My L5-S1 Disc Explosion Pt II
Continued from Part I So after bucket-loads of pills, rest, e-stim, physical therapy, decompression treatment, chiropractic adjustments, and acupuncture I was still a mess. My pain had only gotten worse over the course of 6-7 months. What was the next step?
Steroids
I was referred to another doctor, this time a pain management specialist. I gave him the story that I’ve been repeating over and over to the other health care professionals. He took notes, reviewed my MRI and my treatment history, and decided the next step was to try an oral steroid treatment. Before you shake your head in disappointment and disdain, understand that we aren’t talking about anabolic steroids (I doubt those would have helped me much). The treatment consisted of 10 days of a corticosteroid drug, specifically Prednisone, in a hardcore attempt to kill the inflammation in my spine. The doc was straight up with me and told me that there’s a chance it will help but it’s a far cry from a guarantee. He wrote me the prescription and warned me of the side effects:
-High blood glucose
-Fluid retention
-Insomnia
-Anxiety
-Weight gain
-Severe facial swelling
-Fatigue and weakness
-Mental confusion
-Steroid dementia syndrome
-Infection
-Joint pain
-Blurred vision
-Acne
-Depression, mania, or psychosis (wait… what?!?!)
I followed the directions closely and took the pills everyday for ten days. The dosage started high and tapered down throughout the duration. I can’t say I felt much of a difference throughout that time. The pills didn’t make me feel better at all, but I didn’t get any noticeable side effects either.
So soon after that I’m back in the doctor’s office to see what the next step is. We agree that something more invasive needs to be done, but not surgery… yet. He suggests an epidural steroid injection. An epidural injection does not “fix” the issue of the blown up intervertebral disc, but can provide lasting relief for anywhere from a few weeks to a year or more. In combination with a solid rehabilitation program, many patients have had great success with these injections.
A few weeks after the oral steroid treatment, I’m in the doctor’s office ready for my first injection. It was definitely a scary thought, the idea of an enormous needle driven right into your lower back, but I was a desperate man ready to take desperate measures.
They provided some local anesthetic to my lumbar region, and proceeded to stab me in the spine with a Super Soaker of a syringe. They warned me that it would hurt, and it did. I felt an extreme sense of pressure in my lower back, as if an elephant stepped on it, followed by intense pressure down my left leg. When I got off the table to stand up I almost collapsed, because my left leg was still numb. They told me this was normal and that I should regain the feeling in my leg in a couple hours.
The pain in my back and down the leg at this time wasn’t completely gone, but it was significantly dulled. I remember feeling a sense of hope, that I was FINALLY on the path to recovery. The dulled pain continued for a few days, but then slowly started creeping back. I called the doctor with concern, but he let me know that sometimes it actually takes a couple weeks for the drugs to kick in 100%, so I should give it time.
Over the next two weeks I remember trying to ignore the fact that the pain was coming back, but after a few days of waking up to the full blast pain that I felt before, I went back to the doctor. He recommended a second injection. The second injection was just as pleasant as the first one, and left me numb for a day. This time the doctor also wrote me a prescription for Cymbalta.
“An anti-depressant?!” I asked. I mean this injury is depressing for sure but c’mon doc.
He explained to me that the drug is a seratonin-norepinephrine reuptake inhibitor (SNRI) and that yes, it is used to treat clinical depression but also to treat peripheral nerve pain. Reluctantly I took the prescription and took about a weeks worth. I quit after that first week because I felt like it wasn’t helping and I was becoming paranoid about the dictionary-sized list of associated mental side effects.
The dulled pain lasted about three days this time and immediately returned. After another couple weeks I came back for injection round three. The limit for these injections is three per year, and I reached this limit within a couple months. These injections definitely aren’t child’s play and you can’t haphazardly just shoot them up into your spine whenever you want to. With each injection you run the risk of infection, dural puncture, nerve damage, and even joint degeneration in the long run!
