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Anybody doing triathlon after a chronic back injury?
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Hi everyone
I am 38 and I have always loved triathlon. I used to play waterpolo like 20 years ago. Then I had my first problem with my low back because of too much training. Disc protusion. After 2-3 years struggling and a knee injury I started to do running for 3-4 years and swimming ocassionally... then some bike, some run, basketball, just fun... Then, 5 years ago, I noticed a pain at the middle of my low back-sacrum that was increasing month after month. I have tried everything and I am trying to find a solution, I am sure I will be freed from this s**** at once.
Many doctors advice to avoid running (I just swim backstroke and so some fast walking) but if I am lucky to recover I´d love to go in triathlon. Is there anybody that has gone trough a back injury and has been able to train and compete?? I am talking about a taking it easy thing---- 5/6h week training, no more

Cheers

Spaniard. Sorry for my english for the sensitive ones :P
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Yes. Bulged discs, degenerative disc disease, sciatica. Heck, I even have some scoliosis and kyphosis congenitally. The long and short of it is that these were all worsened by having extra weight in my belly. Started swimming, then jogging, then really running and lost weight (30lbs) to the point where my back wouldn't get sore. Weight off the front of your torso pulls your spine more out of whack—Less weight and a stronger core keep things in check. Once I started doing the full s/b/r thing, I've lost another 25lbs. I can still hurt my back, like pull something and have a spasm--but it takes doing something stupid.

So, if weight is your problem...start slow and try to take it off.

Equipment-wise, I chose a bike with a fairly high stack which seemed to work well with the above and I doubt I'll ever get long and low. I am 5'11" with a 31" inseam. A large-framed Shiv keeps things pretty happy.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Yep, herniated l5 and a couple bulged discs.

I didn't go straight into triathlon though, i swam for about 5 years then got back into cycling. I'd never run in my life and was worried about my back when i started but it was fine. Now training 10-15 hours a week and competing at a decent level for someone who was downing painkillers everyday for a year.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Yes. Ruptured l5 in 2006. Not always a picnic bit I feel best now since 2006!

24 Hour World TT Champs-American record holder
Fat Bike Worlds - Race Director
Insta: chris.s.apex
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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I've worked with quite a few people with a variety of chronic back problems. It takes a long term commitment and lots of patience.

The most important step is confirming a specific diagnosis. Without that, you can't know what sort of movement patterns and alignment bias are indicated and contraindicated. With the wrong diagnosis, or proceeding based on the wrong assumption, it's possible to do the exact opposite of what will help. (Some issues require you maintain a pelvic and spinal extension bias while others a flexion bias.)

Then work with a good physical therapist and trainer who are both knowledgeable in spinal issues and understand your athletic goals and the demands of triathlon. They will strengthen the supporting muscles and simultaneously train for optimal hip complex and thoracic spine function.

Depending on your diagnosis, you may also have to modify your bike fit and swim technique from what you've done in the past to maintain the right pelvic and spinal bias for your condition.

After the pain has been drastically reduced, or eliminated, you can resume s/b/r progression, but take a conservative approach, limiting progression to less than the 10% guideline. At any signs of symptoms recurring, back off, and give your body more time to adapt.

____________________________________________
Don Larkin
Reach For More
http://www.reachformore.fit/
USAT Lvl1 Coach, NSCA-CPT, NASM-CPT, BS Exercise Science
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Re: Anybody doing triathlon after a chronic back injury? [TriMyBest] [ In reply to ]
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hi, thanks for the replies. I am 6,12feet and 178lb, no belly...but hyperlordotic, and bulged disc in l5s1. I have taking painkillers for almost a year...
I have been told about Dr. mc gill's theraphy.... also about doing Pilates, hilauronic acid injections, ozonetherapy... I'll visit my doctor the next week and a rehab doctor and i ll see what they think....
see how it goes.crossing fingers

Spaniard. Sorry for my english for the sensitive ones :P
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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I think Don has a really good answer here. I'm suffering from some chronic low back pain (muscular, it seems), and haven't made it back yet to racing. And it sucks, so I feel you.

I don't know about the other therapies and how they'll help--and frankly I'm pretty skeptical of the last two (this is chronic, and it's not clear either of those are long-lasting or corrective). Dr. McGill's approach I've read about in passing, and don't have an opinion on.

Surely, this isn't your first trip to the Dr. for this? It may take a good long time to strengthen, adapt, or simply work around whatever problems you have. G'luck -J

----------------------------------------------------------------
Life is tough. But it's tougher when you're stupid. -John Wayne
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Have had back problems in the past that were addressed by maintaining good core strength. This past winter I hurt my back -- bulging disc (pain in glute/lower back, a lot of nerve pain down the leg to ankle, lack of mobility and muscle activation) -- doing reno on the house, and had to push through it for a while before I was able to rest it.

