Femoroacetabular Impingement and Football Kickers. "That's Why My Hip Hurts!"

Femoroacetabular impingement (FAI) syndrome has become more widely recognized thanks to folks such as Kevin Neeld, Eric Cressey, Mike Reinold, and a plethora of other smart coaches.  FAI is a common* syndrome/injury in athletics and football kickers are especially susceptible due to the nature of the violent hip flexion during the kick off/punt.  At the end of the article I'll put some links for more information regarding testing for FAI, research regarding FAI, and other resources. The last two posts have been marathon length, so we'll keep today short and to the point. What is FAI?

FAI is essentially:

Femoroacetabular impingement or FAI is a condition of too much friction in the hip joint.  Basically, the ball (femoral head) and socket (acetabulum) rub abnormally creating damage to the hip joint.  The damage can occur to the articular cartilage (smooth white surface of the ball or socket) or the labral cartilage (soft tissue bumper of the socket).

from www.hipfai.com.  Athletes that participate in activities that include repetitive hip flexion and internal rotation or folks who have super crappy mobility in their hips are at a higher risk of developing hip issues. Also, athletes who are constantly in a state of anterior pelvic tilt (aka: nearly every one of them) are also primed for some impingement.

Now, look at a football kick off. Check out the crazy hip flexion and internal rotation (when his leg crosses over the midline of his body around the :29-:31 mark).

Can you see how a kicker might develop a problem? Especially if they're not a physically STRONG kicker?

Just so you know, FAI comes in three flavors, none of which include chocolate or vanilla:

     CAM- bony overgrowth on the femoral head (ball)

     Pincer- body overgrown on the acetabulum (on the socket on the pelvic bone)

     Mixed- a lovely combination of both.

How do I spot FAI?

IMPORTANT: Remember, unless you're a doctor, you CANNOT DIAGNOSE. The following are merely indicators that something is amiss. A visit to the doctor and possibly the Wonder Machine (MRI) will be the only sure way to diagnose any pathology.

Now, as a coach/player it's important to be aware of FAI and be on the look out for the symptoms. FAI will most likely manifest on the kicking leg simply because it is subject to that the crazy-hip-flexion. Bilateral FAI is found more often in sports with bilateral hip flexion such as hockey or powerlifting. However, this doesn't mean that both sides can't be affected, so be on the vigilant!

There are two simple tests that you can do yourself (though I STRONGLY recommend you see a professional..cough, cough.)

One is the Faber Test.

The other is a supine hip flexion with internal rotation of the femur.

If this lights you up, and you're also experiencing the symptoms below, you should probably high tail it to a person with the initials, "M.D." after there name.

A few other symptoms that as either a coach or a player you should be on the watch for (and probably perform the aforementioned tests):

1. Pain with squatting below 90 degrees. Speaking from experience, it feels "pinchy" in the front of the hip, just a smidge medial (inside) of the pelvic bone.

2. Pain with internal rotation and hip flexion. For example, getting into a car leading with the affected leg (one has to flex the hip to sit and internally rotate the hip to slide into the car).

3. Another potential, but not always present, is a history of repeated sports hernias or groin pulls.

4. As a coach, if you're watching a player squat, if one hip seems to drop more than the other. The hip that DOESN'T go as low, will be the affected hip. The player will also weight shift towards the affected side as they stand up from the bottom of the squat.

Don't be stupid and keep training through this pain (again, I speak from experience). Some of the associated symptoms/pathologies of FAI include: cartilage damage, labral tears, (the labrum helps keep the hip stabilized. It's really important.) early on-set osteoarthritis of the hip, sports hernias, and low back pain.

Speaking as someone who has bilateral FAI (and the labral tears), it sucks. Don't be a hero, go to the doc if you're experiencing these symptoms.

What are the Implications of FAI?

An athlete the has impingement of their hip will have limited hip flexion range of motion (ROM) on the affected side. What does this mean for a football kicker?

