Ok but working to be more than ok.....

....it all happens with focus and the 'over throw' of the arch enemy.

The completion of 2 swim session over the last 2 evenings has been a small step forward. Last night saw being able to complete a 2.8km session which included a main set of 5 x 400m (3 x pull buoy and 2 straight freestyle) However by the end of the session there was a little soreness in the back but very little discomfort.
Tonight's session was another couple of baby step forward with the completion of another full session. On an aside....I finally won another 'snake' in the end of session relay (thanks to my fantastic team mates)....by the way that's 2 wins in over 2 1/2 years...one more and then I can average 1 win a year....woooohoooo.

Is walking on water any easier....

This week brings a new commitment to training particularly after jumping on the scales last night...and then again this morning to check that the scales weren't telling fibs....as I guessed....they were telling me things were going backwards.

Focus...Focus....Focus...Focus....Focus...Focus....Focus...Focus....Focus...Focus....

Do I want it....after further consideration..(which wasn't much)...sure DO!

IM NZ is still a realistic goal..but I need to get my head back on track.

Swimming tonight was a good start to the road to recovery....but it's got to be baby steps. Tonight I lasted 1hr & 15min in the pool before I felt a little discomfort. A positive result I think. Really enjoyed the session as a whole.

Injury Update - progress report

There has been some deep thought going into where to next in terms of my direction with training and racing over the next number of months.

So...where are we at:

• still injured? ....yes but things are slowly improving, the pain level in the left leg has subsided more and there is a little less discomfort. I am booked in to see the spinal specialist on the 17th of December....MRI before then....hopefully a early Christmas gift....fingers cross. Meanwhile there is plenty of physio, acupuncture and light massage (beginning this week). I am embarking on other means of assisting the healing in detoxing the body as I firmly believe that if rid the body of those toxins...which I certainly have plenty of....this will certainly assist in the processes of returning to 100%. The other things are meditation and working on the core strength.
  
• the self discipline has gone out the window......the eating has been out of control and the kilos have returned...the lack of self discipline has again been a disappointing factor throughout this injury challenge...there are always plenty of 'walls' that are put up as obstacles throughout the recovery process and this is one that I just can't maneuver round...simply I am running into the wall of ill discipline in many of these challenging periods. The mind need further refinement in this field....when it's down...it's down!!! When it is in form it runs the body like a well drilled army regiment.
• I am struggling with the inability to get out there and RUN...it is irritating me some what....the patience is beginning to run thin.
  
• To overcome this lack of patience I have begun to set myself small achievable goals.

1. Begin light massage this week
2. Get on the bike around the end of the month
3. Run for 5km straight by the end of the year

• Swimming will obviously still play a big part throughout these stages.

Another week...another set of challenges to hurdle....positive thinking and a relaxed body assists in the process to recovery.

Hope and now a little disappointment

Within the last couple of hours I definitely think the local has begun to wear off. Things are beginning to feel like they were last week.....I still have some hope that maybe the steroid part of the injection will 'kick' in shortly....please...please...please. I'm not desperate ;-)

Further research....the road to recovery.

Below are some core strength exercise that I'm going to utilise in the recovery process:

Abdominal crunches:

• Lie on your back with your feet on the floor and your knees bent.
  
• Cross your arms in front of your chest.
  
• Lift your head and shoulder blades off of the ground while contracting your abs.
  
• Hold the "crunch" for a second before slowly returning to the starting position.
  
• Repeat 10 to 15 times.

Prone hyperextensions:

• Lie on a mat face down with your arms by your sides and your legs fully extended.
  
• At the same time raise your upper body and legs off of the mat.
  
• Your hips and abdomen should remain in contact with the ground.
  
• Slowly lower to the starting position and repeat 10 times.

Rotations:

• Stand with your back against the wall.
• Extend your arms straight out in front of you, parallel to the ground and with your palms touching each other.
  
• Rotate your trunk to one side while keeping your hands and arms in front of your chest.
  
• Try to come as close as you can to the wall with your hands in a pain-free range of motion.
• Repeat to the other side.
  
• Do 10 repetitions.

Improve flexibility with the back flexion:

• Lie on your back and pull both of your knees to your chest until you feel a slight stretch.
  
• Hold the stretch for 30 seconds, and slowly return to the starting position.
  
• Repeat three times.

Seated lower back stretch:

• Sit upright on a mat with one leg extended against the ground and the other leg bent at the knee with your foot on the floor.
  
• Rotate your torso towards the bent knee until you feel a slight stretch in your lower back.
  
• You can gently pull against your knee to increase the rotation of your torso and get a bigger stretch if desired.
  
• Hold the stretch for 30 seconds and repeat on the other side.

Cat stretch:

• Kneel with your hands and knees touching the mat.
  
