Question from a Triathlete in pain

Hi Andrew,

I wanted to thank you for contacting me a while back through Slowtwitch in response to a post I had made regarding lower back pain. I've had the opportunity to read your book, and am pretty excited to start integrating the concepts into my training as I start back after several months off. The down time was due to a lower back injury that has flared up many times over the past few decades, and has now derailed two consecutive tri seasons, so I'm highly motivated to figure out how to avoid another recurrence. Many of the pitfalls you outline in the book regarding poor training practices really resonate with me, so I have some bad habits to undo, and some areas of weakness to address.

As I think about the offseason and next season, I'm tentatively planning to use the Endurance Nation outseason and HIM plans to build up to Wildflower long course and then Vineman HIM next year -- roughly as follows:

8 weeks -- transition phase. Just get back into some (fairly unstructured) training and test the back out. In week 2 of this right now.
20 weeks -- Endurance Nation Outseason plan
12 weeks -- EN HIM plan.
Wildflower long course
10 weeks -- EN HIM plan
Vineman HIM

My back pain is currently a 1 or 2 on a scale of 1-10. It's not completely gone, but it's not inhibiting easy/moderate training at the moment. I'm continuing to see a chiro/ART practitioner, and am also doing lots of stretching and using a foam roller and Stick at home to try to continue to make progress.

My question is regarding integrating a strength training routine into this plan. You mention in your book that you recommend that anyone with a training age of less than one year avoid the MS and PC phases, so I believe that an appropriate strength plan for me would look something like this, but I'd love some input.

remaining 6 weeks of transition: only core-specific circuit from AA phase + Horse Stance Vertical (hopefully back pain is gone by the end of this phase)
20 week OS plan: 8 weeks of AA phase, 12 weeks alternating SM and PPC
12 week HIM plan: 6 weeks of AA, 6 weeks alternating SM and PPC
Wildflower
10 week HIM plan: 4 weeks AA, 6 weeks alternating SM and PPC

Does this sound about right? I'd love to hear your recommendations, particularly as they relate to the next few months as I try to get rid of the back pain and ramp back up to some normal training.

Thank you very much,
-J.Katsoudas

Answer:

Thanks for writing, and I'm glad to hear you're back on the road to recovery. As you focus on your weaknesses and continue to incorporate sound training/recovery practices, you'll find that the back pain becomes a distant memory.

In the meantime, I think your schedule below looks appropriate. I would urge you to think form and pain-free r.o.m. over any other variable. And that includes your swim/bike/run training, too. If you can continue to take two steps forward without taking one step back (typically from being over zealous), you'll have a lifetime of competition and p.r.'s to enjoy.

One area I'd like you to truly focus on is nutrition/lifestyle as introduced in the final section of my book. If you're not thinking, breathing, drinking, eating, and sleeping according to your needs, the training program below won't be as beneficial (both from a performance and an orthopedic standpoint) as it could be. Those foundational factors are the underutilized performance enhancers of any sport, including life.

In your case, I'd specifically consider:
--hydration (with a pinch of celtic sea salt in your glass or stainless steel bottle).
--nutrition. Any food you be intolerant of could easily be inhibiting your abdominal wall secondary to pain/inflammation. Likely suspects are gluten, soy, inappropriate dairy, red wine, or anything you eat (especially protein based) on a daily basis. Medical drugs and stress, too, of course. Additionally, I'd recommend proteolytic enzymes like Bromelain or Papain taken on an empty stomach as a natural anti-inflammatory. Gelatin needs to be in the diet, too. At least 1/3 of your protein needs should be through gelatin/bone broth. And eating to maintain blood sugar stability is critical, as well.
--movement. Make sure you're stretching what needs to be stretched and not what doesn't. And do consistent body work on your own with the stick, foam rolling, Epsom salt/baking soda baths, massage, etc.
--sleep. 10-2 is physical recovery, so don't shortchange this critical aspect of healing.

We could go deeper into all of the principles, but those are the ones which most commonly impact the success or failure of a person's rehab.

Working on the postural endurance of your hip extensor muscles with exercises like the bent over row and prone cobra will be great compliments to your core training/HSVert exercises.

You should also look into home/work place ergonomics to ensure these are not contributing to postural aberrations and the resulting orthopedic dysfunction.

Feel free to write again if you need clarification on any of the above. It's really the tip of the iceberg, but you've got some good info here and in my book to help you on your road to recovery. And there's a wealth of free info on my blog or in my app (Daily Tips for Holistic Health), too. If you ever want to do a more thorough analysis of your diet/lifestyle, I can send you the appropriate forms. Either way, let me know how you're doing--success stories are always good to hear.

Good luck, be patient, and enjoy the process.
In health and happiness
--Andrew