- No more squatting. Think about it: 1) hip flexion ROM is going to be limited on one side. 2) If you're bilaterally loaded, as in a squat, one hip will drop lower than the other, and if the hips can't move independently, as they could in a lunge, you're going to impose some wonky forces on the spine. 4) Wonky forces on the spine eventually lead to injuries and pain.  Not the best game plan. (You could get away with squatting above 90 degrees, but no sense in playing with tigers if you don't have to.)

- There's a study found here that looked at hip flexor strength a group of people with diagnosed FAI. The study found that those with FAI had weaker hip flexors than the controls. (I can personally attest this is true.) Whether the people had FAI because their hip flexors were weak, or the hip flexors became weak with FAI onset, doesn't matter for this discussion. What does matter is that the HIP FLEXORS ARE WEAK! Now, in a football kicker, what's the main group of muscles used to kick? HIP FLEXORS! Do you see a problem? If a coach is oblivious to this, yelling at a kicker to kick harder isn't going to do much. Also, without proper training (perhaps some focused work for the hip flexors such as SL marches or hanging leg raises), other muscles are going to take over for the lack luster hip flexors and then you have a whole new set of problems.

- Hip dominant exercises (deadlifts, RDLs, glute bridges, and swings) and single leg work (split squats, step back lunge variations, step ups (as long as the hip stays >90 degrees), and single leg RDLs) must be the bulk of lower body work. All of these tend to keep the hip out of excessive hip flexion + internal rotation. They also hammer the glutes, which will help keep the femur from gliding forward in the socket and causing more ruckus in the pelvic region. Food for thought: I've personally found that walking lunges/forward lunges tend to make my hip ache as do back-and-feet elevate glute bridges.

- As far as corrective work goes, hammer hip stabilization and anterior core. Low level glute work such as double- and single leg glute bridges, monster walks, and bowler squats will challenge the smaller stabilizers of the hip. This in turn will keep the femoral head from gliding around and causing more damage. Anterior core is necessary to, hopefully, control anterior pelvic tilt (which most athletes sit in anyway) and even, possibly, pull the pelvis a little posteriorly. This will, again, keep those bony overgrowths from grinding on each other. Here's a great video by my better half on anterior core progressions.

Another note: I've found that single leg anterior core exercises (such as a single leg plank) bother my hips. Be mindful and if it hurts, don't do it.

Wow, so I broke my promise of writing a lengthy post. However, this is an EXTREMELY important issue that many kickers are faced with (we've had one walk through our doors, not to mention the other handful of other athletes from a range of sports).

*Just chew on this; a recent study of asymptomatic people found that  of the 215 male hips (108 patients) analyzed, a total of 30 hips (13.95%) were defined as pathological, 32 (14.88%) as borderline and 153 (71.16%) as normal. That means potentially 1 in every 3-4 males have some sort of underling hip "thing" going on. (thanks Kevin Neeld!) That's a lot.

As promised here are some links for more information:

Post on Mike Reinold's site with more in-depth diagnoses.

Kevin Neeld has a bunch: 1, 2, and 3 (and the one linked above)

And Tony Gentilcore, who does a fantastic job communicating a complex topic to the lay population, while adding some humor to boot.

Whew!

The Fallacy of More Is Better

Let us travel back in time... not that far, just to Monday's post. Building on the theme of "Magic Bullet" fitness, there's another fallacy that runs alongside Magic Bullet, kinda like those weird fish that attach themselves to sharks:

It's the mentality that more is better, if you're not gasping for breath and barely able to stand after the workout, then all is for naught! Oh, ho my friends! How far from the truth does that little fish swim.

This is not to say that I don't enjoy a good heart-pounding, sweat-pouring workout now and again (they're fun) or that you should never push yourself beyond your comfort zone. What I am saying is that progress and the value of a training session should not be measured on a) soreness b) tiredness c) vomiting. Matter fact, if the last one does occur, that's the signal your body gives you that you were an idiot and pushed it beyond it's ability to recover (both during the session and possibly after, depending on other stressors). Way to go, bucko.

Let's clear the air a bit and distinguish between soreness that leads to progress and soreness that leads to poop. (that's a technical term by the way.)

