Don’t Call it a Comeback….

This Military Athlete was in a wheelchair 8 months ago… now he deadlifts 645 lbs!
Derek was in a wheelchair for 2 weeks before the pain decreased enough to be able to walk and drive again. Two months of Physical Therapy traction, transcutaneous electrical nerve stimulation (TENS), and basic stretching reduced his pain enough to begin exercising.
The main goal of physical therapy in persons with acute back pain is not to increase strength but to achieve adequate pain control so they can begin to move again without sharp pain. Many people expect that Physical Therapy will return them to the physical condition they were in before the injury, but this is not the reality of how the system works.
Once Derek was released from therapy, I assessed his mobility and strength between the right and left sides and found significant differences (greater than 20% in this case) in strength between the legs. There was also a difference in the size of the two legs, the injured leg lost over 1 inch in diameter when compared to the non-injured leg due to inactivity and lack of weight training.
The exercise program I designed consisted of mobility drills and bodyweight stability training working each leg independently and working his core (lower back, obliques, and abs) focusing on balancing the strength between the two sides.
Progress allowed us to transition to strength exercises while still working on each side of the body to bring the injured side up to the level of the non-injured side. Once we were close to a 5% difference between the sides then two leg exercises (deadlifts, squats, etc.) were once again part of the workout program.
All of the hard work to balance out the body allowed Derek to quickly stack weight to his lifts and surpass his PR from before the injury. Everyone looks at the numbers he is putting up for his big lifts, but the truth is he still performs most of the single leg exercises and core work that I originally implemented to maintain his strength and prevent the risk of future injury.
The number 1 predictor of an injury is a prior injury. Why? You did not return the injured area to full use by balancing out the body side to side, removing the compensations you developed, returning to full mobility, strengthening the stabilizing muscles around the injury, and working on your balance.
His recovery highlights the correct process to recover from a back injury and how we were able to transition him back to full fitness.
Injuries happen to us all. The US Bureau of Labor Statistic states, “About 80% of adults are estimated to experience a back injury in their lifetime.” It does not matter if you are involved in sport or not. Life is a contact sport. This statement seems to surprise people about the fact that injuries are more the norm than the exception. However, fully recovering from an injury is rare. We often see the aftermath (compensations and alterations in motor patterns) for years after the injury due to failing to return the body back to normal.
The typical causes for lower back pain are…

Sitting too much…
Standing idle too much…
Not moving enough…
A tight upper back or thoracic spine…
Tight hips…
Tight hamstrings…
Weak Glutes
Weak Core…
Muscle imbalances…
The 4 correct steps to return from a back injury:
1. Control of pain and the inflammatory process – Pain treatment should be initiated early and efficiently to gain control. Ice, transcutaneous electrical nerve stimulation (TENS), medications, and relative rest may help with controlling the pain and the inflammatory process.
Excessive bedrest, however, may lead to deterioration in lumbar segment motion, loss of muscle strength, and general deconditioning with blunting of motivation. In the last 10 years we have seen changes in post-surgery protocols that have patients up and moving (quite often the same day) after major surgery to greatly reduce the deconditioning that can occur with bedrest. The body is built to move and movement has been shown to increase blood flow to the injured areas and actually speed up the healing process.
2. Change Habits – As we get older, we tend to move less and when you move less, you tend to sit more. The problem with sitting is that you compress and de-activate your backside (glute and hamstrings) and shorten the front of your hips. Both bad things for function and healthy movement.
Taking frequent rest periods from sitting changes the demands on your spine to let the muscles responsible for holding you in good posture take a break.

Keeping a bad posture. You know the deal, slouched forward with a rounded low back while watching TV, working at the computer, or reading. Using bad body mechanics and letting your low back move during lifting instead of using your hips. We consistently see bad habits of poor posture contribute to increased risk of back injury later in life.

3. Mobility and Stability – After an injury your body will naturally tighten up and limit Range of Motion to prevent you from further injury. You need to gradually return mobility to the injured area with mobility drills and stretching, foam rolling, myofascial release, and activation techniques.
The ability to achieve range of motion with stability is one of the most important aspects to quality of life.

Exercising to engage and strengthen your core muscles without moving your low back. Perform stabilization exercises that allow you to maintain a good back posture while lifting, getting on and off the floor, in or out of a chair.

Mobility and stability imbalances side to side need to be returned so that there is less than 5% difference between the left and right sides. You will never be exactly the same on both sides, you will always have a dominate arm/leg. But, more than 5% difference will increase your risk of another injury, and also indicates you are probably still compensating (shifting weight, favoring one side, over use of 1 arm or leg, etc.).
The stabilization musculature around the injured area needs to be challenged slowly to increase strength, providing support to the injury and allowing you to work larger muscle groups while reducing the risk of re-injury.
4. Strength – Strengthening your core is far more than performing the latest variation of a sit-up. When we talk core strengthening, we mean that your back contributes 40% to your core, your abs are another 40%, and your oblique’s (love handles to some) are 10% each. Endlessly working your abs while neglecting your lower back and oblique’s is the quickest way to re-injure your lower back.
The stronger and more mobile you are, the less risk of injury. Sometimes the injury cannot be avoided, but with strength and mobility you will recover quicker and return to your normal life and the activities you enjoy.
Doing things that truly make you able to move better and more often are the things that will make you better. Unfortunately this isn’t found by sitting on machines or in a chair. Dr. Stuart McGill, spine biomechanist at the University of Waterloo states, “The use of machines that buttress joints and restrict range of motion at specific joints not only retard the various levels of motor learning required for optimal functional performance, but can encode patterns that are detrimental to both performance and the avoidance of injury.”
Lower back injuries make up over 40% of the injuries we typically encounter in clients and according to the US Bureau of Labor Statistic, “More than $50 billion is spent each year trying to treat back pain.”

One of our philosophies is whatever your goal, it starts with first being able to move well and move often. To be able to play with your children or grandchildren, pain free. To be able to keep up with your hobbies, whatever they may be. Never having to give up anything because you’re limited by back pain.

Be like Derek, seek out information and professionals to make sure you fully recover from back pain. Once you have a back injury, you will always have a back problem. It’s a matter of how well you take care of your back that will determine if you live a healthier and happier life or one in pain.

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