Those of you reading this who have been around this forum a few years may remember that I did not start exercising consistently until I was in my early 50s. 52, to be exact. 2005. I started because I'd had arthroscopic surgery on my right knee, had not done any formal rehab (long story, blame me, not my surgeon, who is friend) and had got stuck on a steep hillside in the high mountains of north-central Papua New Guinea, too weak to take the next step without stopping to rest literally every step or two, thinking my national friends would literally have to carry me up the mountain to the village. I eventually got there under my own power, and as soon as I got back to Kudjip (the place where I live), I went and looked at the little weight room that some of my fellow missionaries here had set up. It had a multi-station lever and pulley machine that looked intriguing. With no more knowledge than faint memories of college PE, I started doing every exercise on the poster that came with the machine. Browsing the internet and watching fellow exercisers in the gym lead me to start trying free weights, eventually abandoning the machine almost entirely. That browsing lead me here, and people like Tim, Ironman, Stu and a handful of others started teaching me. Of course I read other stuff, tried out a lot of different approaches. I had fun, got stronger, got healthier.
Pain, similar to what I'd had in my right knee for a long time gradually started showing up in other places, including my low back. I self-diagnosed the spread of osteoarthritis to my spine. Remember what they say about he who is his own doctor having a fool for a patient? Or maybe it's the other way around. I keep thinking, hoping that if I found the right combination of stretching, activation, good form and good luck, I could exercise the pain away.
About 3 years ago I was in the US, traveling around, speaking in churches and attending meetings, and spent a couple of weeks in the Indianapolis area. Jason Nunn, who was (probably still is, though not active) a member of this forum invited me to come to his gym to work out. What I definitely didn't expect, but what happened is that I got several one on one training sessions with him. Jason has his MS in exercise science, is CSCS, is very smart, very strong and one of the world's nicest guys. Not only did he work with me one on one for those sessions, but he offered to continue helping me with distance training. He took over all of my training programing, which was a huge benefit. You know what they say about he who is his own trainer has a fool for a client? That had been me. I'd read about some exercise that I really should do, I'd try it, wouldn't like it, abandon it and go back to the comfortable and familiar. Under Jason's guidance I gave up back squats (

He would write a 4-workout program, I'd do it, then email him to report how it had gone. I felt that I had some latitude to change things on the fly as needed, but I basically stuck to what he gave me. Then he would email me the next 4 workouts. We'd correspond in between when I had questions.
Finally, about a year ago I started questioning my medical diagnosis. My hips were more and more limited in extension ROM. My theory was that that put my L spine into hyperextension, and made the pain worse. If I could just increase the hop mobility, the back pain would go away. It didn't. About a year ago I was at a medical meeting and talking to a rheumatologist. After I'd asked him some questions, he asked me if I'd taken any x-rays of my back. Embarrassed, I confessed that I hadn't. I just work in a tiny hospital where my office is about 20 steps from the x-ray room, and I can go there any time I want and they'll take any views I want, and no cost to me. But, no, I hadn't.
When I got home from the meeting, I got the x-rays. The moments immediately after I put the first film on the view box were shocking and life-changing. There where the lowest 3 vertebrae and discs should be was a hunk of crap. Severe arthritic changes in the joints, and badly degenerated discs. Honestly, my weight training friends, my first thought was about squats and deadlifts. I nearly cried. Then my friend and co-worker came up behind me, looked over my shoulder and asked, in an incredulous tone of voice, "Is that YOU?" And then started laughing. There I was with my heart breaking, and my friend was laughing at me! It was really what I needed to keep me from taking myself too seriously at that point. The next day I passed the same guy who was standing at the view box with a medical student. I heard him say, "At least it's not as bad as Andy".
So, I wrote to Jason, he complete changed my program. No axial loading with added weight (eventually I would add in light goblet squats). Step-ups, RDLs, etc. Bench, chins, pull-ups, various rows, core stuff.
For a while after I started working with Jason, I would cross-post my reports to him in my log here, but eventually forgot a couple of times, then was so far behind that it was too much work to catch up. There comes a point where who would want to read about months and months of my workouts. Maybe the same people who would read this far into this? I got busier with some other things as well, and had less time to browse the forum, so eventually pretty much dropped out of sight. Then a couple of weeks ago I got curious how y'all were doing, and came to check. So I'm back.
