Well, this is not a fun post but i'll share because i think it's highly relevant in the context of this blog.
Nani has been everything to me. She's just been incredible since the day I met here as a little pup just weeks old. She's traveled all over with me. The mountains, oceans, lakes, streams, forests, hotels, mansions, you name it. She's been my side kick. She's never had to be in a kennel when I've been away for racing. We've been lucky and grateful to have family and loved ones help care for her and give her what she needs. She really reminds my of myself, quiet when in the house and chilled out. But when outside, she is a ripper. It's almost as though she loves doing intervals as much as me ! She will play fetch until she drops and swim just as much.
She's getting close to 9 years old now, save for a few grey hairs on her chinny-chin-chin, you'd never know it. She's the epitome of a healthy and strong and thriving dog. Always so happy, such a beautiful girl.
SO, here we go. She's been noticeably more sore after her excursions of outdoors, taking just a little bit longer to get up to speed in the morning, and even while out on the trail. Though, full steam ahead, you'd never know once we are out there. Being conscious of it, we try not to let her overdo it.
When I returned from racing, she had been spending the week with my mother in Sedona. She's got a lab as well, and gets to hang out with her all day. As an added bonus she hits the trails and Oak Creek in the evenings to cool things off. When I saw her for the first time in a few weeks, I could see she had some increase in muscle tone along the top of her hips, and a small loss of muscle tone in her thighs ( she's muscle bound, so it's not a lot, but for me I could tell ). Also, when I gave her some loving, she whimpered a bit in what appeared to be pain. ( Takoda, our other dog may whimper too, but his is in excitement ).
The next day, we went out to the trail and water, and again, you'd never know she was in any pain. Jumping off some 8 ft high rock into the water to fetch a ball, swimming back and forth as fast as, if not faster than Lilly Grace and Takoda. When we are done, she slows down like usual and rests up. This time, an hour or so later, she was visibly different, and hindsight tells me in pain.
So, this week we took her to get some imaging done and an evaluation at the Vet. Of course all things go through your mind what could be. I'll save those thoughts and go to what is. As the images show below, she's got some significant degenerative changes in the lowest lumbar segment ( L7 / S1 ) right above her sacrum. When we look at the rest of her body, it looks great. The hips look good, the knees look good, the rest of the spine looks good.
So, here is the relevant aspect of this post to you, the reader, and to what I do and see EVERYDAY.
This is the exact thing that is going on with so many of the active lifestyle and elite athletes out there. Think about it, you're physically fit, you enjoy exercise and do it regularly ( probably one type more-so than others ), you become good at it, maybe even compete in it. Base your day around it, measure your fitness and worth around your ability to do it, and enjoy the places and things you can do while partaking in it.
Ok, now after all that, think of what I get to see and hear everyday someone comes in with a similar scenario. They've been at it for years, or decades, they attribute some of the physical changes, aches and niggles to being part of the training or sport. And, or they have "just started to notice it" in the last 3 weeks, maybe 3 months, well when they really start to think about it, a long time. But again, it hasn't stopped them in their tracks until now.
Then when we evaluate and image what is really taking place, low and behold we have years and years, if not decades of degenerative change that has transpired.
What is the explanation? Well, there is a camp that can let you think that it's "old age". In my camp, I'll have you understand that sure, age is a function of time. However, as we examine the rest of the body, sure enough, all the other parts ( THAT ARE THE SAME AGE ) are well and good in their ability and carry out their functions. So what's that all about?
YEah, you've built an engine far too big for some of the parts that are required for the effort you're asking out of them. Let's take it back to Nani Mana for a moment. Do you think her Lumbar spine all of a sudden just decided to go to shit? That, all of a sudden when she is XX age, it's just what's going to be. Like you'll be had to believe it's genetic. You can't do anything about it? Well perhaps there is a component, but why is the rest of it not worn to pieces ? She's fit as a fiddle, so genetically she probably has genes to be so good, but if we didn't run her and exercise her, we wouldn't know.