This time the doctor wrote me a prescription for Gabapentin as well. Gabapentin, also known as neurontin, is a drug used to treat epilepsy but has been successful in treating neuropathy as well. Apparently it’s also a popular recreational drug because of its potential psychoactive effects. What is this doctor feeding me?!
Anyways, after three injections and a bunch of sketchy drugs, I was back to square one. No relief. When I came back to the doctor I already knew what they were going to tell me: “We’ve exhausted all of our options and it may be time to consider surgery.”
The Surgeon
My girlfriend, who works at INOVA, did some digging on several reputable orthopaedic surgeons in the area. After consultations with three different surgeons, I decided to go with Dr. Thomas Schuler of Virginia Spine Institute.
As one of the top 100 spinal surgeons and specialists in the country, recognized among the top 1% of physicians in his specialty, and top 10 spinal surgeons for the NFL, his reputation preceded him. Being the spine specialists for the Washington Redskins had nothing to do with my decision… I think…
During the consultation at his office, he and his assistants spent almost two hours of dedicated time with me, running me through a myriad of tests, looking through my records, performing another x-ray on my spine, and analyzing my MRIs.
When it was all said and done, he was confident that a microdiscectomy would be the way to go.
A micro-what now?
The plan was to perform a “micro-surgery” that was relatively minimally invasive: The doc would slice into my lower back, push the erectors out of the way, cut some bone away from the lamina of the vertebrae, find that insidious piece of disc that was pushing on my sciatic nerve and ruining my life, decapitate the herniation, and stitch me back together.
Terrifying… I thought. “Let’s do it,” I said. My consultation was on a Thursday, and the operation was scheduling for the following Monday.
The Surgery
Like almost everything in life, the operation came with a bunch of paperwork. I filled out all my papers, signed a will (yeah, really), and they sent me home with my pre-op packet filled with instructions.
There wasn’t much to do from my end pre-op. I couldn’t eat or drink anything the night before and had to shower with a special soap.
The next day I showed up at the hospital, checked in, and waited in the waiting room with a number of other poor souls like myself that were about to get cut open. When I was called up they prepped me up in a gown and surgical socks and rolled me away on a bed to the anesthesiologists.
The anesthesiologist prepared the IV and stuck it into my arm. She explained that she would soon inject the drug and I would fall into a deep sleep. I remember her asking me where I went to school, to which I replied “George Masgfughabluhhhhhhh…” BAM! I was out like a light!
After what seemed like a minute or two, I slowly woke up, very hazy. One eye half-open, I looked up at a nurse and asked “when are they taking me to surgery?” She chuckled and replied “Oh honey, you’ve been out of surgery for hours. It went perfectly!” I didn’t want to argue so I went back to sleep.
The second time I woke up I was in the recovery room with my girlfriend and family. After the blur started to wear off I realized that the intense pain in my back and left leg were gone. I was so happy I could’ve cried. Pain had become such a huge part of my life that I forgot what it was like to not be in agony. I was definitely sore from the flesh wound I now had in my back but it was merely a slight discomfort compared to how I’d been living that past year.
I spent the night there, still in a daze from the morphine and eating French toast while watching The Simpsons. It was definitely one of the most joyous days of my life.
Stay tuned for Part III!
Give Me Strength!: The Process
It hurts. The short-term effects from strength training often leads to pushing the body to places the mind may not want to go. But, if the mind is open and willing, the body can be pushed to places it may not realize are possible. Strength-training, like any activity, requires a detailed process, which focuses on daily progression. Below are three tips to help your mind stay right as you get your body tight:
- Goal-Setting: It’s imperative to have daily, weekly, and monthly fitness and strength goals. These should not just be based on weight loss/gain or amount of weight lifted. Instead, there should be deliberate practice goals, which focus on progression. Focus on the process of improvement rather than simply end results. Examples: Daily - Commit to trying one new exercise [pick one to help you put extra emphasis on a weak area or an area you enjoy training] for each daily training session for a month; Weekly - Commit to a weekly schedule of weight training, avoid a haphazard approach... what time does your workout begin? Don't be late!; Monthly - Did you achieve your daily and weekly goals? What does the next month look like, what are you planning to accomplish on a daily level? Is it time to do a quantitative test yet?