• Round your back up as if you are trying to pull your navel into your spine.
  
• Hold the stretch for a second before reversing the movement so that you are pushing your navel and glutes outward and stretching your lower back.
  
• Repeat 10 times.

1.10pm : Spinal Epidural Steroid Injection

It has been done....relatively painless procedure and so far worth it....there was instantaneous relief. The sensations are rather weird but there has been some relief.

Some background information on the procedure is detailed below:

Why is it done?

It is usually done where there is pain due to nerve irritation or compression in the spine. Specifically, it is most often used for two conditions. The first is spinal stenosis and the second is sciatica, usually due to a disc protrusion. It is sometimes done for low back pain, but it is not often very effective for this.

What is it?

This is an injection into the spine, into the epidural space. This is the space between the bony spinal canal and the spinal cord and nerves. The procedure is similar to that done for pain relief during childbirth. The injection is different in that it contains local anaesthetic and steroid.

How does it work?

The local anaesthetic works to numb the nerves in the area. This is temporary and lasts about twelve hours (usually overnight). The steroid is like prednisone or cortisone, and it acts to decrease swelling and inflammation. It helps decrease the nerve irritation, and usually starts working a day or two after the injection.

5 weeks...........Baby Steps

Tonight was to return to some form of training. It saw a return to the water.

Driving into the pool, I was a little apprehensive but new that I had to just give it a go.....you judge something without first giving it a go.

The session was that 'full on' but it was hard enough to put some stresses on the back to give me an indication of whether further swim session were possible. Things like 50m with bands gave it a good workout.

Thought out the session there was some discomfort at times but it was bearable and at no time was it painfully sore, good sign I guess...but baby steps I say...my new philosophy for moment.

Tomorrow is the spinal epidural steroid injection. Here's hoping...

Hold on to the hope.....

This morning I had the first bit of treatment on the back since I injured the back 5 weeks ago.

Now knowing what the injury is, and the extent of the injury, it is a little more logical that now I can present the this to practitioners and then they can effectively assist in the recovery of the specifics of the injury.

This morning was a trip to the physio. Talking through the injury with my physio helped in me moving forward and working with some hope. The strategies to go forward are along these lines:

• Weekly physio treatment. This includes electrotherapy, ultrasound and light 'rotational' massage.
  
• Swimming is back on the cards, but the other 2 disciplines are so forthcoming.
• Going to focus more on the 1%ers. This includes diet/nutrition, stretching and core strength which will assist in the recovery of the injury.
• Off to see a back/spinal specialist.
• Start some accupuncture treatment.
• I am also reviewing the looking at whether the back to back IM is such a good idea for 2010 and maybe better to consider for 2011. NZ IM maybe the main focus

Injury Update - Finally a diagnosis

Findings of CT Lumbar Spine

L4/5 shows moderate spinal canal stenosis with broad-based central disc protrusion with liagamentum flavum redundancy and there is probable pressure on the thecal sac and descending L5 nerve roots.

L5/S1 shows mild spinal canal stenosis with broard based central disc protrusion to a lesser degree with possible pressure on descending S1 nerve roots. There is some dystrophic calcification of the degenerative L5/S1 disc.

Final Impression : Moderate spinal canal stenosis at L4/5.

Treatment options to this point in time:

• Epidural Injection (Friday)
• See one of QLD leading back specialist
• Getting a second opinion.
  

Further Info......

What is lumbar spinal stenosis?
Lumbar spinal stenosis is a broad term referring to the symptoms which may result from the narrowing of the spinal canal in the lower back. This may be due to age, injury, or degeneration.

Lumbar spinal stenosis occurs when the bony tunnels in the spine that transmit the spinal cord and nerve roots become narrowed. The spinal nerves (or nerve roots) typically become compressed, leading to pain in the lower back and legs.

Lumbar spinal stenosis may affect one or more anatomical compartments, including the spinal canal (lumbar canal stenosis) and intervertebral foramen (lumbar foraminal stenosis).

The spinal canal is a long tunnel running down the centre of the spine. This canal sits directly behind the bony blocks, or veterbrae (‘vertebral bodies’) which form the spine (vertebrae) and contains the spinal cord (which usually ends in the upper lumbar spine) and nerve roots. When the spinal canal is narrowed, the spinal cord and nerve roots may be compressed- this is known as lumbar canal stenosis. The lumbar spinal canal may be subdivided into other compartments, notably the lateral recess and subarticular compartments. Narrowing of the calibre of these specific compartments may give rise to ‘lateral recess stenosis’ or ‘subarticular stenosis’.

The spinal nerves (‘nerve roots’) leave the lumbar spinal canal by passing through the intervertebral foraminae. The nerves then travel to the legs, bladder and bowels where they control sensation and movement. When the intervertebral foraminae are narrowed, the nerve roots may be compressed- this is known as lumbar foraminal stenosis.