Was able to get help from a good PT (specialized in spine as well as running issues, so understood that being able to run/bike was important), and have trained plenty/done some races this summer.

I don't know how applicable my experience would be to yours (my most acute symptoms resolved with rest, and the PT was able to focus on mobility and activation/strength to begin resolving the rest of the symptoms and get me moving again). But, something PT stressed was that when I was starting to run/ride again I shouldn't do *anything* to exhaustion (of the core). I.e., he was fine with my running 10m every day, but didn't want me doing much on any single day.


I'd try to get a good PT (get someone who can identify the current problem), and also consider that just exercising fewer hours a week may not reduce the stress/problem.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Read the book by John Sarno. Lot's of time it's mental after your back has healed. I had a herniated disc L5-S1 from a motocross crash and major sciatica pain down my left leg and while it healed in my case without surgery, it took a while to get over the mental part - "Oh I can't lift that my back will go out", " I can only ride my road bike, the aero aggravates my back", etc. Some of this was caused by another doctor who told me at the age of 40 I would never do another triathlon again, that my back looked like a 70 year old person. Needless to say I'll be 58 this year and I'm still racing and my back is fine. There is no reason to believe your back, is the only thing in your body that never heals.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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I'm 50 years old and have a chronic l4-5 herniation from when I was teenager. I see my awesome chiropractor every other week, do lots of core strengthening and stretching, some yoga etc. I have done 13 ims and over 30 stand alone marathons (including 20 Bostons)....I've had some flare ups, but generally I feel great! I just takes a lot of patience, consistency, knowledgeable professionals, and finding the right amount of training for you. Don't give up! You can def race and train at a pretty high level if you are willing to put in the time it takes to stay healthy:) Good luck!
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Had a herniated disk in 2006, having had quite a few lower back and hip issues prior to that without really getting them properly sorted. The 2006 injury made me get proper help and I found a PT who specialised in rehab for athletes. Over a period of months she got me first swimming, then cycling, then running again. Working with her also equipped me with exercises and routines to strengthen supporting muscles to help prevent injury, and also the knowledge to spot when I had an alignment or other problem and get it addressed before it got worse.

I actually ended up stronger and fitter than I was before. Particularly with running, where improved alignment and form enabled me to do higher volume than previously. I did a second IM in 2008 and knocked an hour off my time.

Every injury is different but there's definitely hope! The key in my view is finding a PT or other specialist who is used to working with athletes. I think so many back injuries are caused by sedentary lifestyles and obesity that many back specialists are just more familiar with that kind of patient and how to treat them.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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I would like to thank all of you for sharing your experiences and advices. It´s being a tough period, mainly the last 2 years, when pain has been increasing. Nowadays, I think I am experiencing some light sciatica too, so, next week, when visiting the Dr., I will mention it. Last week I was into a MRI and Xrays and will get the results this friday. I don´t think the disc bulg in L5S1 will have changed significantly...
It´s been 5 years since the pain started, and I cannot go with painkillers anymore, so I´ll try to be positive, find the right person for treatment and if possible, do some triathlon, or at least live free of pain.
Thanks again

Spaniard. Sorry for my english for the sensitive ones :P
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Re: Anybody doing triathlon after a chronic back injury? [cartsman] [ In reply to ]
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I'm currently recovering from a pretty bad disc protrusion with sciatica, hoping to avoid surgery...obviously taking a break from running, but how did you guys do with biking? I'm still swimming but wanted to try and get on the trainer and maintain some fitness.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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I had compression fractures of T4-6 back when I was 14 (22 now). I was out of everything for about 6 months and haven't had any issues since (been doing triathlon since I was 16). I was "lucky" in that everything was supported by my ribs so I never had to wear a brace or anything. But to this day I haven't any problems being on a TT bike, running or anything else.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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severe back pain with bulging L5S1 in 2002, added sciatica in 2006. Guessing 50-60 tris since then including Nationals etc.
Both pains are still there, both managed with PT-prescribed exercises, plus yoga and pilates in times of dire need.
My father had back pain for over forty years, managed with exercises and swimming.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Figured I would share as well. 39 Year old male and back pain started a few years previously. The back pain was very tolerable but the sciatica pain was not. Explored everything - epidural shots, PT, stretching, strength training + multiple doctors. Ultimately decided it was not going to get better on its own and chose to have the L5S1 replaced with an artificial disc (ActivL). I chose this over fusion in the hopes of maintaining other segments as the rest of my spine is in very good condition. I am currently 16 weeks post op and I have been able to start training again. I am currently swimming around 12k, riding for around 2-3 hours at a time with conservative running 12-15 miles a week. The process has not been easy and I have been listening to my body and backing off and slowing down when needed. Everyone's body is different but keeping a strong presence with core and strength is essential in my opinion. I love training and racing but have a pain free life is much more important.
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Re: Anybody doing triathlon after a chronic back injury? [independent] [ In reply to ]
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I may be an outlier, but...

