Tuesday, 27 September 2011

Update on my injury

I've realised I've been quiet on my blog for a couple of weeks now. Sadly my injury is preventing me from doing any sports at the moment. That bad, uh? Not really, just that my body needs time to recover and doing anything might actually further my problems. And so, unable to write about the excitement of a volleyball match is or the challenges of a teakwondo side kick, I am going to further elaborate on my injury and what I learnt about it since it happened.

Contrary to popular belief (mine) it's not rowing's fault. It never was, not even back in 2005 in Oxford. There is nothing wrong with my technique or posture. And it's not even caused by over training (my second best guess).

It's an inflammation of a muscle I never knew about, and can't even pronounce it right (the psoas major, pronounced "so-az"), brought about by a chronic postural problem of my spine.

This picture is an MRI scan of my lumbar region, taken in 2006. What it shows, a part from a fairly healthy spine (no hernias, no cracks, no bulging disks), is a pretty sharp bend in my lower spine.

In medical terms the "arch" or inward bend of the lumbar spine is called lordosis. However an excess "arch" or hyper-lordosis can cause lower back pain. My physio thinks that this is the source of my problem. The extra curve in the spine causes my pelvis to tilt forward. This postural problem (quite common it turns out) has profound effect on the muscles of the core.

The idea is that postural deficiencies lead to not using certain muscles correctly which eventually causes other muscles to overcompensate, particularly during exercise. In the end some muscles become lengthened and weak and other muscles short and stiff. Hence the pain.

Here's a list of things that typically lead to anterior pelvic tilt (or characteristics of anterior pelvic tilt; it's difficult to say what causes what):

  • Lengthened (weak) hamstrings
  • Lengthened (weak) abdominals
  • Lengthened (weak) glutes
  • Shortened (tight) erector spinae
  • Shortened (tight) hip flexors
At the moment the muscle causing the greatest grief is the Psoas major (one of the hip flexors). It's a muscle of the deep hip flexor, attached to the lumbar spine of the lower back and to the top of the femur (thigh bone). It's pretty tight and probably very inflamed. The problem came out during rowing, as rowing is performed sited, and sitting (and a modern sedentary lifestyle) is a major culprit in shortening the hip flexors and tightening the psaos. Each stroke I took flexed and tired my poor psoas more, no wonder that in the end it gave up.

The physiotherapist is working on correcting these issues. At the moment we are releasing and massaging the overtired muscles, the psoas, the gluteus medius and many muscles around the spine which are tender or tight, while trying to tilt the pelvis in its correct alignment. It is not fun at all, it hurts really bad. I am finding sitting excruciating. I've been ordered total abstinence to all activities that involve the bending of the hips, like rowing and cycling, and even yoga, discouraged from contact sports as I might not be able to sustain stress, and persuaded not to run (even though in itself running is not painful, the impact from each step strains the core muscles). I am left with swimming (front crawl only) and stretching (certain stretches being extremely beneficial).

The good news is that nothing is broken, overtired muscles is something one can easily recover from. The bad news is that recovery might take a while, nothing as long as I feared (I've been reassured for instance that I will be fit enough for my half marathon in November), but certainly long enough for me to be bored of watching TV laying on the sofa on a Saturday afternoon while I could be out doing something fun and exiting.

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