Most people, at some point or another, have experienced DOMS (the "Jaws" theme always plays in my head when I hear "DOMS"). DOMS is delayed onset muscle soreness. It usually manifests any where from 12-72 hours after a training session. There's a couple different theories on what contributes to DOMS  but for the most part, it stems from microtrauma (itty bitty tears) to the muscle fibers during movements. The body repairs these tears to be more resilient to tears in the future, thus the muscle becomes bigger and stronger. It's similar to forming a callus: the skin is sore and tender, but eventually toughens up to prevent future damage.

This type of soreness is the kind we want for it leads to progress. Think about when you first start training again after a break or introduce a new exercise, at first whoooo buddy! Your muscles are pretty tender, but after a couple more sessions, those same exercises no longer leave you incapacitated afterwards. Those who train regularly, be it lifting, running, lightsaber dueling, will rarely be sore after a workout. This is a sign of progress since the muscles are now more resilient to the training stimulus (and they're stronger to boot!). Do you see how gauging a good workout on soreness is a rather inaccurate measure? The opposite is in fact true: the lack of soreness (over time) is an indication that the training program has a stellar balance of tearing the muscles and repairing them.

In contrast, workouts that cause soreness (or, one step further, real pain) either during or immediately after, are NOT ideal. Immediate soreness/pain is an indication that the body has been pushed too far, and potentially incurred more serious damage to the muscles, joints, or tendons that in can recover from. Over time, if the body isn't allowed to fully recover between training sessions, this could lead to actual injuries. This is bad. Instead of spending energy to repair the microtrauma of the muscles, the body is going to direct resources to repair the more serious damage.

For example, let's say you do a workout of 100 burpees, 400 m sprints, and 100 pushups. Your muscles will incur the microtrauma mentioned above (the kind that leads to strength gains), but you probably also had some damage done to the muscles and tendons surrounding your shoulders, elbows, ankles, and spine. All of which the body will prioritize in healing before dealing with the smaller tears in the muscles. Overall, you're probably not going to get much out of this workout in terms of strength and/or performance gains as your body is spending it's time with emergency repair crews at the joints and tendons (which, from your body's standpoint, are more important).

 Therefore, if a workout that causes immediate soreness that's an indicator that the body has been pushed beyond it's limits (either at the muscles or joints or both) and will have a harder time recovering from the workout. As we learned from above, the recovery process is KEY to growing stronger and increasing performance. Thus, if recovery is impaired...fill in the blank, folks. (hint: progress is impaired)

So if you're feeling beat-up, exhausted, and shaky after each workout, I would say it's time to reevaluate your training. Sessions that lead to that are not sustainable over time. If the body can't recover, stress will pile up (even if you don't feel mentally stressed) the physical stress can actually inhibit your fitness goals by either a) cortisol, a stress-related hormone, is jacked up which hinders overall recovery (if it's too high. A little coritsol is part of the recovery process, but chronically high levels can eventually mess everything up). b) injury. Your poor body is just pooped. Bummer.

Take-Away:

1. Soreness is ok, especially in a new program or after a new exercise is introduced. Over time, the soreness will decrease and that's a mark of progress (the body becoming stronger and more resilient).

This is not to say that you should NEVER be sore; part of progressing is stressing the system a bit beyond what it's used to. There should be days throughout your lifetime of training that soreness occurs. But, it should not be....

2. Immediate soreness/pain, particularly around joints or the spine. This means the workout was perhaps more than the body could handle and, despite no actual injury you can see, the body IS injured and will require a longer recovery period. If that recovery time is absent, eventually injuries will manifest.

3. Basing the effectiveness of a workout on "soreness" or "tiredness" is not a fair gauge and often the wrong measuring stick. Instead, one should track progress by strength goals, clothes fitting (or not fitting. Growing some hamstrings can cause pants to be tighter), aerobic markers (such as, running a 100m faster, or the ability to rest less during a weight circuit), and other such performance markers over time.

A witty remark escapes me at the moment, therefore, just assume I said something that would be of a high caliber wit.

Designing Practical Warm-ups for the Overhead Athlete

To give a brief recap, if you missed Stevo's post on Friday: August is dedicated to training means, modes, and methods for overhead athletes (these are sports like baseball, softball, volleyball, swimming, and javelin). 

