How to CrossFit while recovering from injury?

May 21, 2010 4:40 PM

I love CrossFit, but I'm recovering from a lower back injury (herniated disc + sciatica). How can I stay active and strong without making my back worse?

I've been going to a really great CrossFit gym for the past 3 months. I *LOVE* it. Unfortunately, 5 weeks ago I had a relapse of left-leg sciatica associated with a herniated disc that I got from being rear-ended on the interstate 6 months ago. The pain returned a day after I went rock climbing.

Mostly I have generalized pain going down my leg that is sometimes accompanied by a sharp pain near my left pyriformis muscle. I haven't really had any pain directly in my lower back since a week or two after the accident.

I read many previous threads here about sciatica and lower back pain. I got a good lumbar support for my office chair. I take stretching and flexing breaks at work. I sit up straight and tall. I got the book "Treat Your Own Back" by McKenzie. I'm going to physical therapy twice a week (though I don't think it's doing much). It all seems to be helping...

BUT. Every time I go to the gym, even though I'm "taking it easy" (by CrossFit standards), the pain in my leg flares up and moves down my leg the next day. If I lay off the gym for a few days, I feel like I'm making progress since the pain subsides a lot (not totally but maybe 50%). Then I go back, and have pain again. I've even tried eliminating the exercises that I know will aggravate my lower back like kettlebell swings and dead lifts. It doesn't seem to matter.

So my question is:

What exercises and cardio can I do that will help me stay in shape, but NOT impede the healing process of my lower back? What has your experience been with this type of injury?

I love to go road cycling, but I heard that's bad. I don't like to run, but I hear it's bad anyway. I heard swimming can be good, but I don't have access to a pool (I could see if the local YMCA has one and join that, I guess). Other than that, I can't think of a way to get my heartrate up and burn calories. Help!!!

(I already asked my doctor and physical therapist, and they both pretty much think CrossFit is nuts to begin with. They "strongly recommend" that I don't do any exercise, but I get the feeling that's because they don't want to make the effort to work with me and so it's a cop-out. Plus everything else I've read says that not exercising at all can actually be bad since your muscles, tendons, scar tissue etc can get locked up.)

posted by buckaroo_benzai to health & fitness (13 answers total)

Kelly Starrett is the expert when it comes to issues like these. He is a CrossFit gym owner who also has doctorate in physical therapy and is plain generally knowledgeable when it comes to exercise movements while dealing with injury. He has a program that promotes performance-based physical therapy and does a lot of consulting in this area. Apparently he offers phone consultations for those who don't live in the area...

- http://www.sanfranciscocrossfit.com/physical-therapy.php

Watch some of his videos within the CrossFit Journal. They are useful and entertaining.

Beyond that I'm not sure because doctor's orders take precedence. Although, personally, I'm wary of those who say that I should never exercise. That said, maybe taking a couple weeks off completely can't hurt. You can always rebuild strength.
posted by rlef98 at 4:57 PM on May 21, 2010 [1 favorite]

I'd highly suggest pilates from a really qualified teacher. I say "really qualified" because pilates originated as exercises for physical therapy for war veterans, before it became the ass/ab fad that you see now.

Ideally, you want someone who is going to ask which vertebrae are damaged and how, and may even want to see your scans from the doctor.

They should be able to a) give you specific exercises to help your body stabilize the damaged areas so you'll be less likely to reinjure in the future, b) help you get the piriformis to relax (you may also be one of the unlucky people who has their sciatic nerve grow through the muscle), c) let you know what exercises you can do that won't reinjure or trigger the nerve.
posted by yeloson at 5:02 PM on May 21, 2010

oh my. Back off from the Cross Fit. And from Insanity! Boot Camp! and any regiment that is trademarked, registered, or designed with a gimmick. These are so awfully not good for your body. Treat them as you would the latest fad diet. They almost seemed designed to aggravate existing injuries.

And why the F*** are you doing ANYTHING like kettle ball swings if you have a preexisting injury? Do not ever go back to the trainer that suggested that to you. Serious. Sorry for the shouting.

I don't have specific sciatica / herniated disc advice, so please do check with your therapist first.

But I do coach, and in general (and this is for everyone) avoid anything that involves swinging or bouncing. Avoid anything that involves hyper-extending any body part, especially the lower back. Use weights that you can control (i.e., for a delt-lift you should be able to hold the weight a second at the top of the lift. Swinging it up then down, you're using momentum and putting stress on vulnerable body parts). As you get into heavier weights use dumbbells instead of barbells (unless you're a bodybuilder) - you'll have a more natural range of motion.

Find a sport that will help you learn good body mechanics. Yoga and dance are the two that come to mind.

And don't push it. People with joint issues are often out of commission 6 months while they heal. Pushing it extends the healing time rather than decreasing it.
posted by kanewai at 5:10 PM on May 21, 2010 [1 favorite]

You didn't say, but have you discussed it with your CrossFit trainer? Some of the level 1 certified trainers may not have that much experience with working around an injury, but others really do. They may even have gone to one of Kelly Starrett's seminars.

My experience with CrossFit + jacking up my lower back turned out to have a very simple 3-word answer. Form, form, form. I had to go back to deadlifting 65 (and I would have gone even lighter except that I needed the 10-lb bumper plates to keep the bar off the ground) and concentrating on doing them perfectly with respect to keeping my abs tight and my back properly positioned. It turned out the deadlifing made my back feel much better, provided I didn't stop paying attention and lift with sloppy form.

