A 43-year-old fixed his back pain to tackle the world's toughest triathlon by eating more protein and doing 5 simple exercises

• A 43-year-old triathlete was sidelined by a hip injury from sitting too much and could barely walk.
• He said working with a physical therapist on hip stretching and strengthening got him back to running.
• Eating more protein also helped fuel his recovery as he prepped for the toughest triathlon in the world.

In the first ten minutes of his run, Pablo Sampaio knew something wasn't right.

The 43-year-old Michigan resident was in his second day of a weekend conference, sitting for about 10 hours each day before hitting the hotel gym to train for an upcoming triathlon.

With just a few months left to get ready, he decided to run multiple days in a row, between conference events, despite his trainer's warning not to.

The first day was fine. The second day, Sampaio felt pain but pushed through to complete the workout. The third day, he could barely walk.

"I knew I messed something up," Sampaio told Business Insider. "I couldn't land on my feet without excruciating pain."

His triathlon was three months away, and it wasn't an ordinary race — the Norseman is considered the toughest triathlon on the planet. To Sampaio, it had been bucket list event ever since he attempted but couldn't finish it in 2014.

"I made a lot of rookie mistakes. It haunted me for a decade," he said.

But he couldn't move without pain, let alone think about tackling the Ironman-style event: a 2.4-mile swim, 112-mile bike and full marathon of running, much of which is uphill (or in this case, up a mountain).

With the help of physical therapists, Sampaio said a consistent program of stretching, simple exercises, and recovery habits helped him offset the damage from a desk job and finally finish his bucket list race injury-free.

Hip flexor stretches help offset the damage from sitting

Long hours at a desk job, combined with lengthy endurance workouts, had twisted Sampaio's pelvis, according to Andrey Simeonovski, a physical therapist who worked with him.

"When he came in, he wasn't able to do anything," Simeonovski told BI. "Because he was training so hard and sitting so long, his hip flexors tightened so much they pulled his pelvis into rotation."

To help stretch the hip flexors, Sampaio did exercises like:

• Modified pigeon pose — Pigeon pose in yoga typically involves having one leg extended along the ground with the other bent at a 90 degree angle in front of your body. An alternate version can be done by elevating the front leg on a box or bench for less pressure.
• Figure-four stretch — Start by lying on the ground face-up, bend one knee toward your chest, and then cross your opposite ankle over the knee. Gently pull your knee closer to your chest to increase the stretch if needed and hold.
• Half-kneeling rock — From a kneeling position, extend one leg out to the side with the foot flat on the ground. Slowly rock backward, stretching the front of your hip, return to the starting position, and repeat.

Sampaio said his PT team also did a lot of manual therapy like soft tissue mobilization, and later had Sampaio use a kettlebell to put pressure on tight spots (like an extra-intense version of foam rolling) which was uncomfortable but effective.

"A lot of it was just trusting the process and trusting the team, " Sampaio said.

Strengthening the glutes can fix lower back pain

Problems with the hips and back are common for people who work a desk job, but fixing muscle imbalances can help.

Simeonovski said that helping Sampaio run without pain involved strengthening his glutes and hip muscles like the extensors with exercises like:

• Glute bridges — Start by lying face-up with both heels on the ground and knees bent at 90 degrees. Push your feet into the ground to lift your hips up. Variations like using one leg at a time or wrapping a resistance band around your hips can make the exercise more challenging and help address imbalances.
• Single leg Romanian deadlifts — Holding a weight like a kettlebell or dumbbell in one hand, lift one leg off the floor straight out behind you, hinging your hips back and keeping your pelvis parallel to the ground as you balance on the working leg until the weight reaches about shin height. Return to the starting position by pushing through the standing leg and bringing your hips forward.

The key to relieving pain and imbalances with glute and hip exercise is performing them slowly with control and perfect form.

"They can be frustrating because they seem very simple. But it's very easy to compensate instead of isolating the proper muscles," Simeonovski said.

Sampaio said progress felt slow, but his patience started to pay off as the race approached.

"It probably wasn't up until two weeks before the race where I did a two-hour run," he said. "It was a huge milestone for me. I wasn't pain free but I thought, I can swing this."

Eating more protein and hydrating is key to recovery

Sampaio said better nutrition and recovery habits also helped him bounce back from injury.

For one thing, he found as a vegan, he was only eating about 50 grams of protein a day — the typical recommended amount of protein is around 140 to 150 grams daily for an athlete of his size.

He noticed a major improvement in how he felt after eating more plant-based protein sources like tofu and lentils and supplementing with protein shakes.

"That changed the game, I felt like I had more energy, I was recovering faster," Sampaio said.

He also drank more water at his doctor's recommendation.

Still, Sampaio wasn't sure if it he was ready to tackle the Norseman, even the morning of the race. It wasn't until he took his first step off the bike and could run pain-free that he felt a sense of hope, and said the triumph and closure as he finished the final mile was one of the best moments of his life.

"To this day I'm still in disbelief," Sampaio said. "There was so much suffering involved, there was a lot of grief, but crossing that finish line was amazing."

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