The pre-practice and pre-competition warm-up is extremely important for any athlete, but to an even greater degree for those athletes who need to give special consideration to the shoulder complex. As a strength coach, I've given numerous warm-up protocols to numerous athletes over the years and while, in a pinch, I could easily produce one that would be well-balanced and comprehensive, I've always preferred to plan my warm-ups in advance.

Preplanning ensures that every muscle, joint, angle, whatever has been taken into consideration and a decision has been made about how to address it for that day (or not). The important thing here being that you must give yourself the chance to make a decision about something ahead of time vs. simply overlooking the area.

Most coaches plan warm-ups on the fly, but like most things at SAPT, we tend not to do what "most" do... that's usually the easy way... and we know the right way! Thus, why we're the premier strength and performance training facility in the Fairfax, Tysons, McLean, Vienna areas.

Getting back to the practical warm-up: Over my time working with college athletes, I ended up developing an ever-evolving template of warm-ups that I would rotate and match to the first 15- to 30-minutes of the practice plan. For example, if the start of practice was going to be ripe with sprinting, the I would choose the plan to match. On the other hand, if practice was starting with quite a bit of hitting (volleyball) where I knew the shoulder needed to be totally warm and ready, then that would inform my warm-up choice.

http://youtu.be/IfJi8KLhtlg

This video is just showing the team warming up... keep that in mind while you watch the power + the height the guys are getting on the ball off one bounce. What's the warm-up look like before this part of the warm-up??? I bet it's a pretty good one.

Anything is an option: body resistance only, bands, medicine balls, actual sporting equipment (i.e. a baseball), weights, etc... Shoot, you can even use a sled/Prowler to do a fantastic total body warm-up that fully addresses the shoulders.

So, when planning a warm-up (or your own set of templated warm-ups) make sure you are addressing all the primary movers and in all directions - planes of motion - plus weaving in extra prehab that may not occur in the weight room and copious amounts of shoulder friendly mobilizations, stabilizations, and drills.

You Want To Be Fast, Huh?

Intern Post By Goose & Josh:

                      Get infinity times faster by going beyond your understanding of speed.

Humans have an addiction to speed. No matter what we do we are never fast enough. Whether it is from running to jets flying over the open sky we build/engineer these bodies to go faster. The question is how do we engineer speed and how do we do it properly? We can break it down into 5 parts strength, cardiovascular endurance, muscular endurance, form, and genetics. Having a firm understanding of these 5 elements will allow you to harness a power that the human race strives to attain.

Strength

Being strong does not mean being able to lift heavy things and put things back down. It is the matter of building a foundation for speed. Without strength speed cannot be accomplished. Strength determines the rate of force development (RFD) meaning how fast your muscles contracts to produce a maximal amount of force. With minimal strength there is low RFD meaning that the muscles in your body will not be able to get you to the finish before the guy that can produce the same amount of force is a shorter period of time. Strength training, done correctly, can and will excel your RFD to the next level.

Strength training is also vital to injury prevention. It is much more beneficial and time efficient for the athlete to prevent and injury versus recovering from one. Resistance training strengthens one’s connective tissue and increases the size and strength of ligament. Strong ligaments especially in areas such as the Achilles are necessary for an athlete to keep running at top speed. The physical stress from resistance/strength also increases bone density, which will help prevent overuse injuries such as stress fractures.

                    Did you know that the Hulk can run at least 215 mph? That is pure strength.

Well some of you also may be thinking, “I lifted once and I got hurt…” Well yes improper lifting can hurt anyone just like improperly can cause stress fractures. Make sure you know exactly what you are doing and if you do not ask people who do. I’ll admit it is difficult to find people who know how to teach lifts properly and this requires research. Well you might be thinking this is a lot of work just to pick things up and put them back down. Let me tell you this, if you truly want to get faster then you will do whatever you can to get it done.

P.S. As strength coaches it is our responsibility to understand that we are responsible not just for making them lift more weights but for the athletes overall health and well being.

P.P.S. If you still are not convinced about building strength and its obvious benefits then check out this great article: http://saptstrength.com/2013/06/17/lifting-running-monster-benefits-an-intern-post/ It should help clear up some doubts.

