Two years after undergoing an abdominal surgery, a long-term patient and friend who has completed 80 Marathons and 20 Ironman triathlons over the course of 15 years challenged me to complete an Ironman triathlon within a year. “How can you treat triathletes if you yourself haven’t raced yet?” he asked jokingly. (A full Ironman triathlon is a tough race. The course consist of a 2.4 mile swim, 112 mile bike and 26.2 mile run).
I have always been very active, but training for a race like this is incredibly challenging. “Let me start with a half one first!” (A half Ironman is a 1.2 mile swim, 56 mile bike and 13.1 mile run). I looked up the pool closest to me, got a swim coach and with his guidance, I was able to build up to the required 1.2 miles within a couple months. However, I noticed two things: one, that I finished my long swim sessions with a dull, nagging, aching pain in my lower back, that just wouldn’t go away. This worried me. How will I continue with a 56 mile bike ride and 13.1 mile run following the swim? Two, that my swim was rather slow, and I had a difficult time improving my speed.
I decided to revisit physical therapy - luckily I did not have to go far to find a great PT :-)
After surgery and other abdominal procedures, it is hard for the brain to find and activate key muscles to maintain a neutral alignment due to trauma to the abdominal muscles and fascia. Surgery can also involve a loss of sensation at or around the scar, inflammation in the abdomen, and pain in the lower back. When the low back experiences pain, research has found that there is an inhibition to the the deep core muscles & lumbar spine stabilizers that support a neutral lumbar alignment. Since this inner cylinder of lumbar stabilizers are turned off, compensation patterns develop. In my case, my posture change resulted in shortened back muscles and hip flexors with an extended abdomen. This posture compressed my lumbar spine and created a sacroiliac dysfunction. Sarah initially worked to undo some of my compensations by improving my sacroiliac movement, decreasing some of the muscle tension, and improving the fascial mobility by using manual techniques to include joint mobilizations, muscle energy, and myofascial release. She then helped me to locate those “lost” muscles from my procedure. After I found those muscles, I was on to establish a neutral spinal alignment. Sarah reported that finding these local stabilizers and neutral alignment were the crucial foundation I needed to successfully progress for my triathlon.
I also needled my scar. Scar formation is a normal response following any injury or surgery; it is the way the body heals injured structures. Scar tissue may involve only the superficial skin, or it may involve the deeper tissues beneath it, including nerves and tendons. Scars can become overly sensitive and can limit motion and function. Needling my scar helped reduce sensitivity and loosen adhesions to deeper structures and allowed me to produce a scar that is smooth and moveable.
Eventually, my therapy progressed from isolated core work. We worked to connect my core to my arms and legs via dynamic upper and lower extremity movements that replicate swimming.
With the help of the combination of therapies my lower back pain resolved within six weeks. I am now able to effectively engage my core and maintain spinal stability. I have better alignment, and as an added bonus, I’ve noticed positive improvements in my swim.