Interesting visit to the PT

[Crankin]

So, I finally went back to see Walter, the MacKenzie PT I've been seeing on and off for 2 years. My lumbar region is just giving me a hard time, as well as other various areas of stiffness and pain.
After reviewing the exercises I've been doing, per his previous orders, and his testing of my strength, he determined that I have extremely weak glutes and my piriformis is weak, too. He said my quads and hip flexors are wicked strong, and this is putting a strain on my lumbar region. I know this is a typical cyclist problem, but it does explain why I have trouble standing when I ride; it tires me so much that it's hard for me to see why people do this to get up a hill!
So, I have a whole new set of things to do 2x a day, in the hope that after 12 years, I can actually strengthen these areas. He delightfully told me that some of my morning stiffness is "normal age related stuff," without insulting me. Running is off of my plate, maybe forever, but at least until I can work on this.
Walter is the only medically related professional that treats me like an athlete, and not like an old person.
My DH was amused when I told him that I need to work on my azz muscles.

[Catrin]

Crankin - glad you got to see your PT! Sorry to read you can't run right now, but perhaps this will make you stronger in the future. Have fun working on those azz muscles :)

[OakLeaf]

Good luck - hope the pain resolves very soon!

[Crankin]

Oy, it took me 35 minutes to do all the stretches. I don't have to work today, but I am trying to figure out how I am going to do this on M, T, TH, when I am very busy and I go to the gym early AM on 2 of those days. Some of the things i only need to do once a day, but some need to be done twice. A few can be squeezed in before/after my class on Monday and Thursday.
I could make a career out of keeping myself in shape.

[DebSP]

What does that pay? LOL. I hope you don't get stressed out trying to fit everything in. Feel better soon.

[emily_in_nc]

Sounds like a productive visit, but I know that PT "homework" can be a bear to do. I always start out all motivated and then start slacking over time...

Another reason standing to climb tires you is because you're bearing your body weight -- I believe I've read it's something like 25% more effort (maybe more) than seated climbing. So it's not just muscular. I can only do it for short periods of time, but with the way my Trek is geared (12-25 in the back, higher than any bike I've had in decades), I end up standing more than I'd like to avoid having to use my granny gear.

Good luck with the PT!

[Crankin]

I don't avoid the granny gear. It kind of depends on the ride, though. I've had to use it for smaller hills I usually do in the middle ring on my Kuota, so as not to aggravate my back. Climbing does do that. I also have a 12-28 on the rear. I have a compact with mountain gearing on the back on my Guru, so if I'm in the small ring, who cares? I have to change gears a lot more on the compact, while I can be mostly in the middle on my Kuota. But, I do live in a hilly area.
Today I used the Kuota for my metric ride to celebrate my birthday. We were in towns I rarely ride in, and did lots of neighborhood hills, some up to 5-8% grades. My back started in at about 20 miles, but, it was nothing horrible. After I stretched, it's fine.

[OakLeaf]

Funny ... standing doesn't bother my back, climbing while seated can ... different injuries, different bikes, different bodies.

I was having the same conversation with my LMT the other day. She gives me at least one new stretch every visit. So does my DO. Add all the exercises I have from the PT and the DC and it would literally be a full time job. I do the ones that seem to help and slack on the rest.

[emily_in_nc]

Don't get me wrong -- I am happy for and do use my granny gear on steeper climbs. But there are some hills around here that are either short, and I can power over pretty quickly if I just stand; or long and slow, but not too steep, where I just don't want to have to shift up twice in back to get to where I can shift to my granny. I'm stubborn that way. :D

My MTB, which I also do urban rides on often around here, is obviously geared much lower, so staying in the middle ring most of the time is not even an issue. But on my roadie, I do have to work a bit harder to stay there.

[Crankin]

Yeah, Oak, I made a decision on some of the exercises. The paper Walter gave me says to do 2 sets of some of the exercises, but he never "told" me to do 2 sets. I know he copies this from a generic PT book and puts together an individualized program. So, I am just doing one set of each, except for one. There are a couple that only need to be done once a day.
Emily, when we went to Spain, the bike I had on the tour had a 25 on the rear. I don't know how I did some of those climbs on that, even in the granny. There were a couple I skipped because of this. I had a 25 for years, and then a couple of years after we moved to this neighborhood (the hill), I got a 27. Last year, it went to a 28. I really didn't need that, but my take on it is that I'd rather use easier gears as I age, as long as it enables me to keep riding!