2 back surgeries, L4/5, L5/S1 (1999/2003)

Subsequent Kona qualifier x4, 2010,2012,2016.2017
Last edited by: triFP: Sep 21, 17 16:11
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Re: Anybody doing triathlon after a chronic back injury? [triFP] [ In reply to ]
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Finally got the results: centered herniated L5S1disc . some facet joint arthrosis. i ll see what the doctor advices... hope no surgery but i must stop taking pills for this f**** pain

Spaniard. Sorry for my english for the sensitive ones :P
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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juanillo wrote:
Finally got the results: centered herniated L5S1disc . some facet joint arthrosis. i ll see what the doctor advices... hope no surgery but i must stop taking pills for this f**** pain


Honestly (and I don't mean to sound sarcastic), This doesn't mean much. You are 38. If you did an MRI on all of slow twitchers who are 35-55 most would have these findings, some would have back pain, a lot wouldn't. Highly advise against surgery and injections. Stay active. There's a great book called "Why do I hurt" by Adrienne Louw, PhD,PT. Explains a ton about the neurobiology of pain for the layperson. There is really good research going on in this area due to the back pain epidemic, not to mention the opioid addiction problem we have.

The book will explain how chronic pain works.

CB
Physical Therapist/Endurance Coach
http://www.cadencept.net
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Re: Anybody doing triathlon after a chronic back injury? [PTinAZ] [ In reply to ]
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100% concur. I’m also willing to guess your pain is not chronic, but episodic in nature- coming and going more frequently than you want. Being active will control your pain far better than medical intervention.
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Re: Anybody doing triathlon after a chronic back injury? [Calvinbal6] [ In reply to ]
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No no, my pain is chronic, it's gotten worse in the last 2 years. The report that comes with the images reads that the herniated part affects the nerves surrounding, so ,yes, I d like to think that it is not just physical, but I am also aching light pain in my left leg....
Of course, I will tell the Dr. that no more painkillers...so, if he advices specific core exercise, etc, i ll go for it. If aint enough...I'll try with a second opinion...I am not the kindda who likes going for the knife easily

Spaniard. Sorry for my english for the sensitive ones :P
Last edited by: juanillo: Sep 23, 17 0:41
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Look up McKenzie credentialed physical therapists in your area. You need a mechanical exam of your spine and then specific exercises to centralize pain out of your leg, to your back and eventually abolish its existence. Core exercises will not help. The longer the pain has been around the more work it will be, but reduction is possible. Good luck.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Few threads on this I have posted my quick story on all of them.......2012 I herniated L5 and got a locked faucet joint on L4. Spent 2 months sleeping on the floor and laying on the office floor between my patients (I am a dentist), the pain would shot from my lower back all the way down to my big left toe. Took lots of naproxen just to get through the day. Did PT about 3 x per month at that point and there was no working out, it was hard to even take the dog for a walk. Months 3-4 I was able to do some core work (followed routines in "pilates for the outdoor athlete") and I could do some light swimming, i stopped doing PT as what they where doing i was able to do at home. I was trying not to eat to much since i really could not do much. Months 5-6, was able to surf some but had to be very careful, did my core work 15-25 min every morning and 15-30 min every night, still could not run and could not bike. Months 6-8 pain would only go into butt and no longer shot down to my toe, was able to run 1-2 miles swim, surf, and continued doing the core work. Months 9-10 I CAN RUN! Ran a 5 mile thanksgiving race (not fast).........Just kept doing the core work and slowly kept building on other stuff. In 2014 i did my first IM. By 2015 I finally did not have any consistent form of pain but was still cautious, second IM done at KQ. By 2016 I stopped worrying about it and only got minor flares ups. 2017 only 1 flare up and another KQ. I credit the consistent core work to my current recovery. I still have to be careful but it seems to be in the rear view mirror. I have had many patients with lower back injury's its one of the most debilitating and some don't seem to be helped long term by surgery. Good luck its a long road as you know.