Cardiovascular Endurance

What’s the point of running fast if your heart cannot keep up? Cardiovascular endurance determines how long your heart rate can pump at a high rate. The heart is the most important muscle in your body and without it there is no life, thus no speed. To have a healthy heart can mean to add more years to your life, which means more time to go fast!

Yes sure a healthy heart is great and goes without saying, but honestly how does this effect my force production to create more SPEED!? Well let’s put it this way, your heart pumps blood through out your body right? Well that includes your muscles too. What muscles need in order to function is oxygen. Well guess what is in the blood going to your muscles, OXYGEN!

So that being said if your heart poops out and pumps less blood after 10 seconds, your muscles start getting less and less oxygen. If your muscles are not getting enough of oxygen then the they will have a much harder time contracting thus = less force production. So the longer the heart can pump blood without straining the longer your body can propel itself at full speeds.

Having strong cardiovascular endurance is also vital for recovery between your bursts of intense speed. The aerobic energy system is responsible for full recovery between bouts of sprints, so that you can sprint fast on each successive sprint rather than seeing drops in performance. It clears out metabolic byproducts of anaerobic work such as CO2. Clearing out the waste allows for ATP to be produced and ATP is what we use for energy to create explosive speed.

             Long story short DON’T skip cardio day! Never know when a zombie will show up

Muscular Endurance

    The body derives its energy from three different energy systems, the Phosphagen, Anaerobic, and Aerobic Systems. Generally speaking the Phosphagen System provides energy for all out efforts lasting 6 to 15 seconds, depending on the nature of the activity. Meanwhile the Anaerobic System provides the energy for submaximal bursts of speed lasting 30 seconds to2 minutes. Finally the Aerobic System provide a low but constant flow of energy for long lasting activities such as distance running. Whenever you exercise all three of the energy systems are turned on however the amount of energy you get from each one varies depending on duration, intensity, and the nature of the activity.

When sprinting you primarily rely on the Phosphagen System and the Anaerobic System for energy. The Aerobic system is being utilized during the activity but its main role is providing energy for recovery. This is why it is important to have a strong cardiovascular system, it’ll help you recover faster so you can sprint for longer. Muscular endurance training teaches your body how to push the limits of these energy systems and how to recover faster. This can be done through interval workouts, fartleks, hills, and bleacher/stair workouts. By continuously putting a high energy demand on your body and teaching it to keep working under stressful conditions you are actually pushing your Lactate Threshold back further and further.

Your body naturally produces lactate throughout the workout but when you do high intensity muscular endurance workouts you get to a point when the lactate overwhelms the system which gets rid of it. Once lactate production exceeds the removal capacity of the body it starts to accumulate in the blood stream. This is bad news because it interferes with the production of energy by the 3 systems I mentioned before. This begins the downward spiral to you ending up on the ground with vomit all over yourself. During workouts you push your body to its Lactate threshold but not passed it, this paired with your body’s awesome ability to adapt to new stresses over time will keep pushing the threshold further back. This is how people “get in shape”, they constantly put stress on the body which causes it to adapt until the previous level of stress is no longer as challenging.

Mental Toughness! My personal definition of mental toughness is being able to push yourself to do what you have to do even when it hurts. My favorite example of this is the 400m dash. The 400 meters is a great but terrible race for no matter who you are/how fast you are the last 100 meter are ALWAYS going to hurt. The high school scrub who runs 53 seconds and the all-star who runs 46 seconds are both hating life during that last straightaway. The difference being that the all-star has taught himself to ignore the pain and maintain form, meanwhile the scrub is thinking too much about the burning in his quads while his arms flail everywhere and everyone flies by. It’s the mental fortitude to ignore how tired you are and being able to remain focused on the task at hand that separates champions from benchwarmers. Only by constantly putting your body in this tired state, through running workouts, and testing your mental fortitude will you get tougher.

                                           Only the toughest person wins the race!