Anyway, now back to what I do everyday and want to help teach this community. Apply this to you. Do you see all the injuries and imbalances that we have in our sports? Then why wouldn't you be creating them also? What can you do to minimize that from happening, what can you do to stave off those injuries and prolong your enjoyment of whatever you partake in?
This is what we providers regularly see and try to educate about on a daily basis. I am a firm believer in pre-hab and having providers care for my body along the way. Spreading out that time and money in a fashion that will allow me to be the best at all moments. Because, when you really look at what you want to be doing on that vacation in 6 months or 6 years from now, I can guarantee you it does not include a blown out disc, hip, shoulder, etc. ( those are just the musculoskeletal issues, we could go into a rabbit hole on auto-immune, inflammatory, cardiovascular, endocrine, etc problems. But its all the same, prevent it ).
So in the case of my baby girl, Nani Mana, it appears there was likely a trauma that caused an acute injury in that area. What happens next is good and bad for the body. Because we don't see it bleeding on the outside, we tend not to think about what could be taking place inside. So let's imagine she takes a big jump off a rock, or slips and falls hard, or turns at high speed chasing a ball, she could have some soft tissue damage that takes place. The body will then spasm to lock down the use of this tissue ( be that muscle, tendon, ligament, disc, etc ), but when we keep exercising and moving excessively, it continues to stay in lock down mode. Now, with that lack of motion in the particular segment, everything else has to do more work. With no motion in these lumbo-sacral segments, they begin the degenerative process. If you're not aware, the body needs regular motion through the joints of the spine to load an unload the discs to keep them hydrated and healthy. When hydrated and healthy, they have ample space to allow the spinal nerves to exit the spine to communicate with the rest of the body, back to the brain.
Constant compression to these nerves can lead to function loss and or pain depending upon the degree off pressure and injury to the area. In Nani Mana's case, there was likely pain, but because she is stoic and cannot tell me verbally, she will just begin to deal with it. Sounds similar to anyone you know? YEs, most people chalk up that stiffness and lack of motion in their body to age, and disregard that it could be they are overwhelming those areas of the body with the ability they've built up for an activity/exercise.
When you understand this can be evaluated and managed early, instead of letting things go to the point of where Nani is, why wouldn't one begin implementing measures to help ensure? Well, from what I see, it's a lack of understanding and information for most. It also comes to priorities as well. Try as I might to connect and get these principles across to patients and friends, the reality of application is not so high. We have booked our schedules so tight with everything and anything we can, to get the most out of life. I know, I try too. But to find time to check in with what is happening within, physically, mentally, spiritually is utterly critical before it's too late.
What may be lost in this journey of endurance is that wether you're aware of it or not, you're committing one way or the other. Committing to stay on track towards long term health, or committing on a track to go astray. Imagine the mother who's done the most amazing job in the world raising children while still holding a job, putting everyone else first. Now the kids are out of the house and she's got some extra time and energy that she can focus on herself. She did a desk job sitting for hours a day, nearly two decades. Now she finds love of hiking, running, cycling, or swimming. All repetitive, all forward moving. She loses weight, meets amazing people, feels inspired and loves what she does. Gets the bug enough to do an event. She trains up for it, and a few weeks out she hurts her back, hip, knee, plantar fascia, or any other part you see injured on endurance athletes.
What do you think could be? Maybe just bad genes? Maybe she's getting old? OR, may I suggest that foundation she built her fitness upon, with no guidance on running form, cycling form and position, or poor swim stroke eventually became so imbalanced that it was pulling itself apart from the inside.
Why would I say this? Because this is what we see so often. I'd like to help people understand they should be aware that even though we can be extremely happy for this individual because feels more self confident, likely more healthy metabolically ( another rabbit-hole we can go down ), maybe inspiring a spouse or loved ones, we do want to be aware that one can benefit from being evaluated and implementing some of the things we do for our patients.
Now that i've just spit out something on my mind that has been waiting to get out, realize that this is very vague in it's instructions and overall guidance. No, I cannot just give out info on what and when to do things. Each individual has a unique set of circumstances, experiences, and goals. What I can say is that the therapies and providers that have tools and information to help people on track, instead of letting them fail and take a reactive approach, should really be the way we care for our communities.