps up to 100 for all three sets on both movements. Then start using the Olympic bar, 45 pounds, drop your reps back to 75 and steadily work back up to 100 reps. When you get to that point, you’re well on your way. Start adding plates, and drop the reps back to fifty a set. When you are able to put on the 25-pound plates, giving you 95 pounds, begin doing three sets of 25 reps. Stay with this formula for at least four weeks, 3 sets of 25, and move the weight up whenever you feel able.”

Ed was busy writing all this information on a note pad.

“Anything else?”

“You will also need to pay attention to your nutritional supplementation during this rehab period. Start drinking a protein milkshake daily, and increase your B-Complex vitamins as well as your C.”

“I take a multi-vitamin that has all that in it.”

“Your multiple is a good start, but when you are helping your body repair itself, you need to make sure that you are providing it with ample material to do the job. The additional protein will insure that you have a sufficient supply to rebuild the damaged muscles, the extra B-vitamins will assist in the assimilation of the protein, and the C is most valuable for building the strong connective tissue.”

Ed now had two pages filled in his pad.

“OK, I can handle that. How much C?”

“Take ten grams a day for a week, and then drop back to six.”

“Is that it?”

“Not really. I want you to continue to see your chiropractor until all pain is gone. Also, there are inversion boots at the gym in town. Use these after every exercise session. Hang for 5-6 minutes each time. Call me if you have any questions or problems.”

As he walked to his pickup he was no longer limping, although he did appear weary. Ed had consumed my reading hour. I would have to wait to find out how Michelangelo faired with the Pope. It was time to do some typing.

It was almost a month before I saw Ed again. I bumped into him as I was leaving the Safeway.

“So, how’s the back?”

“Hey, better than OK. I’m using 95 pounds for all three sets in the good morning and 225 for my last set of haltings. The hanging really seems to help and I think the extra C, B’s and protein have given me more energy. I feel good. I stopped going to the chiropractor last week.”

“That’s terrific. Just be cautious. Stay with that 95 for another month in the good morning and you can start doing them just three days a week. The same with the halting, but you can creep the poundage up on that. Just be aware that your lower back is still not at full strength just yet. You no longer need to baby it, but don’t be doing any limit lifts, not even any heavy fives or threes.\

“Do this program for a month, then drop the reps to 10 on both exercises and start doing five total sets of each, three times each week. After another month, you can ahead and do your regular power program, your back will be stronger than it has ever been. It’s also time for you to start working your abdomen. Remember that your midsection is a girdle and all parts must be kept in proportional strength. Do some leg lifts or bent-knee sit-ups each workout.”

“I started doing frog-kicks last week.”

“Fine, they’re even better. I’m glad to see that you’re improving.”

“I appreciate your advice. Ah . . . could you give me some tips on how I can get my bench to move? I’ve been at 320 for months.”

“Later, Ed. Later.”