Back exercises - difficulty, goblin mode
February 27, 2023 12:07 PM Subscribe
I have spinal stenosis. For years I have had a lot of pain when straightening my back, walking or standing. Now I have some moderately effective PT, but...
...I've been walking around hunched over in what I think of as goblin mode for years. My back is weak in several particular ways and I'm looking for the specific things below:
1. Recommendations to help me remember to stand up straight - I tend to drop into my old scuttling posture reflexively even when my back feels good.
2. Some way to strengthen my back for long-term standing. Right now, I have more mobility and less pain than I have had in years, but my back is so weak that I get spasms and fatigue if I stand for long. I do some weights currently but the issue is standing for extended periods - how do I strengthen for that? I can lift, but not endure, so to speak.
I cannot do glute bridges under any circumstances. They compress the spine and hurt badly because of the stenosis.
This makes me sound like a loon, but: I cannot ask my physical therapist about this, because I developed my PT routine (a mix of core and glute exercises) myself. I saw several PTs over several years for this and the exercises did not help, so I made up my own more strenuous routine*.
I notice pain especially in my mid and upper back when standing - it's not an achey kind of pain at all, it's fatigue and spasms. It is not in the mid-lower-back region where people often get back pain.
*Mainly I think that the PTs I saw were used to treating spinal stenosis on older, frailer people (my poor crumbly spine is terrible for my age) and underestimated the role played by hip tightness and weak gluteus medius...once I started looking at exercises that were good for cyclists AND didn't hurt my spine, I made improvements.
...I've been walking around hunched over in what I think of as goblin mode for years. My back is weak in several particular ways and I'm looking for the specific things below:
1. Recommendations to help me remember to stand up straight - I tend to drop into my old scuttling posture reflexively even when my back feels good.
2. Some way to strengthen my back for long-term standing. Right now, I have more mobility and less pain than I have had in years, but my back is so weak that I get spasms and fatigue if I stand for long. I do some weights currently but the issue is standing for extended periods - how do I strengthen for that? I can lift, but not endure, so to speak.
I cannot do glute bridges under any circumstances. They compress the spine and hurt badly because of the stenosis.
This makes me sound like a loon, but: I cannot ask my physical therapist about this, because I developed my PT routine (a mix of core and glute exercises) myself. I saw several PTs over several years for this and the exercises did not help, so I made up my own more strenuous routine*.
I notice pain especially in my mid and upper back when standing - it's not an achey kind of pain at all, it's fatigue and spasms. It is not in the mid-lower-back region where people often get back pain.
*Mainly I think that the PTs I saw were used to treating spinal stenosis on older, frailer people (my poor crumbly spine is terrible for my age) and underestimated the role played by hip tightness and weak gluteus medius...once I started looking at exercises that were good for cyclists AND didn't hurt my spine, I made improvements.
Have you got rhomboid squeezes in your routine? If not, that might help with both the strengthening and posture. I do them like this, but there are other techniques.
One of my dance teachers describes good upper body posture as coming from "putting your shoulder blades in your back pockets" (pulled down the back, which also draws them together slightly) - I don't find it sustainable for long stretches, but it's a good reminder when I'm transitioning postures - stand up, put my shoulder blades in my back pockets.
posted by EvaDestruction at 12:32 PM on February 27, 2023 [4 favorites]
One of my dance teachers describes good upper body posture as coming from "putting your shoulder blades in your back pockets" (pulled down the back, which also draws them together slightly) - I don't find it sustainable for long stretches, but it's a good reminder when I'm transitioning postures - stand up, put my shoulder blades in my back pockets.
posted by EvaDestruction at 12:32 PM on February 27, 2023 [4 favorites]
I get that sort of fatigue/spasm pain in my mid and upper back from standing. What has helped me is lying on the floor with a foam roller under my upper back, then rolling over it gently repeatedly up and down my back. (So the foam roller is perpendicular to my spine.) In essence I'm doing a tiny arch with my upper and mid back to counteract hunching over all the time. I feel immediate miraculous relief after a minute or two of rolling.
(I don't know anything about spinal stenosis so forgive me if this is unhelpful for you.)
posted by mcduff at 12:35 PM on February 27, 2023 [2 favorites]
(I don't know anything about spinal stenosis so forgive me if this is unhelpful for you.)
posted by mcduff at 12:35 PM on February 27, 2023 [2 favorites]
Response by poster: Thanks for the suggestions so far!
