I have a client who herniated three disks between L4, L5, and S1. This occurred while training for the National Women's Rowing Team. The injury occurred in January 2000 and she has not rowed since. I have a go ahead from her doctor and physiotherapist to start a strength training program to get her back into elite level condition. However, most all of the recommended exercises for sport specific training for rowing place a great deal of stress on her lower back. What precautions should I take in order to ensure overtraining does not occur again? What exercises could I use to help strengthen the core area to help support the spine? What exercises should I stay away from?
The area of injury, in the lower- back of L4-5 and S1, seems to be where most people get injured. You did not include the level of injury to the discs, like the distance of the bulge and if there is any vertebral degeneration. Another thing that makes it difficult to “dial-in” an exercise prescription is the “sport specific” exercises that irritate the injury, and, how she originally hurt herself? With all these things in mind we will endeavor to press on.
There are many health care professionals that specialize in low back pain. One common thread they all seem to agree on is training the extension part of the hip-lower back region. This can be accomplished many different ways. We have a portfolio of exercises in the library here at PTontheNET.com. Look them over once you get your client to that level.
The answer to your question will be given in an indirect route, by way of application from one of my people at Specialized Personal Training (SPT).
One of the guys that trains at SPT is an ex-Olympian rower; Dr. Rod. Doc Rod had “blown” his lower back out doing squats while getting ready for the 1976 Olympic Games. Rod suffered a lower back injury in the L4-5 & S1 region, just like your client. Fast forward a few decades and Doc walks into the SPT gym looking around. He told me all he had done after rehab, long ago, was ride stationary bikes and lift weights to stay fit. He is a motivated guy and was curious if he could ever row a single again? So, we began his training “curve”.
Obviously, anyone who makes an Olympic team is somewhat geared for that sport - genetics are in their favor. The hardest thing for the athlete to do is start “slow”. That means having a long training “curve”. This allows thorough adaptation to occur in the connective tissues, the skeletal musculature and the circulatory system. There is a large volume of research on training adaptation times. They range from weeks to years. I believe that the higher level the athlete the longer the curve - years. Your client must re-dedicate herself to a long curve. With this being said, we return to Dr. Rod.
Rod was somewhat fit from the stationary bike work he was doing. This is my first suggestion: find a piece of aerobic equipment she can use without pain or residual pain. Then get her fitter with this mode. Next, we located a few resistance machines that did not cause pain and started setting ROM parameters before increasing the loads. Second suggestion, get an overall resistance training program started and develop general strength, without pain.
Months roll by and now Rod is ready for some freedom. We start with basic body weight exercises, pushups, chin-ups, crunches with hips flexed for back protection, some wobble board entertainment… All of which does not create a problem for Rod or your client. You now start alternating between machine work and BW training. The bike workouts now become interval sessions. Really, starting to get the ventilation levels up with 3-4 minute pieces and 2-3 min.rest periods for 30-40 minutes. This type of training is stressful and should be introduced about 1: 5 rides.
More Months roll by and Rod is starting with some Olympic bar exercises. We begin with the squat. 1/4, 1/2 and then 2/3. We add upright rows, dead lifts as tolerated, front squats with a press and hang cleans. We are now rotating the training pattern through the above-mentioned exercises, still equaling 3 X week for lifting. Volumes and intensities as tolerated. Bike work is elevated to 4 X week with IT 1:4 workouts.
Rod has now been training with “intent” for 1.5 years. We can now start rowing on an ergometer. It is light, light, light with ROM as tolerated. Duration is warm-up long, 5-10 minutes. “Get off of the erg Rod”. Finish the aerobic work on the bike. Strength work progresses as tolerated. Add weight to the Olympic bar and begin strength and neural development. We kept Rod at 10 minutes on the rower & finished with the bike until he could train 4 X week without problems.
Weeks roll by and Rod gets a little more aggressive on the erg. He gets his pace up to a moderate level for 2-3 intervals of 2 minutes, finish on the bike. Add more weight and move the volumes around for stress accommodation. We keep this fashion for about a month. Then progress “slightly”. Inch by inch you climb the hill.
Another year goes by and Rod is now tolerating full rowing workouts at max Heart rate values without problems. He can 2/3 squat 225 for 3 X 8r and likes doing dead lifts with same weight & reps. We have Rod do a lot of variation exercises on machines without problems and still pursue the bike for alternate training.
After almost 3.5 years, Rod set the Masters indoor World Ergometer Rowing record at the World Championships. It took this length of time for him to really absorb the stress placed on his total body and injured area. The way I see it, rowers do not need a lot of super duper balance training on balls and stuff. You just need to start with some well-tolerated movements and build from there. Give your client a long training “curve”, like Rod’s 3.5 years, and she will adapt. Hope this is helpful. Let me know if you have any questions.