[Wahine]

I'm glad to hear that your getting thins taken care of! That type of azz weakness is an epidemic in our sit-way-too-much society.

Here are some tips for making the exercises fit in your day a little better:
1) Treat them like a workout. Or even exchange them for a workout (like running).
2) Ask Walter if you can combine some exercises to cut your total time down. For example, I give an exercise that combines stretching the piriformis and quads at the same time, thereby cutting 2 exercises down to 1. I also have a strengthening exercise that combines hip abduction and exernal rotation.
3) Ask Walter to prioritze your exercises for you. There are going to be days when it will be impossible for you to get it all in and it's good to know what your 3 "Best bang for the buck" exercises are so that you can focus on getting at least those 3 done.

It's important that you give your PT feedback like, "This routine takes me 45 min to do and I don't really have that much time to do these consistently on a daily basis." Sometimes it's hard for us PTs to see past all the little things that we'd like to give you to do and remember that life still happens and time is not infinite. A good PT will help find the best comprimise between exercises that need to be done and life demands.

[Crankin]

Wahine, the sitting thing is indeed a major cause of my issues. In the past 6 years, I've gone from teaching, where I pretty much stood up all day, interspersed with some sitting, to being in school/internship, where it was a little problem, to now where I do therapy all day, drive all over to get to my clients. Then I sit at my computer or desk to do paperwork. This was not caused by any sports at all, but more a combination of things. I'll be cutting down my work hours over the next few weeks, which = less of the driving and sitting. My next job will be close to home and will not involve driving to clients.
I pretty much have prioritized the exercises from my session/discussion with him last week, but so far, I think it will work, except on Monday and Thursday, and then, I can combine some of them with my stretching after my class at the gym. I will be skipping that class on Thursday and Veteran's Day to give it a rest. Cycling doesn't bother it at all. It's just the next day, when I get up, it's there.

[tulip]

Crankin, it sounds like you are on a good path with your PT. I've noticed my lumbar region starting to ache again, and for me, I know exactly why. I have slacked off my Pilates for months, and it is catching up to me. I knew it would. Pilates works wonders for my back issues and relieves my too-much-sitting work habits.

I always point out to anyone who is considering Pilates that in my opinion it's extremely important to study with someone who is certified and experienced--and I don't mean the weekend certified "instructors" who work at most gyms, as in my experience they can do more harm than good. I do it on my own at home, but I studied at a classical Pilates studio for three years so I'm pretty confident in my abilities to do the movements correctly. Eventually I will want to advance so I'll go back to the studio for that.

[antimony]

If you are sitting a lot, have you ever tried a kneeling chair? Solved all of my lower back issues, although only helped a little for my neck/shoulders problems from sitting at a computer too much. The exercise balls as chairs work for a lot of people, too, and then you have one for workouts if you want it, but I don't like them as much.

[Crankin]

I've heard people say this before, Tulip, but Pilates has always hurt my back like crazy. Even with modifications. I tend to use yoga the way you use Pilatess and I have definitely slacked off on that.

[Crankin]

Antimony, I could do that at home, but not when I see my clients in their homes or at school. And definitely not at my office. I've been standing a lot more.

[Kathi]

I have ongoing SI joint issues and am back in PT for it. This time I think getting hit by a ski lift chair because the lift op didn't hold it set everything off. Anyway, 2 of my symptoms are painful sitting and low back pain. Stretching doesn't help at all and Pilates made me more painful. I haven't tried Pilates since my SI Joint issues were discovered although my current PT thinks it's probably ok. The last PT worked with me in getting more mobility in my spine due to a flat back. Now when I exercise my left glute gets very sore and painful. My current PT, and I agree, thinks I have an asymmetry in my hips. Yesterday, he had me doing RNT squats with a band. The way the are performed works individual hips. Yikes! my left side felt strong, confident and also reacted with some muscles soreness. The right side felt like a wet noodle and fatigued very quickly. My left side was still complaining when I got home. I know this sounds dumb, and to remember what I did, I repeated the exercises again on the right. The left side calmed down.
My point is you have to keep searching for answers. My last PT promised that getting more mobility in my spine would solve my problems. A year and half later spinal mobility created more problems and I'm having to continue my journey toward performing my activities without pain. I refuse to accept that being 65 causes my pain. Inappropriate posture, long time SI joint dysfunction, stressing it with activities that I didn't train appropriately for, in other words just living a full, active life contributed more to the issues than age does. As I read certain authors and learn about my body I'm accepting that this is a continuing journey that I will deal with as I age. I see my friends slowing down, stop living their passions, if they were passions, while I continue to learn, grow and thrive at my age. I have a friend who is 75, skis like a 30 year old, biked cross country at age 73, she was a newbie cyclist, and this year climbed Mt Kilajamaro. Who knows where her passions will lead her next and I plan to be just like her in 10 yrs in spite of my SI joint issues. Sorry for my rant but I know too many people, often younger than me, who give up their activities because of pain, back, knee, etc. and blame it on age.