The standing/walking is pretty routine stuff - I stood long enough to sweep and mop the kitchen floor, for instance, and instead of having to rest midway through due to pain I was able to push through the back fatigue and spasms (so much better than the nerve pain!) to finish the task. My back was really tired the next day and I could not stand for long without significant spasms.
In the long term, I would love to be able to walk distances without pain again - it's been years since I could walk more than twenty yards in a socially acceptable upright posture without pain, and even scuttling around in goblin mode I can't walk very far. I don't know if that degree of improvement is possible, though, so right now I'm focusing on the kind of standing and walking needed for routine chores around the house/yard.
posted by Frowner at 1:27 PM on February 27, 2023 [1 favorite]
The standing/walking is pretty routine stuff - I stood long enough to sweep and mop the kitchen floor, for instance, and instead of having to rest midway through due to pain I was able to push through the back fatigue and spasms (so much better than the nerve pain!) to finish the task. My back was really tired the next day and I could not stand for long without significant spasms.
In the long term, I would love to be able to walk distances without pain again - it's been years since I could walk more than twenty yards in a socially acceptable upright posture without pain, and even scuttling around in goblin mode I can't walk very far. I don't know if that degree of improvement is possible, though, so right now I'm focusing on the kind of standing and walking needed for routine chores around the house/yard.
posted by Frowner at 1:27 PM on February 27, 2023 [1 favorite]
Can you add a pullup progression to your routine? If the thought of doing a pullup is just like hahahahahanope!, this progression from Hybrid Calisthenics starts with wall pullups, which from your description I think will be doable and target the problem area... but IANAPT and certainly NYPT.
If you want to try professional advice from a different point of view, the OTHER kind of PT - a personal trainer - might be worth a go. They don't only work with athletes.
posted by inexorably_forward at 2:01 PM on February 27, 2023
If you want to try professional advice from a different point of view, the OTHER kind of PT - a personal trainer - might be worth a go. They don't only work with athletes.
posted by inexorably_forward at 2:01 PM on February 27, 2023
A little more Hybrid Calisthenics specific to posture.
Is the front of your shoulders tight? Lying down and letting them stretch should reduce the work your back has to do.
posted by clew at 2:22 PM on February 27, 2023
Is the front of your shoulders tight? Lying down and letting them stretch should reduce the work your back has to do.
posted by clew at 2:22 PM on February 27, 2023
I hunch over, and rowing helps me stand up straight without thinking about it. So did having a personal trainer for about 6 months before I got bored with what he was suggesting. (I could probably do a weights routine myself now but rowing it currently sufficing.)
You’ll want to be careful about your form so you’re not asking too much or too little of your erector muscles to start.
posted by supercres at 2:55 PM on February 27, 2023 [1 favorite]
You’ll want to be careful about your form so you’re not asking too much or too little of your erector muscles to start.
posted by supercres at 2:55 PM on February 27, 2023 [1 favorite]
Have you heard of Feldenkrais for alignment corrections?
Here’s a playlist from a YouTube channel I like a lot.
I have found this and Somatic Method to be extremely gentle and healing modalities. Here’s the (paid but a one time fee and so worth it) Somatics exercises I do.
posted by hilaryjade at 3:00 PM on February 27, 2023
Here’s a playlist from a YouTube channel I like a lot.
I have found this and Somatic Method to be extremely gentle and healing modalities. Here’s the (paid but a one time fee and so worth it) Somatics exercises I do.
posted by hilaryjade at 3:00 PM on February 27, 2023
What mcduff is talking about sounds a lot like something I learned from a PT called "I T Y". It uses a half foam roller like this (rando example). You lay on it along your spine with your head at the top. And do "I" (your arms straight over your head) for a minute, then "T" so kind of like a crucifixion (?) gor a minute and then "Y" so somewhere between the two for a minute.
Depending on your back pain, your legs can be planted on the floor knees up, or eventually flat. It's very passive but really makes a difference.
I love it because I always feel taller when I stand up.
posted by atomicstone at 3:47 PM on February 27, 2023 [2 favorites]
Depending on your back pain, your legs can be planted on the floor knees up, or eventually flat. It's very passive but really makes a difference.