- Willpower Talk: Use committed words like “will” over words like “gotta”. Direct attention to what you will do rather than what you gotta do. The more you talk about will the more you will get. For example, what is your weakest area that you WILL improve to build muscle and strength? A lower body unilateral exercise, perhaps?
- Expectation Scorecard: Create a scorecard for yourself to grade your mental performance during a strength-workout. Have categories like attitude, positive self-talk, energy management, etc. so that you will grade your mental-toughness. This will hold you accountable to maximizing performance.
A couple other things to consider: what is your pre-workout preparation? It probably involves some foam rolling and a warm-up, but are you preparing your mind to take full advantage of the soon to start training session? Are you fully focused when the first set begins?
Like most things in life, success in strength training, fitness, endurance training, fat-loss, etc. is at least 50% mental. The process of engaging in a long term progressive program also teaches excellent (mental) practices that translate into many other areas of life (discipline, goal setting, enjoyment, commitment, etc.).
Strength as a Foundation
On March 15, 2013 I became a regular person - well my perception of regular anyway - and I love it!
Why did I have to relinquish my super-hero status? I’ll leave it at this: I saw my dreams not just faltering, but failing. So, to get back on track, I stopped working two full-time jobs... which I had been doing for years for "fun" versus necessity. I took a break from my love-affair with iron. I also sit more than I have in about 15 years... that's a mega regular person activity!
Well, if we fast forward to today, my big dreams in life are properly realigned and effectively back within reach. But, I want to talk about what has happened to my physical foundation over that time.
SAPT’s methodology is based on the approach of Strength as a Foundation. We use various examples to explain why this is the best approach for building speed and explosiveness, but my favorite is “imagine shooting a cannon out of a canoe” sounds silly, right? Well that’s because it is. Never having operated an actual cannon myself, I can still easily imagine how ineffective and potentially dangerous it would be to try to shoot the thing out of a canoe.
The same concept holds true for performance training. If Strength as a Foundation is ignored, you’ve effectively set yourself or your child up for ineffective and potentially dangerous training.
Okay, so getting back to my little story: since becoming proudly “regular,” I’ve been working out at home and put a huge emphasis on improving my overall fitness. “Fitness” in this case meant I wanted to put a big focus on improving my cardiovascular system's functioning and efficiency. My exercise of choice? Running. And because of time limits I have only been lifting an average of 20-minutes, twice a week... but my running workouts stick around 60-90 minutes, 4-5 days a week.
Do you see where this is heading...?
I've let my foundation crack. My strength foundation. It sort of sucks. But, I planned for this to happen... I guess I just didn't know what it would feel like once I arrived. I've been lifting consistently since I was 19 years old. The longest break I’ve ever taken (up until this year) would have been a MAXIMUM of one week off from lifting. Crazy, but this 20-min/2x per week lifting has been going on for almost 4-months. With several weeks in there taken completely off from lifting.
I’ve been trying to shoot a cannon out of an ever destabilizing canoe. Attempting to keep up such a high volume, frequency, and intensity of running without maintaining my strength foundation is trouble. I’m feeling it now.
My goals have been accomplished in terms of “fitness” but I’ve been surprised what a slippery slope running that much and lifting that little has been. It’s like the losses are compounded. My knees often ache and the muscle mass in my legs (read: glutes and hamstrings) has dropped significantly.
What’s the plan and what’s the lesson?