In summary, lumbar canal and foraminal stenosis are both caused by the same underlying processes, and can present in a similar fashion. The two conditions commonly co-exist and can be broadly referred to as lumbar spinal stenosis.

What causes lumbar spinal stenosis?
Lumbar spinal stenosis is common and is usually caused by osteoarthritis and disc degeneration. Typically, a combination of disc degeneration and bulging, joint and ligament thickening (‘hypertrophy’), and sometimes a slight ‘slip’ (or ‘spondylolisthesis’), causes compression of the nerve roots. Risk factors for spinal osteoarthritis and intervertebral disc degeneration include smoking, poor posture, obesity, repetitive heavy lifting, and ongoing exposure of the lower back to significant jolting or vibration (for example, racing car drivers).

Trauma can also cause spinal stenosis. This includes the kind of injury caused by picking up heavy objects improperly. The vertebrae (spinal bones) or intervertebral discs (shock absorbers between the bones) may be injured, resulting in pressure on the spinal cord and/or nerves. Spinal fractures may result in fragments of bone which intrude into the spinal canal.

Lumbar spinal stenosis may also be caused by the spread of cancer to the vertebral column, or by infection (discitis, osteomyelitis, epidural abscess).

What are the symptoms of lumbar spinal stenosis?
The symptoms of lumbar spinal stenosis can vary, and in some patients there may be no symptoms at all. The degree of compression changes with posture and activity, accounting for variations in the pattern of pain.

Symptomatic patients with lumbar stenosis typically experience pain on standing or walking, and may have trouble walking for any length of time or for long distances. They need to sit down or lean forward (such as when pushing a shopping trolley) to relieve the pain. The pain typically returns when standing upright. This pattern of pain is known as ‘neurogenic claudication’.

In severe cases of spinal stenosis, nerves to the bladder or bowel may be compressed, which can lead to incontinence (loss of control) of urine and/or faeces. Anyone who experiences problems controlling their bladder or bowels should seek urgent medical attention.

How is the diagnosis of lumbar canal stenosis made?
Making a diagnosis of lumbar stenosis can sometimes be difficult because the symptoms may mimic other conditions. For example, the leg pain of neurogenic claudication can be confused with that of vascular claudication, or poor blood supply to the legs. Vascular claudication becomes worse when you walk uphill and improves when you stand still, whilst neurogenic claudication is usually worse walking downhill and improves when you leaning forward or sitting down.

To determine the cause of you symptoms, your neurosurgeon may require several investigations. These may include computed tomography (CT), and magnetic resonance imaging (MRI). In some situations, such as when you are unable to have an MRI, you may also undergo a CT myelogram, in which CT imaging is performed while a contrast dye is injected into the spinal column. Ultrasound scans of the blood vessels in the legs are often carried out to exclude vascular insufficiency as a cause of the symptoms.

What are the treatment options for lumbar canal stenosis?
Lumbar spinal stenosis is almost always treated conservatively in the first instance. Medications to relieve pain and reduce inflammation are utillised. Analgesics include pain relievers such as paracetamol and codeine. Non-steroidal anti-inflammatory drugs (NSAIDS) include aspirin, ibuprofin and naproxen, and these relieve pain as well as reducing inflammation and swelling. Other pharmacological agents include a short course of corticosteroids (prednisolone, cortisone), as well as agents specific for nerve pain (such as pregabalin).

Other nonsurgical treatments for lumbar stenosis include physiotherapy, hydrotherapy, pilates, chiropractic, acupuncture and osteopathy. A physiotherapist can teach you exercises to help you build up and maintain strength, endurance, and flexibility for spinal stability. Some of these exercises will help strengthen your back and abdominal muscles (core muscle groups), since they help support the back. Physical therapy can also include the use of heat or ice packs, ultrasound, electrical stimulation, and massage. These treatments can relax tight muscles and ease pain or discomfort. A back brace or corset can also help support your back and may be especially helpful for people who have degeneration in more than one area of the spine.

In more severe cases, you may be prescribed a corticosteroid injection into the spinal canal. This may comprise an epidural injection. Local anesthetic may also be injected around the compressed nerve (transforaminal nerve sheath injection) and can have both diagnostic and therapeutic value.

Your neurosurgeon may also suggest that you rest your back by restricting your activities. Rest followed by a gradual return to exercise can help the back heal in some cases. Prolonged strict bed rest, however, is generally not recommended.

Severe cases of spinal stenosis may require surgery. There are several types of surgery done to relieve pressure on the spinal cord and nerves and to help strengthen the spine. The most common surgical procedures are decompressive lumbar laminectomy, laminotomy, and spinal fusion.