2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz
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Re: Anybody doing triathlon after a chronic back injury? [PTinAZ] [ In reply to ]
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PTinAZ wrote:
juanillo wrote:
Finally got the results: centered herniated L5S1disc . some facet joint arthrosis. i ll see what the doctor advices... hope no surgery but i must stop taking pills for this f**** pain



Honestly (and I don't mean to sound sarcastic), This doesn't mean much. You are 38. If you did an MRI on all of slow twitchers who are 35-55 most would have these findings, some would have back pain, a lot wouldn't. Highly advise against surgery and injections. Stay active. There's a great book called "Why do I hurt" by Adrienne Louw, PhD,PT. Explains a ton about the neurobiology of pain for the layperson. There is really good research going on in this area due to the back pain epidemic, not to mention the opioid addiction problem we have.

The book will explain how chronic pain works.

I've seen some good TED talks on chronic pain and how most of it is just in our heads. Doesn't make it feel any less real, but makes it hard to treat.
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Re: Anybody doing triathlon after a chronic back injury? [Calvinbal6] [ In reply to ]
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Calvinbal6 wrote:
Look up McKenzie credentialed physical therapists in your area. You need a mechanical exam of your spine and then specific exercises to centralize pain out of your leg, to your back and eventually abolish its existence. Core exercises will not help. The longer the pain has been around the more work it will be, but reduction is possible. Good luck.
Thank you Calvinbal. I have heard and read trough a small bit about this treatment...might be a good option. I am just wondering what my Doc will advise...anyhow I think there is not a single approach to heal. McKenzie's may work, McGill's, pilates, injections... I'll try the softest things first and if not working i will have to go with injections or surgery if it is necessary. But, I am stubborn, very hard working, and I ll be able to do some tris in the future. Crossing fingers.

Spaniard. Sorry for my english for the sensitive ones :P
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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juanillo wrote:
Calvinbal6 wrote:
Look up McKenzie credentialed physical therapists in your area. You need a mechanical exam of your spine and then specific exercises to centralize pain out of your leg, to your back and eventually abolish its existence. Core exercises will not help. The longer the pain has been around the more work it will be, but reduction is possible. Good luck.

Thank you Calvinbal. I have heard and read trough a small bit about this treatment...might be a good option. I am just wondering what my Doc will advise...anyhow I think there is not a single approach to heal. McKenzie's may work, McGill's, pilates, injections... I'll try the softest things first and if not working i will have to go with injections or surgery if it is necessary. But, I am stubborn, very hard working, and I ll be able to do some tris in the future. Crossing fingers.

That's somewhat part of the problem. There are a lot of so called "cures" for back pain that are not really effective. Yet folks spend a ton of time and money doing them hoping one will stick. There is clinical evidence showing a lot of these approaches really DON'T work.

Agree that you need a good spinal exam and those are tough to find. Stay active, find a PT who is reputable with the spine. Don't spend hundreds of $$ on passive type treatments (manipulations, injections, pills and other modalities)

You'll be able to compete again.

CB
Physical Therapist/Endurance Coach
http://www.cadencept.net
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Technically not an injury, but I picked up triathlon 3 years after a spinal fusion (T2-T12, so pretty much entire upper back) and am 'seriously' doing it last year, 6 years post-op. For me 'seriously' is around 14 hrs moving time/week

Backs are delicate of course, and the main thing is that it takes time to figure out what works for you... mileage levels, pre-hab, core, doctors, etc.

For me the biggest thing was gradually getting into the sport and increasing my training load, and of course running is the finest game of give-and-take. I have found that being strong on the swim, getting core done, and some massage work (on top of gradual increases in mileage) is MY personal ticket to staying mostly injury free. I still have to be very careful because my body just can't move the way it was designed to. My back causes tightness in the hips, which causes tightness in my left leg. I have found ONE chiro/PA who used to be a triathlete who has been able to fix the problem and prescribe pre-hab exercises, and for that same leg issue I saw 5-6 other doctors, but this particular one did the trick! So just keep on trying till you figure out what works for you.
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Re: Anybody doing triathlon after a chronic back injury? [fate] [ In reply to ]
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I started this thread one year ago...and I should have re-name it as the nightmare of the chronic back pain...
During the last year I have had up and downs... After almost 5 years, I was pain free for 3-4 months, even pushing on my swim, but after carrying some furniture at home, the pain has come back...
Since Sep 17 I have gone through epidural injections, facet joint blocks (twice) and pills , of course (gabapenthine worked for some time), but now these pills are not working, and I having the classic painkillers...
I said a nightmare because I think I do everything I gotta do: I swim 4-5 days a week (backstroke and freestyle, more backst. indeed), core work, stretching, good pace walking for 1h..but I am sitting down the whole day at work...and I think that kills me. I went to a therapist, I talked to him about the Mc Kenzie approach and told me that did not work for me and he kind of concluded that my pain is not related to my injury (i.o.w., my back does not look bad in the images), but the nerves are irritated and send a sign of pain every time I push too much or I make a bad movement. But he did not touch me at all, just a little, in the first 2 sessions...then just speaking. As I realized I was not going forward I decided to give up and then, following some of his advices, I started to feel better...
I guess, after hearing some physios, that I have my nerves surrounding the painful area damaged(centered, L5-S1 level, not pain in my muscles, no sciatica) or the disc is dehydratated,or the inner nerves ends damaged, or whatever... but I just hear some doctors telling me to go for the vertebrae fussion and the physios day "no way, it will be worse, you are too young and the upper discs will get spoiled in the medium term really fast"...so, now, using pills, same routines and expecting some miracle or learning to deal with pain and to not expect it to leave me for a while at least....
I know that sometimes, just the pain itself is the problem, so, a neurological approach may help, dunno what to think....