You'll want to avoid the faster ones like cleans and snatches, though, for a while. Too hard to pay attention to your back when you're also thinking about the rest of the movement.

I'm no doctor or physical therapist, though. Talk to your trainer and see what he/she says.
posted by ctmf at 5:27 PM on May 21, 2010

rlef98: Thanks. I'm actually not too far from San Francisco so I'll see what I can do.
posted by buckaroo_benzai at 5:43 PM on May 21, 2010

Actually, road cycling has been very good for my lower back rehab (after microdiscectomy of L1-S5); with good improvement of my sciatica.
posted by Rad_Boy at 6:06 PM on May 21, 2010

The therapist who worked me through the Mckenzie exercises after my microdiscectomies (I got into a bad car accident two years after the first, part of the disc actually wrapped around my spinal cord... not fun) told me that, when it comes to healing from sciatica/disc issues, pain is bad. He advised that, if at any point during stretching, I experienced any symptoms in my legs, I should stop immediately and return to a non-stress position, then slowly ease my way back into the stretches.

I'm talking about Treat Your Own Back type stretches here. The leg lifts, the back stretches. IANAD, but if you're at the gym, lifting weights and getting symptoms in your leg? STOP. You need to take care of your back because you only get one. You don't want to fight through/push through sciatica because it only irritates the nerve more, only puts more pressure on your disc. I pushed too hard, too soon after surgery, and as a result, I haven't been pain free in nearly ten years. Take this chance to try and heal before you end up hurting yourself worse, and need surgery (which, dear god, I wouldn't wish on anyone).
posted by Ghidorah at 6:46 PM on May 21, 2010

The elliptical for cardio. Any strength training that does not involve flexion. With the basic McKenzie extension exercises, your back will heal. Then resume cross fit.
posted by mizrachi at 7:23 PM on May 21, 2010

It seems a little odd to me that you sustained this injury in an accident 6 months ago, but were able to do CrossFit workouts for 2 months until you re-injured yourself rock climbing.

In any case, you should work with someone who understands your injury and is used to working with lifters, and ideally can watch you lift. If the trainers at your CF affiliate are good, they should be able to help you. It may not be a good idea to follow the same programming as everyone else at your affiliate. That doesn't mean you have to rule out movements that use your back though. A properly performed deadlift will strengthen the muscles that support your spine without doing any damage to your discs. If the CF trainers can't help you rehab your injury and adapt your programming, you may want to look elsewhere. A good trainer is harder to find than clueless internet commenters or doctors who will tell you to stop lifting, but they exist.

Lifting after back injuries has come up many times over on Starting Strength-author and former CrossFit barbell expert Mark Rippetoe's forums. It looks like a bunch of folks there report continued lifting success after injuries like yours. Good luck.
posted by ludwig_van at 8:06 PM on May 21, 2010

ludwig_van: Tell me about it. I was feeling so fine for a couple months. Not sure what it was about the rock climbing that did it, since it was a beginner class and I didn't think I was being crazy. My daily CrossFit workout seemed much, much more strenuous at the time. Now I can't even seem to do 25 burpees without my leg hurting the next day. I'm sure it's not helped by the fact that I have a 9 hour a day desk job so I'm sitting down more than I ever have in my life (despite working on my posture and taking breaks). My employer ordered me a sit-down/stand-up desk which should arrive soon... I'm hoping that will help my recovery.

Thanks for the link to the startingstrength.com forums.
posted by buckaroo_benzai at 8:25 PM on May 21, 2010

I can promise you one thing: KStarr will tell you that you have 24 hours before you're cleared for an exercise. If it hurts anytime in the 24 hours after you work out, you can't do it yet.
posted by ch1x0r at 10:21 PM on May 21, 2010

What is the physical therapist doing with you? If you feel it isn't helping much and that your therapist doesn't want to bother to work with you in developing an exercise program, perhaps it is time to find a new therapist. There can be a huge difference in approaches, expertise, and results between different facilities. Many facilities have therapists who are also Pilates trained, this may be one of your best options. By all means, find a good therapist who is willing to help you with an appropriate exercise program.
posted by Lost at 4:20 AM on May 22, 2010

After 15 years of recurrent chronic back pain following a lower back injury (which periodically reached the level of back brace/cane/prescription opiate painkillers), I discovered the Egoscue Method of postural alignment physical therapy. I've posted about it a fair bit because it's made such a huge difference for me.

There's an Egoscue clinic in SF, since you mention you're reasonably local. You can also get a copy of Pete Egoscue's book Pain Free from the library to try it out without any financial commitment, which is what I did. I started it six weeks into the worst, most immobilizing sciatica attack I've ever had, when I was feeling desperate to get off the painkillers (my system does not like opiates). Four days after I started doing the exercise routine for lower back pain, I realized I'd forgotten to take the Tylenol with codeine, because the pain was so much less. I wrote about it in my LJ here and here at the time.

A common saying among Egoscue therapists is "First straighten, then strengthen." Get your body back into proper alignment and able to move freely without pain, then add strength training, running, rock climbing, or whatever higher-effort activity you like. Otherwise you're just making dysfunction and misalignment worse and probably increasing your pain.
posted by Lexica at 3:41 PM on May 22, 2010