Sports Injury

Exercises using swiss balls and other gym training tools like dura discs and wobble boards are frequently prescribed to help train the core muscles. This instability training is often viewed as a great way to enhance core strength.

However, a recent review of the research by Behm et al. 2010 (Appl. Physiol. Metab. Nutr. 35(1): 91-108) identified that while instability training can increase core muscle activation, it may not be the best choice in all situations. Unstable training can reduce overall muscular power output, which may have important implications if the goal of a given training program is to maximize the output or physiological stress on a given muscle, as is the case in certain types of athletic training.

The authors are not against unstable training, saying that "Training programs must prepare athletes for a wide variety of postures and external forces, and should include exercises with a destabilizing component."

"While unstable devices have been shown to be effective in decreasing the incidence of low back pain and increasing the sensory efficiency of soft tissues, they are not recommended as the primary exercises for hypertrophy, absolute strength, or power, especially in trained athletes."

"For athletes, ground-based free-weight exercises with moderate levels of instability should form the foundation of exercises to train the core musculature. Instability resistance exercises can play an important role in periodization and rehabilitation."

At various times in their careers, long term athletes might be prescribed a cortisone injection in a body part that has a niggling injury. Cortisone is a powerful anti-inflammatory medication. Also called Corticosteroid, it’s not a pain relieving medication, it only treats the inflammation.

When pain is decreased from cortisone it is because the inflammation has diminished. By injecting the cortisone into a particular area of inflammation, high concentrations of the medication can be given while keeping potential side-effects to a minimum.

They’re particularly useful in long-term injuries that are stubborn, even with extensive rest, physiotherapy and rehab exercises. I had an injection in my elbow after suffering tennis elbow for over a year. After the injection and a focused period of rehab, it steadily improved.

I first went for treatment for back pain in 1993. It hasn’t been around all the time, but just for periods here and there. It flared up enough in 2007 to keep me out of competition. At the time I got a MRI and the report said:

Moderate sized left paracentral disc protrusion at L4/L5 compressing the left L5 nerve root and probably the left L4 nerve root being irritated as well.

Symptoms weren’t there all the time, but were easy to bring on - I just had to sit in a chair for 10 minutes! Not a great lifestyle limitation! I type either standing up or lying down with the laptop on my tummy.

Today, after a period of unsuccessful physiotherapy, I had an epidural injection of Celestone (a brand of cortisone) between L4/L5 vertebrae to try move the injury forward faster. The procedure was relatively comfortable. That report said:

Under CT guidance, a 22 gauge needle was directed into the epidural space at L4/L5 towards to left side from a right approach. Two ampules of Celestone was administered, flushed in with a mixture of saline and contrast. Impression: Successful.

The early signs are good - practically no pain or discomfort. And most pleasingly, the serial tightness I had in my left hamstring and hip flexor muscles seems to have gone - both sides are now about equal in tightness. I believe the tightness was there because the disc was pushing on the nerve root just a little.

Of course, it’s not just about getting an injection and ’she’ll be right’. They’ll be a lot of core stability work, stretching, icing, walking and all that good stuff.

Anyway, today is just day 1 - for my benefit, and anyone who faces similar, I’ll come back to this post and insert updates below.

Day 1 - All fine, no pain in back, just iced it a few times.

Day 2 - A little trouble sleeping last night - they reckon insomnia is a possible side effect!

Day 3 - Back good - feels younger! Starting to do more core exercises. A little stiffer after sailing today, but still definitely better.

1 week - Still really happy with it. I’ve gradually worked it a bit harder and actually have some back soreness from some exercise yesterday, but it feels like regular muscle soreness rather than anything in the disc.

2 weeks - It’s still pretty good - I was worried for a few days but years of thinking about one spot on your body can do that! I can feel some stiffness develop after exercise, but it dissipates with icing and stretching.

3 weeks - Much the same.

1 month - Had some good days and not so good in terms of back discomfort, but I’ve been consistent with core and back exercises and have been able to increase the level of some of the back exercises. I feel less discomfort on a daily basis and consistently wake up less sore than before the injection. I should have had it sooner!

2 months - Improved some more. I don’t feel like it needs to be iced it as much - maybe just twice a day now. I’ve reduce anti-inflammatory drugs and have increased back and abdominal exercises without worry. So it feels like it’s on the up and up. I’m still just walking and a little bit of body-weight lifting for exercise, but hope to do a little jogging and even try cycling gently soon. By the way in the last few months I also read a book called Healing Back Pain and those with chronic back pain may also find it a very interesting read.

3 months - Still relatively good and have done a tiny bit of running plus a little more overall strength training for the back and rest of the body. I do like to keep icing it.

12 months - Went backwards a little a few months ago - got some pain in the back and my left hip when doing some exericse. I iced it, took anti-inflammatories and rested it and it settled down pretty well. It’s been ok since, but I’m still not running or cycling, just walking. I went to see a back surgeon recently and got a MRI. The MRI indicated the discs’ buldge had decreased but there was still a small tear. The Doc concluded he couldn’t make things significantly better by going under the knife. So, my daily exercises continue!