Spaniard. Sorry for my english for the sensitive ones :P
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Sorry for your frustration...I went through a similar thing a few years ago. The disc protrusion ultimately hobbled as I tried to "come back" time and time again.

After a few years of frustration I lost the ability to walk and had a laminectomy/discectomy -- which was successful. While I am pain free, I haven't been able to find the same power - and had to dramatically reduce the amount of training altogether. The trade off is being pain free.

The ultimate lesson for me was that after spending much of your life training at a high level, it takes some time to learn to be satisfied with a good level of fitness. The goal changes. As opposed to trying to maximize performance you must find the benefit for your overall life/longevity. It's just a different game.

In any event, my suggestion would be to make the back your top priority. That could mean changing your overall approach to training and finding ways of gaining fitness in a manner where you are not always inflamed.

Good luck in your recovery...be patient with yourself and try to maintain a positive outlook!
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Yes multiple bulged and a ruptured disc, i train up to 15 hours a week in heavier periods just fine. But it’s taken years to get to this point, the rupture wrecked me for a year where i pretty much did swimming only.

Just seen the update, for the chronic pain the best thing i did was go on an antidepressant, made a massive difference.
Last edited by: TriguyBlue: Oct 29, 18 6:50
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Re: Anybody doing triathlon after a chronic back injury? [TriguyBlue] [ In reply to ]
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TriguyBlue wrote:
Yes multiple bulged and a ruptured disc, i train up to 15 hours a week in heavier periods just fine. But it’s taken years to get to this point, the rupture wrecked me for a year where i pretty much did swimming only.

Just seen the update, for the chronic pain the best thing i did was go on an antidepressant, made a massive difference.

I am taking antidepressants for other reason...and aint enought..
I just want to live with no pain...if I cannot run, I can swim, but I will not risk my back for practising sports. Of course, I dream of doing whatever I like without thinking of ...might it be bad for me?? will I have pain afterwards?? I cannot live without practising any physical activity...I always dreamt of training hard but my body is just...a piece of shit :D

I will keep on doing what my body allows, if I cannot run, I´ll walk, if not, I´ll drag :D
Thank you for your posts

Spaniard. Sorry for my english for the sensitive ones :P
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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I had dealt with chronic back pain for about 15 years when I was strictly a runner. Sometimes the flareups were so debilitating I could barely walk. I went to chiropractors but the relief was mostly short term. I would do hip raises that helped the most.

Incredibly getting into triathlons about 7 years ago has helped my back the most. I think it was the swimming that helped. Also, I bike much much more now and hardly run. I think the pounding was giving me the most problems. I haven't had a bad flareup in many years now. Knock on wood.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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You’ve experienced the traditional medical model for lower back pain and it’s obviously awful. There is no reason you can’t return to full health and functioning without meds in a reasonably short period of time. It should be noted that I’m a PT with an orthopedic and spine specialty focus.

First, consider that back pain is episodic in nature and virtually everyone will experience it at some point in their lives. If you remain active, without aggravating it, back pain is typically self limiting and will resolve.

Second, consider that we don’t know what structure in your back is causing the pain. Half of all people over 45 have disc pathology and everyone over 70 has it. Also, we all begin to show degenerative changes (arthritis)of the spine from 20. All this means is that our spine ages. Changes from aging don’t hurt. An MRI can rule out cancer or other nasty things, but is generally unhelpful in uncomplicated LBP.

Third, you went to a bad PT. It’s good you got out, but you should have found another who could reasonably talk to you about the McKenzie approach. This is a method to evaluate and treat LBP, irrespective of pain causing structure. This is NOT a set of exercises to perform, rather it identifies a mechanical preference for treating the spine- a direction to bend or move regularly that will reduce and abolish your pain.

Fourth, on your own you’ve tried a mishmash of things that have taken you through various positions. You likely haven’t found the right one in the right way for the right amount of time.

