56x11, thanks for taking the time to read my post and give a thorough and well thought-out reply. Let me address your questions.
I guess it's pretty evident from my lack of training-related posts since 2010 that my once so promising lifting career must've come to a screeching halt. I'm the guy who used to do 220 lbs barbell curls for reps, squat 400+ lbs in very high rep ranges and use 1.75 bw for OHP'ing - at a sub-200 lbs bodyweight.
Who - despite still carrying an appreciable amount of muscle - wasn't able to carry his slim wife over the threshold. Now, even mundane things have become quite the obstacle. I need to kinda plan my movements in advance when getting off the bed or when pleasuring my wife. Yesterday, I went fly and wasp hunting at home and couldn't use my right arm for about 5 hours without excruciating pain. Push-ups? No way.
I'm glad you came to that conclusion: it shows your appreciation of my symptoms and possible causes. Take it from me: a lot of docs I've visited over the years didn't take my condition seriously.
That's a good question. I know for a fact that it's a herniation, at least. But ever since you can palpate something squishy under my skin around L4/L5. Even now, 5 years later.
I've had to contend with pain, leg and foot numbness and - most importantly - a severely changed gait. It appears that my right leg is shorter, but only functionally.
Again, I'm glad we're on the same page.
I haven't been doing barbell exercises for the last 2.5 years and have relied on doing unilateral exercises, only - at least for my upper body. I had also started to do unilateral leg work, albeit relying on machines, only, since I'm lacking the necessary stability to do things like pistol squats or unilateral deadlift variations.
Also, it should be noted that I had ulnar wrist surgery in december 2005 which had me wear a full cast for 4 weeks and a forearm cast for 3 weeks. And, of course, I rushed right back in doing heavy barbell exercises. Come to think of it, I didn't have noticeable structural imbalances until 2007, but ever since coming back from the wrist surgery my right side was never the same, especially strength-endurance-wise.
Prolotherapy just gives you a way to control the wound healing cascade, more specifically to restart and intensify it. Barring any congenital issues with wound healing, everybody should be able to benefit from prolotherapy. Most of the miss cases made one or several of the following mistakes:
- take NSAID and/or fish-oil and other anti-inflammatories during prolotherapy
- bad nutrition
- bad lifestyle habits / lack of sleep
- unmodified training protocol: tissue remodeling during wound healing benefits from loading and training in general, but someone having received prolotherapy for partially torn wrist ligaments shouldn't do olympic weightlifting for at least 3 months after the last prolotherapy injection
- bad injection technique: prolotherapy requires the practicioner to employ a very specific injection pattern, especially w.r.t. to the fibro-osseous junction of ligament tears
- target tissue: ligaments and tendons respond well, ditto fibrous cartilage - joint cargilage, however, not so much
My wrists are almost as good as new.
My wife's ankle, too. And a few other ankles and ACJs of people I've convinced of giving prolotherapy a shot. As I've said: it's a means to control the wound healing cascade to a certain degree and thereby to prolong wound healing which usually shuts down roundabout 6 weeks post-injury - it's no panacea.
As you're well aware, core training usually puts a lot of stress on the SCJs, so I have to be careful and work into it. Not everything works, either.
Around march 2013, I've found out I couldn't pull my left into my hips in a standing position, i.e. raising my left foot about an inch off the ground, without falling over. Genius that I am, I've finally concluded that I need to address my week core muscles - especially something around my right L4/L5 area - ASAP. Due to my SCJ not having tolerated most core exercises for the better part of 2,5 years, I had neglected core training until 2013.
Here's what I'm doing:
pallof press (I wasn't able to do them until the beginning of 2013 - my SCJ hadn't tolerated it until then)
FattyFat's Crossover: stand on one leg, brace my abs, try to maintain neutral hips (both horizontally and vertically), flex my trunk to about 80 degrees (as with a bent-over row), raise one arm to the front, raise the contralateral leg to the back: initially, I did this without weights, now I'm able to do it with about 7 lbs. I've also added a chain instead of only using plates to achieve additional stability demands. As expected, this exercise consequently shows my right L4/L5 area (including multifidii and obliques) is weaker than on the left side.
FattyFat's hypex, which is a variation of the aforementioned FattyFat's Crossover: I'm using my 45 degree hypex bench, activate my quads, flex my abs and do hyperextensions by coiling and uncoiling my spine. During said uncoiling movement, I'm raising one arm overhead. Originally, I started with 2.5 lbs, not I'm doing like 7 lbs for multiple reps on this one.
FattyFat's rotational hypex, which is a variation of the aforementioned FattyFat's hypex, only I'm also twiting my trunk. I wasn't able to do this one until about a month ago.
Also, my spinal erectors and abs have become stronger and thicker since starting this routine.
Additionally, I'm doing my 'real' lifting in unilateral fashion.
I'm starting with the aforementioned core protocol
unilateral lat rows: these need a tad of explaining, since I've never seen anyone but myself doing them: using the upper pulley/cable attachment, I use a pronated grip (maximum reduction of SCJ as opposed to using a supinated grip), standing about 2 meters from the cable stack and then assume a 80 degree position (relative to my legs) with my trunk. Keeping my arms as close to my body as possible, I pull with my elbows. This is the only back exercise I'm able to do without aggravating my SCJ. It's almost all lats with negligible scapular retraction.
unilateral rope curls: rope + chain + plates
unilateral tricep push-down (upper cable)
unilateral lateral raises in scapular plain with swinging chain
unilateral shrugs, pronated grip (<-- has done a lot to keep my SCJ in a good enough position)
unilateral leg curls
unilateral leg extension
treadmill, 20 degree incline, sometimes steady-state cardio, sometimes 'HIIT' with a weight vest - running is no option
Only with my own core protocol. Mind you, I'd been to multiple physicians with this, to no avail.
I've even went so far as to show my wife how to dry needle my e. spinae in the L4/L5 area. She does this once a week and it helps my hip alignment for about a day.
I absolutely concur, dude. I've been knowing this for quite some time but couldn't find a doc noticing this, too.
Thing is: I don't know how to address it.
I'm not sure: my teres minor trigger points automagically vanish after dry needling my right L4/L5 e. spinae.
There was one doctor who suspects some constant irritation going on in the L4/L5 area. His opinion is that neural therapy / pain management at this area might be worth a try. That's a very recent assessment, though and I wasn't able to go about finding a practicioner for this, yet. Also, I'm sure this is only part of the solution, at best. Hence my starting this thread.
My thinking, exactly. As I've said: I know it's necessary but I don't know how to do it.
There's no need for you to sugar-coat your words, pal: I'm well aware of my incredibly small margin of error and so glad you took the time to address my issues.
I'm willing to do whatever it takes.
To give you an idea: last year, I wanted to come to Vail, Colorado to have a reconstruction surgery done on my SCJs. But both my professional and private lives intervened, let alone the costs involved (I'm living in Germany).
I'm years past any unwillingness to stop doing certain exercises - I'd be happy to be able to carry-fuck my wife, again
By the by: as much as I love T-Nation, it takes some time for my posts to appear. If it's ok by you, I'd like you to contact me via e-mail (see my profile for contact info).