Monday, 26 August 2013

Look After your Back

I seem to have a bit of time on my hands as my back symptoms are troubling me again so bike time has become computer time for a little while. Back pain is so common yet so debilitating.  Like a lot of folk reading this I have had back problems for years. Some fair wear and tear, a lot from poor lifting and handling, and a bit from direct injury.

My “story” goes back to my early 20’s before Fiona made me use my brain and do some studying and follow through with something medical related.  Stacking 3 metre pulp as chainsaw feller (lumberjack) up to my arse in brash I soon developed chronic back stiffness. A particular injury was trying to turn a 2 ton 4.5m log with a “cant hook” to get at the branches that were embedded in the ground.  The lever snapped and I went back downhill landing on rocks and got knocked out.  I woke up with the rain on my face unable to walk.  A crawl to the road where workmates found me lying I was heaped in a van and taken home to the forest house we rented as part of the job.  Crawling up the path and into the house where Fiona found me lying on the floor a few hours later when she came back from teaching skiing.  I lay in bed for days and the local GP examined me and thought I had a pelvic #.  I couldn’t walk without pain for weeks and was on “Fortral” and “Temgesic” (spew in pill form!)  Later I was diagnosed with crushed lumbar vertebrae.  At this time I was well into climbing and windsurfing so within a year my core was strong but always a simple thing like getting up out of bed too fast and I would be locked up in pain from muscle spasm for days.

Next drama was mountain biking at Learnie Red Rocks where I jumped a berm at about 30mph and then woke up in Raigmore. Helmet smashed to smithereens and Ko’d the spinal X Ray was clear so I was let out that night.  Fish n’ Chips at Drumnadrocht and I couldn’t swallow as my throat had closed up.  A poor sleep and slowly progressing numbness up both arms I asked Henry Methold one of my work colleagues to take me to the Belford where good old BT sorted me out for an MRI scan back up the road and a Philadelphia collar to wear until the results were known.  Seems I had fluid around a cervical disc. That still bothers me as on the TT bike I struggle to look up, and any bump to my head causing neck flexion my arms go numb and my throat gets sore. That makes me hold back a bit on the MTB as it affects my thinking and I get flashbacks at speed and this has major psychological effect i.e. fecks with my head. Waking up fully packaged wondering how it’s going to play out isn’t easy to forget.  Maybe these injuries are why I used to fight for the packaging of injured skiers and climbers to be good and would get in trouble for arguing with aircrews doing a snatch rescue of someone that might have a spinal injury.
The Learnie Helmet
There will be a # under there then ?

I am not trying to be a pussy here as I still give it a go on the bike and don’t let it hold me back much.  It’s just that its fekin scary and sore beyond belief being on a spine board. I should add that at Learnie the Helicopter and ambulance staff were very, very careful when moving me.
This last back injury has probably been a long time coming.  Folk talk about having a slipped disc when they have back pain but let me assure you a prolapsed disc if you have one is amongst the worst possible injuries for pain. Having broken ankles, collar bones, fingers and toes a true slipped disc was/is a true 10/10 in the ouch scale for me.  For the last few years I have had transient nerve jabs down my legs so probably a lumbar disc has been bulging.  Ironically I have always worked hard on my core stability and flexibility but maybe it was left too late to make a difference.  Start lifting correctly when you’re young and do core workouts before you get injured folks!

January 1st this year Ski Patrolling up at Glencoe doing avlx control work I got taken out by a small slide that buried me up to my waist and pulled me down 50 meters.  My bindings didn’t release and I got out just fine if humbled,  but my back definitely took a hit as for the next six days I couldn’t get my socks on without help, and each day started face down on the floor. In my wisdom(?) I decided to do the Barcaldine XC Race which those who did it will know involved ducking under and over fallen trees, bog mashing, getting tree’d and was general anaerobic hell.  It hurt but by God it cleared the lungs.

Next day I woke up with my right leg having a workout of its own.  A walk with Fiona and I noticed I couldn’t lift my leg as easily, but we kept walking up the woods to look at a new trail we were going to make.  Above Glencoe Lake/Lochan my right foot got caught under a branch and I went to step forward and it was like being shot or stabbed in the back. Instant pain at level ten unbearable and writhing on the ground.  After 15mins of this Fiona mentioned calling out the rescue team and I got on my feet but couldn’t walk.  Freddie Gatting was called and came up and between them in an hour or so they got me to the car. The passing walkers were all pretty alarmed at this screeching nutter between two women.

