I was hoping to get some advice here. A little background, in 2011 I started running C25K. In December 2011 ran my first half-marathon, then did 2 more in 2012, and one in January 2013. I decided to implement Crossfit into my training hoping to gain strength. After a few months, I realized the trainers there didn't know as much as I thought and ended up with a herniated L5S1. I have been benched since March and I'm itching to start running again. I've done PT and anti inflammatories and the dr prescribed injections but I opted against them.
Has anyone else experienced this? How did you start running again without injections or surgeries?
Thanks!! My shoes are missing me.
I can't say this has happened to me (at least to my knowledge it has not), but I will offer you some advice that I hope others will add to, as this post gets read.
The junction of the lumbar and sacral sections of the human spine represented by L5/S1 is one of the most frequently injured. It marks the transition from flexible vertebrae to inflexible (fused) S segments. It is the lowest possible place for flexion, extension, and circumduction of the trunk to occur, and also one of the first to degrade with age. One can argue that there is more force applied to the disk at this junction than at any other.
These combined vulnerabilities are self-explanatory, but I think this injury is unnecessary nevertheless. I say this because unencumbered movement of all spinal segments would act to preclude inordinate stress to this particular segment over others in the lumbar spine. They all should flex and turn proportionately, absorbing this as well as vertical shock, but in many cases they don't and it is important to explain why.
I have no particular beef with Crossfit, although it appears you may have a bone to pick with them, so to speak. There is nothing wrong with increasing strength per se, but for a fitness enthusiast, strength has to come with a particular caution.
Of all popular sports, running is arguably the most repetitive, at least of highly stressful motions. This in itself is not a bad thing, unless a resulting build-up of fitness or strength translates into a dangerous increase of tone, which often translates into a loss of elasticity or flexibility.
The problem with building tougher muscles, is that they are already the prime movers of the human skeleton, applying more force to bones than gravity or any other environmental factor. These "soft-tissue" forces are going to be applied to bones via firmer tissues such as tendons, ligaments, disks, etc., which are much slower to remodel than dynamic and rapidly growing muscle tissue.
I have often said that patience is one of the most important aspects of running, and I can say that in my own experience, the rule of thumb that one can progress as a runner for about ten years or so, spanning most age groups, was something that I often discounted, sustaining many injuries as a result. My most successful strategy has always been to allow time for things to grow, and to trust that my body would strengthen if I simply remained consistent, not so much trying to become stronger, as to trust that I naturally would anyway.
In your case, I am willing to bet that the additional exercises you took on may have increased muscle tone and force, but reduced flexibility enough that more force was directed towards the pivot point of last resort, L5/S1. It is important to note that the usual attempt to loosen things up, represented by stretching, simply directs more of that increased force to all involved tissues, from soft to hard. It is little more than a flexion in reverse, though greatly slowed down, with similar consequences to eccentric contraction, which in many cases, it actually is.
Your experience reminds me of when I combined a gym membership with my marathon training. I was pumping iron and building up useless muscle, which was later sculpted away by running alone. I became a better runner by letting my body shape itself into what I was asking it to do, and nothing more. Sure, I miss the looks, but a runner's bod develops a lot of subtle, even hidden strengths, benefiting more from a balance of responsiveness and moderate flexibility than from raw tone.
A stride is not only the work of the prime mover, but the relaxation of its antagonist on the other side of the joint. The efficiency gained when strength and tone take a back seat to free range of motion, in my opinion, is a major key to successful running. Tone of course has its place, but restriction of free movement is a clear enemy.
One muscle group that gets emphasis in most sports, all the way down to sedentary activities such as sitting, is the hip flexor group. When too tight (hypertonic) it accents the curve of the lumbar spine by pulling the center of the curve forward toward the hips, increasing pressure on the L/S junction. When trunk muscles come into play, including abs, that stiff core can restrict smooth movement of the ribs above the lumbar spine, and force articulation downward to the last joint in the chain, L5/S1.
The good news is that minus a certain amount of destructive force, disk herniations often actually heal. This does not happen overnight, due to the aforementioned characteristics of firmer, less vascularized tissues, but you can recover from this without surgery, and as you suspect, steroid injections can be counterproductive. The most important element, other than gentler activity, is time. Please make the most of it by regaining as much elasticity and losing as much hypertonicity as possible. Seek out alternatives to stretching, including trigger-point massage. Good luck!
Start with alternating between walking and running, initially more walk than run. Generally the recommendation for dealing with a herniated lumbar disc is to stay active. Genreally the worse thing for a herniated disc is "sitting". After you walk run avoid prolonged sitting in car, avoid taking nap on a soft couch or beach chair. You may need to choose to walk - run on more forgiving surfaces and if the PT hasn't started you on safe core stability work ask for it.
Damien Howell PT, DPT, OCS
I had 4 herniated discs at one point. My dr had me start by walking and eventually I was able to run. This was 20 years ago and off and on I've had bouts of sciatica, for a few years it was bad enough that I did have the epidural steroid injections. Once the sciatica eased up, the most important thing for me was doing the back exercises and stretches consistenly. When I didn't do the exercises, I had bad flareups that lasted for days. Running has actually helped me and my surgeon even said I'd probably never be able to stop as it was keeping it under control. Form is really important, especially on long runs when you might get tired. One resource that was very helpful was the book Treat your own Back. It was recommended my PT at the time and I still use the exercises now.
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