Back pain is mechanical in nature and research shows that meds, imaging, injections provide little relief. Individuals who treat according anatomical structures from MRI will generally not help unless they’ve found the needle in the haystack. Note that research does not support this approach. More than half of all fusions end in poor outcomes for the patient. Rolling, dry needling and core strength are not supported in the literature as a way to treat acute onset LBP. Research supports being active and avoiding bed rest is good treatment.

Find a good PT who is skilled and credentialed (certified or diplomat) in the McKenzie approach and get a mechanical evaluation. They will look at how you move and find your directional preference. Do the exercises and stay active. Seek physician advice for prescription management.
Last edited by: AndrewL: Oct 29, 18 10:17
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Re: Anybody doing triathlon after a chronic back injury? [AndrewL] [ In reply to ]
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AndrewL wrote:
You’ve experienced the traditional medical model for lower back pain and it’s obviously awful. There is no reason you can’t return to full health and functioning without meds in a reasonably short period of time. It should be noted that I’m a PT with an orthopedic and spine specialty focus.

First, consider that back pain is episodic in nature and virtually everyone will experience it at some point in their lives. If you remain active, without aggravating it, back pain is typically self limiting and will resolve.

Second, consider that we don’t know what structure in your back is causing the pain. Half of all people over 45 have disc pathology and everyone over 70 has it. Also, we all begin to show degenerative changes (arthritis)of the spine from 20. All this means is that our spine ages. Changes from aging don’t hurt. An MRI can rule out cancer or other nasty things, but is generally unhelpful in uncomplicated LBP.

Third, you went to a bad PT. It’s good you got out, but you should have found another who could reasonably talk to you about the McKenzie approach. This is a method to evaluate and treat LBP, irrespective of pain causing structure. This is NOT a set of exercises to perform, rather it identifies a mechanical preference for treating the spine- a direction to bend or move regularly that will reduce and abolish your pain.

Fourth, on your own you’ve tried a mishmash of things that have taken you through various positions. You likely haven’t found the right one in the right way for the right amount of time.

Back pain is mechanical in nature and research shows that meds, imaging, injections provide little relief. Individuals who treat according anatomical structures from MRI will generally not help unless they’ve found the needle in the haystack. Note that research does not support this approach. More than half of all fusions end in poor outcomes for the patient. Rolling, dry needling and core strength are not supported in the literature as a way to treat acute onset LBP. Research supports being active and avoiding bed rest is good treatment.

Find a good PT who is skilled and credentialed (certified or diplomat) in the McKenzie approach and get a mechanical evaluation. They will look at how you move and find your directional preference. Do the exercises and stay active. Seek physician advice for prescription management.

Thank you so much for the advice... I'll try to find one that can help me and sort this out...even little by little
Cheers

Spaniard. Sorry for my english for the sensitive ones :P
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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I have had 2 back surgeries due to herniated disc, one was emergent in 2016. I am still doing triathlon of all distances . Find a good PT and stick with the exercises. Listen to your body and alter training if needed. I do a lot of treadmill running and spend a lot of time in the pool but it is worth it to be able to continue triathlon.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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A lot of good stuff has been said here already. I had a torn ACL (and got it replaced) at age 40. 5 years later, I herniated a disc. Guess which phys therapy took longer?
The back!
Also, a lot of injuries are inter-related. Do you have issues with your Achilles as well? Calf pain? IT band?
In addition to the back, I had chronic Achilles issues. Finally found a personal trainer who diagnosed that my glutes weren't firing so the Achilles was taking all the torsion and force.
She got be back well enough to place 8th in the AG at ITU World's at age 50. And my Achilles and back issues are mostly gone.

Some other ideas:

- Don't sit at work, try to get a standing desk. Sitting is "the new cancer" as many have said
- Have you tried focusing on stretching the Psoas? The front hip flexor area as well as the lower back?
- Find a great massage therapist and go often
- Find a personal trainer who has a holistic approach
- Try to stop the pain meds
- Get a hot tub and use it!
- Massage your feet frequently (check out the Melt Method)
- The McKenzie extension (aka, "Cobra") is your friend
- Consider a firmer bed; Tempurpedics are awesome
- Don't sleep on your belly; sleep on your side

Good luck.
Last edited by: twain: Oct 29, 18 18:46
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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juanillo wrote:
hi, thanks for the replies. I am 6,12feet and 178lb, no belly...but hyperlordotic, and bulged disc in l5s1. I have taking painkillers for almost a year...
I have been told about Dr. mc gill's theraphy.... also about doing Pilates, hilauronic acid injections, ozonetherapy... I'll visit my doctor the next week and a rehab doctor and i ll see what they think....
see how it goes.crossing fingers

I was pretty much a wreck after a career of high energy sports. Triathlon just illustrated how dysfunctional I had become. Still working through it 24/7 !