I was taken to A/E and straight for examination by a junior doc with a really shitty attitude as when he examined me I had no sciatic symptoms but really, really sore legs.  The level ten pain was in my knees in which men with hammers were trying to break out and all the muscles in my right leg were break dancing on their own.  A spine X ray was inconclusive but showed a big synovial sack and impingement on my femoral head which might be causing the leg pain (the avlx?). I was referred for a hip MRI, given Diazepam and Diclofenic.

Best decision I made at this time was to see a good local physio who said my symptoms were definitely from a prolapsed disc. After three of the worst weeks of my life, not sleeping, sleeping curled in a ball, and unable to walk I booked to see a consultant  privately at the Nuffield hospital in Glasgow. I saw him two days later and was in such a state (some bladder symptoms) that he had the MRI scanner opened up (it was closed for servicing) and I had an MRI.  That got looked at and the anaesthetic registrar was called so I got a second MRI with contrast die. Within twenty mins I was looking at my spine in 3D and told I needed emergency surgery (private £4,000). The consultation was £160 the MRI £350 but I had a diagnosis of an extruded L4/5 with sequestration and a DVD of the scan to take to the NHS who I was then referred to. An emergency appointment was made at the Southern General neuro). Emergency appointment time waiting list two months or more!  So what to do?  Well I have to say Lochaber Sports Physio sorted me out.  A tailored programme of rehab for my back and hip.  My local GP practice was really helpful and the epilepsy med “Gabapentin” which gave me fantastic dreams reduced the muscle spasms in my legs, and lots of Tramadol and Diclofenic helped.
All that gunk is toxic and presses on nerves
I saw the neurosurgeon in May and he commented that based on the MRI he should operate but based on me as I had been on my bike, tried a TT, skied gently and been walking said that we should hold off as I was doing very well indeed.  I then saw an orthopaedic surgeon and found that I have an impingement in my right femur and a synovial sack and like most outdoor folk will require a new hip at some point,  If I run then maybe 5 years, if I stick with the bike and skiing maybe ten. It’s all a question of wear and tear and if you X ray most folk I know they will all be the same.

I am going fine on the bike but can’t do over a couple of hours yet as my back hurts.  I have slightly smaller right leg quads and that probably won’t change, but working hard on single leg pedal drills on the turbo I seem to be only about 10 watts different and can’t last quite as long.  I can’t do aero well on the TT bike so need to be more upright but I am within 10% of some PB’s and improving. I still suffer back pain and leg tremors, I am another few mm’s shorter (I lost a cm when I crushed my lumbar vertebrae) but overall consider myself very lucky. I know many folk with back problems who are both less mobile and in more chronic pain. Despite doing ok this has undoubtedly been the most painful and debilitating injury I have had, and having researched all the options only surgery might have done anything and even then it’s 50/50 with some folk worse off after surgery due to scar tissue on the cord. Rehab is hard work but it pays off if you treat it like training.

Something’s I learned from the experience:
Over the years I have seen an Osteopath and physios. The physios take a softer more gentle approach. Osteopaths have diagnosed everything from facet joint problems to piriformis syndrome and manipulated my back in various quite alarming ways all to the detriment of my wallet.  If I had gone to one of them with my recent back injury I don’t think I would ever have cycled again. Mucking about with someone’s back blind, with no detailed imagery seems so wrong.  The £500 quid I shoved out privately was a lot but got me a diagnosis and despite the NHS waiting list shortened my time to see a neurosurgeon by about 4 months. Well worth it IMHO.  

I got cycling this summer out of it and my physio new exactly what we had to work on based on the diagnosis. Tom Danielson’s Core workout for Cyclists is an excellent resource when you know what you’re dealing with.  A wobble board teaches the fecked nerves to your legs how to reconnect and without one I doubt I could turn the pedal over the 12 o’clock as for 3 months my brain and leg didn’t know how to do that, but the wobble board repathed these broken connections I feel.  Get physio bands and work all the accessory muscles to compensate for major muscle loss.  Despite a smaller right leg I am nearly back as strong on it by compensating.  Work hard!  I am seven months post prolapse and reckon it will take the full year to get back back to 98% of what I had. The new 100% is different but still damn fast and the full 100 might be possible if you keep at it.  I will tell you next season.

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