Jungledoc wrote:Hi! I'm planning my rehab routine. I'm hoping that several of you will give me some input?
At KPj's suggestion I'm intending to include cable pull-throughs, Pallof presses and GHRs. The GHRs I have some doubts about. Seems like they could put some strain on the low back. I guess I'll just try and see.
Be cautious with them. It hits your glutes, hams, and lower back - these muscles are normally trained 'together', quite difficult to train them separately. In fact, I would advise leaving them out for the first week or so and see how everything else goes. The pull throughs will also use your lower back but you have much more control over the load used, instead of jumping straight into bodyweight. Pull throughs give you the chance to really emphasise your glutes, though.
Planks in the past have been limited by shoulder endurance, not by core endurance, especially side planks. They'd be a good exercise to use, though.
As much as all these isometrics will start to sicken you (if they don't already), you might want to give the push up iso hold a shot, get that shoulder endurance up. Start with 3 sets of 25seconds, you can work up to holding yourself just above the ground, sets of 45 seconds, and even elevating your feet. Great exercise for shoulder health and still involves the core a lot. The good thing about isometrics is that they require little maintenance once you become good at them...
I'm thinking of including step-ups and/or lunges (maybe both would be overkill) as squat substitutes. Maybe do some knee extensions and ham curls to try to keep the legs up, or do you think those would be superfluous (please say they're superflous, as I don't like them very much)?
Well, you could call me biased, but i hate them. 2 lunge variations won't be over kill, especially at first. Good lunge form requires good posture, too, so they will 'help the cause' in terms of getting a solid well functioning core (which will protect your lower back). Step ups, step downs, reverse lunges and the 'static' front lunge are good places to start.... Step downs aren't very intense, though. I actually throw them in between exercises in an upper body day so that I can leave my lower body days for intense stuff. Lunges are great for balancing out leg and hip strength and function, which is more reason to do more of them.
I'm thinking about some form of external shoulder rotations.
After 2 or 3 weeks, I want to add in cautious body-weight squats and light DLs, probably once a week. Should I start with variations of these? Front squats? RDLs? Rack pulls? (I'd have to jury-rig a way do do these, as our rack does not have readily-movable hooks!) Others?
I would prefer you started with a restricted ROM in DL's, such as rack pulls. My gym doesn't have moveable pins, but I can elevate myself on an aerobic step which brings the bar to around knee cap height. If I can't do that, I just get 2 steps and sit the bar on them. The beauty of the DL is that even with a restricted ROM you still train the same muscles, as opposed to the squat where, the more you restrict ROM, the more you take the posterior chain out of it...
In my experience with back pain, you can always find a 'pain free' ROM in the DL. If you want to be REALLY cautious, you could add a tempo. I wouldn't actually count, just lift slow, and feel your way through the exercise,completely focusing on form... Personally, when I started DL's, I started with rack pulls from above knees, due to very poor flexibility. I lifted with roughly a 4 second tempo, just to make sure I got it right. I also held lock out for 2-3 seconds, to emphasise the glutes (I had 'glute amnesia').
In terms of volume, I would just take it easy at first - feel it out. As you know, your lower back is involved in everything you do (even breathing, if you breath into your stomach and not your chest). I think you only realise the extent of this when it's injured... The thing is, the lower back has great potential for strength and even training volume that it can cope with, in comparison to other muscles. When your in pain though, nothing seems further from the truth.
In other words, just play it by ear - be cautious. Start with quite low volume. Personally, I would be reluctant to load you up on squats and DL's until you were competent with the isometrics and a few sets of pull throughs didn't have any lasting effects. So, in my opinion, isometrics, pull throughs and Rack pulls would be plenty to start.
If your going to squat, the front squat is another safe bet. The position on the front of the shoulders means you use less weight, so less load on the spine. It also requires decent upper back stability and core strength for the same reason, so another great 'postural' exercise. All you need to do is check your depth - see how far you can go down before your back rounds / hips tuck under your torso. Then, place a box or step just above this point, and then 'touch and go' to the box... Another great thing about this exercise is that bad form normally means 'drop bar'- it's a lot more difficult to screw up than a back squat...