February 22, 2013

My Bad Back Battle: Progress at Last!

Although I'm dealing with Parkinson's disease and prostate cancer and aging, my primary health concern for the past 18 months has been my lower back pain.

Giving up my beloved biking riding due to my Parkinson's balance problems was bad enough. But then cutting way back on my walks due to the back pain was a real bummer. 

The back pain started with the cracked vertebra I had as a result of my totaling my car in a crash in August, 2011. It's continued with only limited and intermittent relief since then. 

I plan a series of posts next week on the lessons I've learned from my unsuccessful efforts to deal with this. But today I want to focus on the good news.

What's Working for Me: Physical Therapy for Core Muscle Strength
My neurologist at my regular checkup last November suggested that I get a refresher in the BIG exercise program designed specifically for  people with Parkinson's. He gave me a prescription for physical therapy at Georgetown Hospital. In January I did a video post of my PT's work with me.

Fortunately, hearing that the back pain was bothering me more than anything else, my therapist decided to shift our sessions to exercises designed to strengthen my core muscles. We started with two hour-long sessions per week. We're now down to one and probably will wind up the formal PT in a few weeks.

My PT had me try out several different exercise machines and the stretch band, but the main focus was on exercises I could do at home. We tested several, but she recommended that I concentrate on these two:

The "Belt-Tightener"

Lie on your back with your pelvis in a neutral position -- mid way between flattened onto the floor and arched. You should be comfortable.
  • Tighten your pelvic floor muscles as if you are gently stopping yourself emptying your bladder. (The "Kegel exercise" used most often for incontinence.)
  • Then tighten your lower stomach muscles as if you are drawing your stomach gently to the floor.
  • This should be a slow controlled movement and you should be able to continue to breathe normally throughout.
  • Try not to suck your breath in too much or work too hard.
  • Try to hold the contraction for 10 seconds or 10 breaths, 10 times in a row. If that is too difficult then do less and build up
  • Try not to get too focused on the technique of the exercise, finding neutral and getting your stomach muscles working is the key thing here.
I'm doing a variation of this basic exercise by moving my legs outward toward the floor each time.

The Bridge

  • Lay on your back with your hands by your sides, your knees bent and feet flat on the floor.
  • Make sure your feet are under your knees.
  • Tighten your abdominal and buttock muscles.
  • Raise your hips up to create a straight line from your knees to shoulders.
  • Squeeze your core and try to pull your belly button back toward your spine.
  • If your hips sag or drop, lower yourself back on the floor.
  • The goal is to maintain a straight line from your shoulders to your knees and hold for 10 seconds. You may need to begin by holding the bridge position for a few seconds as you build your strength. It's better to hold the correct position for a shorter time than to go longer in the incorrect 
Try To Work With a Physical Therapist
As pictured and outlined above, this looks pretty simple and easy.  But it's not easy to get it right. It took me several sessions to locate the stomach muscle that was the key to these exercises and then to coordinate the tensing, relaxing and breathing.

And my PT worked with me on other techniques to address the back  problem. Lately we've started working on other issues such as beginning signs of arthritic cramping in my fingers and my increasing difficulty with cramped small handwriting (a common affliction for Parkinson's people).

Medicare will cover all or most of the costs of the physical therapy if you get a doctor's prescription.

The Big Breakthrough for Me
I could tell these exercise were helping but I was having trouble working them into my daily routine. But for the past week, I've found a routine that really works. I haven't taken a pain pill for the past three days -- the first pill-free period since the accident 18 months ago.

I've mentioned often on the blog that my 4 or 5 a.m. "Joy of Quiet" meditation hour is a high-point of my day and a major contributor to my well-being. Now even more so.

This hour or so (which starts whenever I get up in the middle of the night for a bathroom visit, is very free-form. I don't follow any formal meditation routine. I just sit in a straight-backed chair and watch the thoughts flow by. I may do some progressive muscle tensing/relaxing exercises or other seated exercises that come to mind.

Last weekend one of the thoughts that popped into my mind was -- "instead of sitting in the chair, why not lie on the floor for part of this quiet time and do the core muscle strengthening exercises every now and then."

I now spend about half my quiet time in the chair and half on the floor. Most of the floor time is spent the same as the chair time -- just watching the thoughts parade by. But I intersperse both exercises. I don't bother trying to keep a count of the number of times I do each exercise, but I'd guess it averages between 15 and 20 times for each.

Progress at last!


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