I need to build muscle and lift weights more frequently. That’s the plan. And the lesson? As advertised, running really is detrimental to strength levels. I’m undecided about how I feel about this. Where I am in my life, running really lines up well with my mentality and goals. I can’t even begin to tell you how many excellent ideas I’ve had while running... SAPT was actually conceived during a run 6-years ago(!). But, I need to prioritize more prehab exercises to keep myself on the trails. In terms of the biggie compound lifts, eh, I’ll probably continue to take a break. 13 years straight of weight training means I’m certain the lure of the iron will pull me back when the time is right. In the meantime, I’ll continue setting a laser focus on building an amazing business and embracing my “regular” side.
Last week I attended a workshop on marketing for the small business owner. It was amazing and led by John Jantsch who is *tha guy* when it comes to this topic. As much as I believe the experience has already had a permanent and positive change on SAPT, I will try to exercise some self-control and stay on-topic. I do mention the experience for good reason: the first - and most tangible - impact from this workshop for our readers is in how we deliver content on the blog. Here are the changes you can look forward to:
- Each month will have a theme that each primary (MWF) post will address. This month's theme: Give Me Strength!
- We will be attempting to up our quality from an internal standpoint by actually editing posts ahead of time.
- All this requires *gasp* planning, so posts should be more reliable with few, if any, missed posts.
Please engage if you like or hate or even have no feeling about what you read here!
SAPT Virtual Sprint Seminar, Episode 1: The Falling Start
This begins a series of virtual sprint "seminars" that I'm sure many of you will enjoy. I - along with two of our Summer interns, Josh and Goose - have been working with a number of our college baseball guys to improve their sprinting speed. Given we meet with them 2x/week outside of their usual lifting program, and that they're making some sort of improvement each and every session, it makes for excellent blogging fodder that hopefully you human movement geeks out there will enjoy.
Questions that will be answered in this episode:
- What is the Falling Start? And why does it help with improving sprint speed and mechanics?
- Why having or developing "quick feet" may NOT actually be the answer you're looking for when it comes to improving sprint speed.
- Common errors that nearly everyone makes during the falling start, and how to correct them.
- How to reduce your risk of injury when beginning a sprint training program.
- What Street Fighter can teach you about ensuring a strong acceleration off the line.
Comments? Feedback? Was this helpful? Mind blown? Share any thoughts below!
Running Faster... It's Not Just for the Guys.
Today's post goes along with the string of themed posts about our new running program we're launching next week. Yes, that's right, a running program. But not just any ol' running program where you plod seemingly endless mile after mile. It's called RunFast... a simple name that explains exactly the purpose of this program. I strongly recommend reading the other blog posts this week, if you don't already, as they're stellar.I'm a Strength and Conditioning Specialist. Or, the title I prefer, Jedi Training Master. Either way, my job as an SAPT coach is to strengthen the bodies and minds of our trainees to support excellence in life (aka: cultivating Jedi Skillz). As SAPT athletes know, I advocate incessantly for hoisting heavy things on a regular basis and eating your vegetables. While I know the a solid strength foundation is essential for success in life, I also know that training the cardiovascular system (outside of a lifting session) is essential for across-the-board excellency. Most of you, I'm willing to bet, immediately thought of running for miles or hopping on an elliptical...
This post is specifically aimed at my ladies out there who think high intensity training for running is either a) for football players or other male athletes or b) inferior to long-distance running (eliptical-ing) for body composition changes. Both are incorrect suppositions.
*Note* I know I have a lot of distance runners who read this blog. I'm in no way advocating that you cease your running; however, I do think you'll benefit tremendously from training the other energy systems mentioned in Goose's post from Monday and cultivating a higher rate of force development.
So, convince me Kelsey, why should I step outside the cardio box and perform sprints, hill sprints, shuttles, and other such bouts of heart-pounding exercise?
1. They teach your body to produce force faster- Remember that Rate of Force Development thing? Ladies, if you want to run faster (and this means during a competitive sport, like soccer or lacrosse, too) you need to push off the ground harder (this propels your forward further) and increase your stride frequency (more steps per unit of time). There's an old adage, "Train fast to be fast." Training at a slower, continuous pace will NOT cause the adaptation in the muscles required to produce that burst of energy needed in sprinting down the field or court. What about sports that don't run much, like tennis or volleyball (only a few steps in each direction)? Training for power will make those few steps explosive and get you in contact with the ball sooner. Therefore, unless you're a cross country runner.... stop. the. slow. speed. stuff.