When on home assignment this past year, I saw 2 orthopedic surgeons, a cardiologist, a pain specialist, a family doctor, a dentist and an optometrist. Only the latter 2 did me any noticeable good! :) Well, the last 3. The FP got my paperwork in order for coming back to PNG, and prescribed my meds. I'm glad I saw the others--seeing them represented some steps that I needed to take. I got an MRI scan along the way, which was necessary, if not earth-shakingly revealing.
I had an epidural steroid injection, which felt wonderful for a few hours (they mix the steroid in local anesthetic, so I basically had epidural anesthesia like ladies have in the US for childbirth), but after that wore off and it was time for the steroids to "kick in" no improvement. Doctor said that that should be tried first, though he warned me that the chances of great help were small. Then I had a radio-frequency ablation of the nerves that supply feeling to the facet joints at 3 levels in my L-spine. Nothing. I discovered, accidentally, how much help my anti-inflammatory med is, when I missed it 3 days in a row, then woke up unable to stand up.
In January of this year, we had a rheumatologist volunteer at out hospital. I decided to talk to him about my arthritis, not thinking that there was much he could do about it. In just a few questions, and a couple more x-rays, he gave me a new diagnosis, both troubling and hopeful. He concluded that I met the somewhat complex diagnostic criteria for a condition called spondyloarthritis. This is one of a group of diagnoses that includes the dread ankylosing spondylitis, but is not that. The bad news it that it can get really bad. The good news is that there are a lot of additional potential treatments, including some of the "biologicals" or monoclonal antibody drugs. More bad news it that you shouldn't take those drugs if you live in an area endemic for tuberculosis. I diagnose and treat tuberculosis many times a day, almost every day of my life. Good news is that there are some immune suppressant drugs that you CAN take in such places. Bad news is that they usually work best for the peripheral joints, and not so much for the axial pain. I've started one of those, and if it helps will take it until I retire, or am reassigned to a place that doesn't have TB. Later I'll try a biological, if I can afford it on medicare! :)
One feature of all the AS-related diseases is fatigue. One very discouraging, draining, frustrating feature. I used to be a person who did OK with 5 or 6 hours of sleep a night. Now if I don't get at least 7 I'm in trouble. It is now 11:30 PM, so if I'm to get up by 6 AM, I'll be hurting before the day is out tomorrow. That has presented a huge challenge with taking night call. For one thing, I am very stiff when I first get out of bed, so jumping up to go deal with an emergency is difficult. Plus, I don't sleep very well when I'm on call, so it increases the fatigue for the next few days. Fortunately, my colleagues here have been very understanding in helping to adapt how we handle call so that I can do a fair share, but less of it at night.
Another problem that is part of this is proprioception, and thus balance. Sometime if I just turn suddenly or bump into something, I lose my balance briefly and stagger around. Haven't fallen, but look funny sometimes. Another is urination. Hard to get started, and it isn't my prostate. Finally, posture. I look funny because I tend to lean forward a lot. When I think about it, I can correct it to some extent, but that hurts, so when I'm real tired I just give in and lean. I guess that eventually I'll walk all hunched forward, but I'm trying to postpone that.
Gradually, I've resumed managing my own training. Jason has gotten very busy, and it was getting harder for him to answer my emails quickly. He actually does the figuring for the progression of undulating periodization on a spread sheet which had always been part of what he would email to me each time. With a little instruction from him, I learned to substitute the next progression in the spread sheet and adjust the index weight from time to time, then the proper reps and sets show up on the part that I print out and use as my training record. He's still available to answer questions and give advice.
Right now, my "big" lifts are flat bench, incline DB bench, step-ups (sometimes holding a light weight) and goblet squats (with about 20 pounds). I do chin ups or pull ups every workout now, doing sets to failure, or my favorite sets-across approach. Accessories are things like light shoulder raises (3-dimentions), planks, Pallofs, half-kneeling lifts and chops, band curls or pull-downs, pull-aparts, calf-raises, band walks, plus a mobility-oriented warm-up. Thanks to Jason I know about and have experience with a bunch of other things that I can cycle in from time to time.
I won't give up on training. I've often told my patients, "It's better to be strong and in pain than to be weak and in pain." So I'm sticking with it no matter what. Some days I cut down on some things, mostly on the volume of accessories. I need to lose some weight, which should help everything. I'm obviously less active than I used to be, which makes weight more of an issue.
So that's it. You've had the story the rest of the story and a bunch more. As one of my colleagues here likes to say, "I've already told you more than I know."