Form

    The reason why coaches are such sticklers about form is because bad form sacrifices efficiency. There’s a reason why all the fast people on TV look the same when they run! Good form allows you to use you’re body’s levers to your advantage and to properly direct the force you’re putting on the ground. In layman’s terms, it lets you do work while expending less energy. This makes the difference in the end of the race/game when everyone is tired. Whoever has the most energy left will win 9 times out of 10. The simplest running form drill that will work wonders when performed correctly are:

-A Skips

-B Skips

-High Knees

-Butt Kicks

-Straight Leg Bounds

-Alternating Quick Leg

-Falling Starts

These drills not only work on running form but also coordination. They can do wonders for kids and adults who lack the coordination to run properly.

**Front pack = world class times, stragglers = average times, form made the difference!**

Genetics

    As much as I would love to say we are all equal and have the exact same potential, that would be a lie. I’m a firm believer in genetic superiority. We all knew that guy in high school or college that had the drive to work hard but barely improved every season. On the flip side, we all had that friend who never tried hard at all and was still the best on the team. You can only fight your genetics so much! HOWEVER, that doesn’t mean you can’t achieve greatness! Sure you may not be a national champion but being All-State or Conference Champ is still pretty awesome. There is still plenty of glory to be had, you just have to go out there and get it! Even if you don’t win but set a personal best, that still means you are now better than you’ve ever been, there should be some small amount of satisfaction there! So what if you’re genes aren’t the best it doesn’t mean you can’t get faster! Odds are you’re not even close to hitting your genetic ceiling, aka you’re body’s full potential. Do work and worry about the factor you can control.

                        **We can’t all be the greatest athlete in the world, but we can try ;)**

A Prerequisite to Lifting Heavy Things: Stability

In my last article, I talked about the need for correct mobility in your exercises and workout. Mobility is extremely important and should always be addressed early on to ensure good positioning and a full range of motion in your lift. Mobility, however is only one part of the puzzle. There’s another aspect that the yogis don’t like to talk about and many people get confused with a BOSU ball: Stability

Mobility and Stability are the two components that provide the frame-work of movement. Mobility is the ability of a joint to move through a given range of motion, whereas stability is the ability to resist being moved. From a biomechanics stand-point they are like yin and yang, positive and negative, peanut butter and jelly. One cannot exist without the other. They are both equally important in training, however the body will always choose stability over mobility for safety and compensations.

Dr. Perry of Stop Chasing Pain is known for his saying, “stability rules the road.” What he means by that is that your body will always give up mobility in whatever joint it needs to create a stable environment if there is dysfunction(muscles not working properly). Will that cause pain and compensation patterns? Probably, but not always. If muscles aren’t working right, then they will not be able to control the motions in joints, and your body doesn’t trust that, so it will lock it down. It’s very similar to walking on ice. When you’re on the ice, you naturally stiffen up, and you consciously will keep your legs in and tight, not using big strides.

So essentially, if you lose stability, you will lose mobility somewhere else. It follows the joint by joint approach just as mobility did in my last article. This is why it doesn’t make sense to just stretch or just to weight train. When I talked about how to create proper mobility, step 4 was ACTIVATE. This is where stability is created, in the hopes that it will start to become automatic when used with movement.

The Misconceptions:

Stiffness is the Same as Stability

Many people confuse this notion of creating stability with creating stiffness. For an area to be stable, you want it to be tense/active during the appropriate movement and yet supple when not in use.

If you’re doing 50 reverse hyperextensions a day to keep your low back, “stable,” then you’re just creating stiffness by overusing the muscles and there for doing it wrong. If you want to create true stability in a particular area, then you must train that muscle/area as a stabilizer.

Stability training is done on bosus and wobble boards

Creating true stability in a joint DOES NOT need to be done on an unstable surface. It is done by creating mobility and then using a particular area as a stabilizer to hold a particular position. This is not to say that using a BOSU or wobble-board is always wrong. They do have their time and place for rehab, but that’s another topic for a blog post.

Anyway, an example of using a muscle as a stabilizer that I like is using the ½ knealing position for variations on exercises to help create some glute stability and open up the front of the hips. What about the guy doing the 50 hyperextensions? Well how about just try some simple plank variations or maybe even a kettlebell halo instead.

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…

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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.

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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!