I love it because I always feel taller when I stand up.
posted by atomicstone at 3:47 PM on February 27, 2023 [2 favorites]
The guy who does the athlene-x YouTube channel really pushes an exercise called “face pulls” to counteract the overdevelopment of pushing muscles that can cause bad posture. I do mine with yoga bands on a pull-up bar.
posted by brachiopod at 6:02 PM on February 27, 2023
posted by brachiopod at 6:02 PM on February 27, 2023
I have spinal stenosis as well, diagnosed about ten years ago. Gabapentin brought the unbearable standing/walking pain under control and kept it at bay for years. I've since weaned myself from the medication, but I've been left with nerve damage that affects my legs. Your description of the postural effects resonates. I have relatively recently started a completely non-demanding yoga routine while my coffee drips, and I've found it to be strengthening and posture-improving. The cat pose in particular just feels good and, I think, helps me stand straight and with my shoulders back. Those poses that stretch the other way, like cow or cobra, are uncomfortable/painful, probably in the same way that glute bridges are for you. I've also found that kneeling on a cushion allows me to assume a comfortable upright position for experiencing shoulders over hips that also feels good and right, with some carryover to my walking/standing through the day.
posted by bullatony at 6:16 PM on February 27, 2023 [1 favorite]
posted by bullatony at 6:16 PM on February 27, 2023 [1 favorite]
Have you looked into hydro therapy to develop stamina. That is, walking in water that is deeper than your waist, stretches and twists in a large hot tub, and basic bending of joints without gravity.
In my experience farmer's carry with light weights has done a really nice job of gently keeping my back (which had been broken, L4, so lower than your issue) in proper alignment. The weight should be just enough to hold your arms straight down, like 1 to 3 kg.
posted by ptm at 7:50 PM on February 27, 2023 [1 favorite]
In my experience farmer's carry with light weights has done a really nice job of gently keeping my back (which had been broken, L4, so lower than your issue) in proper alignment. The weight should be just enough to hold your arms straight down, like 1 to 3 kg.
posted by ptm at 7:50 PM on February 27, 2023 [1 favorite]
If you haven't seen it, you may find HEP2go, a physical therapy exercise reference, previously on MetaFilter helpful.
As far as professional assistance, I happened to find a PT at a clinic specializing in athletes that understood the biomechanics of my issue much better than others I saw (at clinics which worked more on insurance claims, workers comp and motor vehicle), despite that I am the farthest thing from an athlete and the relevant muscles are very weak.
posted by lookoutbelow at 9:22 PM on February 27, 2023
As far as professional assistance, I happened to find a PT at a clinic specializing in athletes that understood the biomechanics of my issue much better than others I saw (at clinics which worked more on insurance claims, workers comp and motor vehicle), despite that I am the farthest thing from an athlete and the relevant muscles are very weak.
posted by lookoutbelow at 9:22 PM on February 27, 2023
Can you do planks? I think just trying to regularly do planks for as long as you can will help build endurance through your core in a functional way.
posted by music for skeletons at 7:06 AM on February 28, 2023
posted by music for skeletons at 7:06 AM on February 28, 2023
Perhaps tangential to your question, but something that was useful to me in rehabbing planter faciitis (and knee and hip pain that was related) was not pushing through pain. If I accepted that limitation, then I was able to do more the next time. If not, I was likely to develop a new issue or regress in my progress.
It was a hard concept, because I had always had the mindset to push through pain to "get better."
My PT recommended not expecting progress to be more than a 10% improvement. For example, if I was able to walk around the block 10 times without pain, I shouldn't expect to walk more than 11 the next time.
posted by bruinfan at 2:11 PM on February 28, 2023 [1 favorite]
It was a hard concept, because I had always had the mindset to push through pain to "get better."
My PT recommended not expecting progress to be more than a 10% improvement. For example, if I was able to walk around the block 10 times without pain, I shouldn't expect to walk more than 11 the next time.
posted by bruinfan at 2:11 PM on February 28, 2023 [1 favorite]
Something else occurred to me as I was doing my PT exercises this morning - have you got a set of neck strengthening exercises that work for you? Chin tucks helped with my upper back pain and weakness.
posted by EvaDestruction at 7:45 AM on March 1, 2023
posted by EvaDestruction at 7:45 AM on March 1, 2023
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posted by HotToddy at 12:27 PM on February 27, 2023