Excellent point.
2. It trains your phosphagen and anaerobic systems- As Goose laid out in his post, these two energy systems are responsible for the quick, explosive, and often the first movement, in sports. Every sport requires the use of these two systems to some degree; therefore, in order to maintain a high level of force output throughout a game or match, it's terribly important to keep these systems up to snuff by challenging them through training. An example to train the phosphagen system would be a short, but all-out, hill sprint lasting around 10 seconds or less. For anaerobic training, shuttles of 25-50 meters, or a burst of activity lasting 30-45 seconds or so. The cool thing is, the more developed these two systems are, the longer your body can rely on them for energy. This translates into the ability to produce high outputs of force for sustained amount of time, aka, sprinting further at higher speeds. Strong girls win right?
You'll also win lightsaber duels.
3. Higher intensity training is superior for body composition changes and maintenance- *This of course assumes you're eating a clean diet with lots of vegetables, lean proteins...* Without going into the physiology of it, high intensity exercise is a great way to raise your metabolism (even for hours after the activity is over, depending on the intensity) which leads to favorable body composition changes. Not only that, but high intensity exercise is muscle-sparing, meaning you maintain your hard-earned muscle mass (and ladies, we need all the help we can get in that department!). Long distance training tends to decrease muscle mass. Again, with a solid weight training program and carefully managed physical stress levels, a long distance runner can be perfectly healthy. However, from a body composition standpoint, it's more efficient for us non-runners to perform high intensity training. Plus, it's also quicker than spending 45 minutes on the elliptical... I'd rather to hill sprints for 15 minutes.
Want a visual? Look at the difference in body types:
Marathoner vs sprinter
Also, have you ever stood at the finish line of a marathon? How many people are limping? If body composition is on your list of goals, high intensity, short duration, cardiovascular training is the way to go!
No thanks....
4. Most people don't train this way- if 99% of the people are doing something in the gym, it's a safe bet that it's not the best nor most efficient way to accomplish your fitness goals. 'Nuff said.
If a TV is involved, you're not working hard enough.
Hopefully the above reasons are enough to convince you to step outside the standard "cardio" box, both from an athletic and body composition standpoint. Even my long-distance runners, train for power and watch your times decrease!
because he employed high intensity training...
RunFAST - SAPT's Secret Program Development
I’ll be honest, I’ve got a secret... it’s about a new program SAPT is developing. We’ll actually be launching all the info about it next week, but I’ve got to let on about it at least a little! I’m simply way too pumped up and have had a little too much coffee to keep this under my hat any longer.
It’s so exciting and will introduce yet another innovative, high-octane training method to the area via our resident performance coaching geniuses at SAPT.
This is the type of program that is born from those really special places that foster high-levels of both creativity and respect. An incubator for ideas where art and science merge. The type of place that values quality, service, and creativity above all else. That’s where these kinds of innovations come from.
The program is called RunFAST... that’s all I’m going to mention, as I think the name tells enough.
And, I have to also tell you this new innovative approach we’ll launch next week is just the tip of the iceberg. I wish I could let on about all our projects. But, for the moment, I’ll simply leave you with SAPT’s Big 3: Purpose, Vision, and Mission. Read into them as you like...
Our Purpose: Strengthening bodies and minds to support excellence in life.
Our Vision: People of all ages, abilities, and resources will have access to, appreciation for, and engagement in regular physical fitness training that will lead to improvements in all aspects of daily life.
Our Mission: To develop, research, and share our comprehensive approach to physical fitness training that fosters long-term engagement, promotes excellence in life, nurtures human relationships and inspires the lifelong pursuit of health through exercise.
Please stay tuned to next week on the blog... we’ll be devoting the whole week to RunFAST details!