Cycling (quads) and swimming (lordosis) is a problem for the back. Running is actually pretty balanced if you do it right.

To fix my back I ended up at the physio. The physio said my problem muscles (like nearly every one:) were too deep and too knackered. So they stabbed me with needles every few weeks for 2 years. I figured I took over 200 needles head to toe. It's called Intra-musclar Stimulation or IMS therapy. Except for feeling like a pin cushion, it worked great!

IMS loosens the muscles that have turned to "rope" (vs rubber). Gave me the opportunity to restore my spine curvature = what a relief. However, unfortunately I have nerve damage from an zoster virus attack down my left leg. Nothing too terrible, it's taking a long time to get rid of or fix that.

Since the summer, I am working in the gym for performance gain and to re-balance through targeted work-outs. Another discovery is the hyperice hypersphere or roller which gives a good deep tissue massage. This vibration therapy goes much deeper than rolling alone.

So in summary -1. Fix/relax the root cause through IMS 2. Get a good PT to ID your imbalances and target corrective training 3. Use the vibrating ball or roller to recover/activate the body (again I work this head to toe for me),

Any questions feel free to fire away.

Training Tweets: https://twitter.com/Jagersport_com
FM Sports: http://fluidmotionsports.com
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Sitting all day at work is killer....possible anterior pelvic tilt, bulging disk and facet problems complicated by aero bike position. I've had all. In my case after injections, dry kneeling, chiropractors etc, my problems helped with working on anterior pelvic tilt, short hip flexors by daily maintenance from things I found on internet sites like mobilitywod, upright health.....sitting puts your glutes to sleep too so hip health important. Body alignment important too and pete ecosgue is good for that. Rounding back bad, hinge at hip...make have to retrain all muscle imbalances. Back pain causes compensations which may not be helpful long term. I am no doctor but some pains are likely muscle trigger points and not necessarily spinal issues. Research trigger points. Don't give up but take it slowly. Find a good PT and if lucky a good massage therapist that can give you cues. My massage guy also recommends eldoa (guy foyer) method. Good luck.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Hey, another n=1 story...

I'm 51 and pain free, active at 6'2, 200#. In 2001 I had a ruptured disc. Insurance dictated treatment in increasing order of cost...so I cycled thru rest, injections, pain pills, acupuncture, PT, chiro, more pills over 9 months.

At the end of all this, I couldn't move and really wanted more pills. Fantastic. Got the MRI and L4 hemilaminectomy; now I play the game with 40% of L4. Instant relief, have not looked back. Lots of tris and mary's in the books since. No real decrease in performance other than from aging.

Advice? Get to the root cause as quickly as possible and make an informed decision about actions to take. The helpless, pain period you're in now is more damaging than you might imagine...mentally, physically, life, work, relationships. It can be devilitating.

And if you're still looking for pain management ideas. For me, acupuncture was easily the most effective. FWIW.

Good luck.



------------------

- I do all my own stunts
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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juanillo wrote:
Hi everyone
I am 38 and I have always loved triathlon. I used to play waterpolo like 20 years ago. Then I had my first problem with my low back because of too much training. .....

Cheers
Was in a cycling accident and among other things had some back fractures. There are things that I try to avoid... can't do long periods in aero and 50+ mile rides are going to need ibuprofen afterwards. Breast stroke is a no go zone for me. What I'm running on makes a lot of difference... more track and grass runs for me post injury.

It's somewhat of a limiter for me but I'm learning what works and what doesn't.
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Re: Anybody doing triathlon after a chronic back injury? [AndrewL] [ In reply to ]
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AndrewL wrote:
You’ve experienced the traditional medical model for lower back pain and it’s obviously awful. There is no reason you can’t return to full health and functioning without meds in a reasonably short period of time. It should be noted that I’m a PT with an orthopedic and spine specialty focus.

First, consider that back pain is episodic in nature and virtually everyone will experience it at some point in their lives. If you remain active, without aggravating it, back pain is typically self limiting and will resolve.

Second, consider that we don’t know what structure in your back is causing the pain. Half of all people over 45 have disc pathology and everyone over 70 has it. Also, we all begin to show degenerative changes (arthritis)of the spine from 20. All this means is that our spine ages. Changes from aging don’t hurt. An MRI can rule out cancer or other nasty things, but is generally unhelpful in uncomplicated LBP.

Third, you went to a bad PT. It’s good you got out, but you should have found another who could reasonably talk to you about the McKenzie approach. This is a method to evaluate and treat LBP, irrespective of pain causing structure. This is NOT a set of exercises to perform, rather it identifies a mechanical preference for treating the spine- a direction to bend or move regularly that will reduce and abolish your pain.

