T Nation

Tuesday - Any Questions?

Any questions?

What kind of cardio can I do with a broken leg in a cast?

Anything out there besides wheelchair games?

–work capacity sucks when you just sit around.

I prolapsed my L5-L4 disc 6 months ago. I have some mild sciatica in my right leg- it has improved weekly since the accident and is almost gone. I never stopped training, but chose exercises my PT and I deemed were safe- mainly lying on a bench, and lots of chins, and I rode my mountain bike to avoid becoming a chubster.

I am dying to return to the rugby field, and to squat and deadlift again. How can I build myself up again to these activities? Should I even? I have a desire to run, to tackle, and to lift heavy weights. My health insurance- supplied PT time is over. Now it’s up to me. Any advice?
Regards, deano

Atreides,

Does your gym have an upper body ergometer?

How far up the leg does the cast go?

How much weight bearing are you able to do?

Sorry to hear about the disc injury?

How large of a prolapse did you have?

What kind of RH has the PT had you do for your back?

You should be able to eventually do squats and deadlifts again, but your form is going to have to be solid. Also, you will have to start light and build up slowly.

You definitely need to do some specific lumbar spine rehab exercises.

Let me know what exercises you have been doing also what movements, positions, etc you have problems with.

If I were you, if you felt the PT was pretty knowlegeable, I would ask him where he felt you were at in recovery with regards to starting back into more demanding training. He should have the best idea, as he has been the one most closely associated with you.

I’ll be glad to give you further advice if you could provide with a little more info.

Take care,

Ryan

I’m not sure how large of a prolapse it was. I had an MRI. It doesn’t require surgery. I had some nasty sciatic pain in Nov.Dec last year but the pain is mainly gone now. The pain is in my ankle and foot, and occasionally in my glutes, but it is nerve pain. The intensity of the pain and its frequency has dropped. My back itself hasn’t been sore at all.

I began my rehab with stretching only. I then added in work on a foam roller, and a swiss ball. I added in simple movements like the horse, plank and side plank. I did some bosu ball work- lunges, and jumping lunges, and crunches and bicycling type-movements on the swiss and bosu balls.

In my last two sessions I have been jogging for 10 minutes without pain.

As for training, I have avoided deads, squats, rows and overhead pressing. Barbell curls also seemed to irritate the nerve. My leg training in particular has suffered. I was able to maintain my upper body though.

I have two PTs. One thinks I should give up rugby altogether. Another thinks I could play again. Unfortunately the sports doctor at my hospital has deemed my case now not serious enough to chew up hospital time, facilities and money anymore so I need to complete the rest of the rehab myself.

I need to get cardiovascularly fit again, to build up my body’s ability to take contact, and my ability to bend and twist as these movements, while getting better, have suffered. I do need to build up my lumbar strength, but have been a bit afraid of doing hyperextensions or anything like that.

That’s about all the detail I can think of at the moment. Sorry about the late reply, but I am at work over here in Nippon.
Regards, deano

I forgot. Other movements which cause me trouble are movements when my leg is completely straight. It seems to irritate the nerve. Standing still for more than a few minutes is a killer.

[quote]Dr. Ryan wrote:
Atreides,

Does your gym have an upper body ergometer??[/quote]Yes, I was thinking the same.

[quote]How far up the leg does the cast go??[/quote]5 inches below the knee.

[quote]How much weight bearing are you able to do?[/quote]None at this time. I was instructed not to even let the foot of the cast rest on the floor.

Atreides,

I would start off with the UBE and when you can put some weight on the leg you may be able to do some stationary cycling, although it would be a little awkward.

I think I saw you mention in another thread that you have been doing some upper body exercises at the gym. You could try to do a circuit type program to keep the cardio up. I would imagine that getting from one machine to another with crutches would keep the heart rate elevated.

Also, you could do leg ext/curls/calves with the good leg and get some neurologically mediated carryover to the injured side. If there is no pain with it, you could do some isometric quad/ham contractions with the injured leg.

Keep me posted on your recovery.

Take care,

Ryan

deanosumo,

Ok,sounds like you have been doing some positive RH.

To give you a better idea of how to work back into a more intense exercise program, I’m going to have to know how your symptoms respond to movements.

So, I want you to bend forward, backward, sideways and rotate and let me know what movements hurt and if any of them increase your foot symptoms. Then bend forward 10 times in a controlled motion and assess whether your symptoms increase, decrease or stay the same with the reps. Then lean backwards 10 times and do the same thing. Also, without using any weight, squat down like you would if you were doing squats or deadlifts, do 5-10 reps and assess your response.

Depending on your response, we will get an idea of how to go about reintegrating you into a good workout routine.

For the leg symptoms you can try a nerve flossing technique and see what happens to your symptoms. Try sitting down and then slowly extending your injured leg until it is straight. Once straight, bend your foot toward your shin. As you bring the leg up, slowly look toward the ceiling. Then, bring the leg back down and as you do that slowly flex your chin toward your chest. Do a set of ten and assess your leg symptoms. If they increase and stay aggravated for a while it may not help you. If they improve or worsen initially and then get better, then do them several times throughout the day.

Take care,

Ryan

[quote]Dr. Ryan wrote:
deanosumo,

Ok,sounds like you have been doing some positive RH.

To give you a better idea of how to work back into a more intense exercise program, I’m going to have to know how your symptoms respond to movements.

So, I want you to bend forward, backward, sideways and rotate and let me know what movements hurt and if any of them increase your foot symptoms. Then bend forward 10 times in a controlled motion and assess whether your symptoms increase, decrease or stay the same with the reps. Then lean backwards 10 times and do the same thing. Also, without using any weight, squat down like you would if you were doing squats or deadlifts, do 5-10 reps and assess your response.

Depending on your response, we will get an idea of how to go about reintegrating you into a good workout routine.

For the leg symptoms you can try a nerve flossing technique and see what happens to your symptoms. Try sitting down and then slowly extending your injured leg until it is straight. Once straight, bend your foot toward your shin. As you bring the leg up, slowly look toward the ceiling. Then, bring the leg back down and as you do that slowly flex your chin toward your chest. Do a set of ten and assess your leg symptoms. If they increase and stay aggravated for a while it may not help you. If they improve or worsen initially and then get better, then do them several times throughout the day.

Take care,

Ryan[/quote]

Thanks for the response. I really appreciate it.

I tried the movements, on the floor in front of my desk at work. Luckily no-one is around to laugh.

Bending sideways is a pain-free movement. Bending forwards hurts a tiny bit. Bending backward brings the most pain.

Bending forward for a set of 10, the pain decreased as the set progressed. I was keeping my back flat though, like I was doing a stiff-legged DL. My flexibility also increased as the set progressed.

Bending backwards, the pain increased with each rep. But 10 seconds or so after the set, the pain was gone.

The nerve flossing technique seemed to work. Extending my leg has been a problem, though on the foam roller it’s pain free.

The squat/dl was a pain-free movement.

I feel quite loose and warm, and pain-free as I sit here and type this.

Thanks again for your continued help.
Deano