[Crankin]

That will never be me!
I suspect there's a hip imbalance, too. I will address this Thursday. I have been promised nothing, which is why I like my pt.
The trauma of my crash hasn't helped this, either.

[Kathi]

Something I find interesting is how the body loses movement without you even knowing it. For example, when my low back was stiff and flat I automatically sat on the floor on my left side. I never gave it a thought but once I got better movement in my spine one night I sat down on the floor to play with my cat and plopped down on my right side. That's when I realized I had lost the ability to sit on the right side without pain. This time around my PT started me out with side planks. At first I couldn't see how they would help but now when I ski I using my right side (an issue that my instructors had worked with me on 4 yrs ago) and when I pedal my bike there is definitely more power coming from my right side. I'm also standing more on my right leg and my hip doesn't jut to the side as much when I stand on one leg. The plank on the right still needs work. I have to be very careful with squats as they can still irritate my low back. Oh, I also discovered I can do single leg squats. Not low but when I did them for PT a year and a half ago I couldn't do them without a fit ball and it's something I quit doing because they irritated my low back.

[Kathi]

My car seats don't have lumbar support and are often very painful to sit in. I went to REI and bought a Thermarest Lumbar pillow. It inflates so I can easily adjust it to the width I need. I also rolled it up and put it in my purse so I could use it any time I was sitting for a time such as plays or concerts. I also used it under my knees or between my knees for sleeping. I still use it in the car.

[Crankin]

Went for my second visit yesterday. I brought up the hip asymmetry/leg length stuff. I don't have it. I *do* have a mild case of untreated scolisosis, though, that might contribute to my woes. Anyway, I told him that I felt like needed a massage, and he did do quite a bit of that, as well as having me go through my exercises. So, despite going to boot camp before the session, and a day of work, I feel much better today. He gave me one more thing to do, but I am basically doing one whole set in the AM, and then a few of the essentials at night.
A funny story. A few years ago, I related this on the running thread, but it it's worth repeating. So for years, when my son was training, he told us about a "mean guy," who would run by him, as he rode by. The guy never smiled or said hi. Around this time, Bill Rogers moved to my former town, and after talking to others, we deduced this was him. Over the years, DH and I also saw him, and our family had a mission to make him smile. We finally got him to say hi.
OK, so yesterday, we were talking, and I knew Walter lived in Boxborough, so I asked him where. He lives on the street my street was off of, where we always saw the "mean guy," aka Bill Rogers. I looked at him closely, and saw to my dismay, that the mean guy was Walter, my PT, who is a really mild mannered, nice person! To check this out, I asked him if he knew Bill Rogers and he said yes, and told me where he lives, which is on the other side of town. Now, Bill may have been running down Burroughs Rd., but it was definitely Walter we made fun of all of those years.
I am going to tell him this in 2 weeks, when I go back.

[emily_in_nc]

That is a funny story, crankin -- and a very small world!

You'll have to post his reaction when you tell him. It really does show us how first impressions can sometimes be oh so wrong. I remember being so terrified of this big burly bearded guy at work when I first saw him, and he turned out to be the biggest teddy bear you'd ever hope to meet. Looks can be deceiving!

[Crankin]

Yeah, he was just concentrating on his running. We got him to smile around the time he must have been injured, as he was walking for a few months.
DS arrives in the early AM tomorrow and I know he will enjoy this.

[OakLeaf]

Heh. That's funny. I wonder if he'll remember you and your son.