Fourth, on your own you’ve tried a mishmash of things that have taken you through various positions. You likely haven’t found the right one in the right way for the right amount of time.

Back pain is mechanical in nature and research shows that meds, imaging, injections provide little relief. Individuals who treat according anatomical structures from MRI will generally not help unless they’ve found the needle in the haystack. Note that research does not support this approach. More than half of all fusions end in poor outcomes for the patient. Rolling, dry needling and core strength are not supported in the literature as a way to treat acute onset LBP. Research supports being active and avoiding bed rest is good treatment.

Find a good PT who is skilled and credentialed (certified or diplomat) in the McKenzie approach and get a mechanical evaluation. They will look at how you move and find your directional preference. Do the exercises and stay active. Seek physician advice for prescription management.

Generally a very good post. I want to adress this part that I've bolded.

Some back pain is mechanical in nature. Not all. Some back pain is neuropathic in nature. Some back pain is nociplastic in nature. If you've had mechanical (nociceptive) back pain for quite a while, you can be certain that there is nociplastic changes that will increase the likelyhood of additional pain flares. The more nociplastic the patient is the less success will ANY approach that aims towards the periphery (spinal structures in this case) will be.

I second that one needs a proper examination from a physical therapist that knows this modern pain neuroscience and can act as a guide through the very murky treatments that OP is being continously offered.

Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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  I don't have any suggestions, this is just a rant and commiseration. I've had cervical stiffness, thoracic stiffness + pain, and lumbar stiffness + pain for 4+ years now at my current age of 42. Not much is helping, but I'm doing everything I'm told to and am not sure what else to throw at this. The myospasms in the back+ traps are the worst part, and they come right back even if I get a deep-tissue massage or nail it hard with a therapy ball. The PT helps warm me up and temporarily helps the pain, but it doesn't seem to be helping long-term.

The worst part of this is the emotional aspect. It's fairly easy to catastrophize and picture onesself fused, crippled, in a wheelchair, an opioid addict, a grumpy old man, and so forth. Some days I think about the discomfort all day long and end up kind of exhausted after work (eeesh.) This is especially bad on days that start at really early mornings, which the pain and stiffness can cause.

-Lumbar has stopped aching all day after I stopped running last month. MRI showed both L4-L5 and L5-S1 partial disc collapse + mild facet arthrosis + mild to moderate left foraminal stenosis. I hate leaving the running but I want to be able to walk/hike with my kids and be a normal, fun dad.

-Thoracic still bothers me. I had a T5-T9 bilateral rhizotomy in January and got some relief for about a week or two (sheesh). MRI only showed a giant Schmorls node (50% collapse) of T11 superior and nothing else. Rolling + self-traction temporarily helps, especially when I get some good pops and releases out of the area.

-Neck feels *a little* better after left C3-C7 rhizotomy, doing the right side in a couple of weeks. MRI showed C3-C4 and C4-C5 mild uncovertebral spurring with resultant mild right foraminal stenosis + C6-C7 2mm disc bulge with a posterior osteophyte ridge.

The good news is that I think most people are able to find things that work for them. I think I'm just some kind of outlier or haven't found my magic ingredient yet.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Yup, cervical stenosis, arthritis in cervical and lumbar regions. Chronic pain sucks, but I won't let it stop me from living.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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I had two ruptured discs back in 1998 when I was at my highest weight and in the worst shape in my life. Not smoking or anything like that, just not working out, eating badly and wearing all the accouterments go with being a law enforcement officer. My doctor told me that the only solution was to lose the weight and gain strength in my torso so that my spine wasn't carrying all my weight.

I very slowly started to lift weights, walk, did some low intensity indoor cycling until my weight went down to a more reasonable level, then started to cycle outdoors, run and then got shanghaied into triathlon in 2009. Within two years that resulted in my first marathon, my first century ride since the 1980s and a 70.3 completion medal. Since then I have completed 7 marathons, 13 half marathons and 1 full IM (well, kinda. IM FL 2014 the swim was cancelled).

My advice is to lose weight if needed, gain strength in your torso (back and abdomen), and try to see if a chiropractic adjustment would help. It did in my case, I wasn't able to sit or stand when I first ruptured my discs; I went from laying on the floor in the chiropractor's office to walking normally in about 2 weeks, then I slowly started back towards fitness. I took a lot longer than most for personal reasons (lots of moving to different jobs and family angst), so it shouldn't take 10 years to get back in the saddle.
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Re: Anybody doing triathlon after a chronic back injury? [juanillo] [ In reply to ]
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Did not read all the responses but: Herniated at L4 and I get a lock joint at L3. Two bad relapses since 2012 (one being this past Jan). Yes I still race just have to be a little more careful in taking care of myself.

2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz
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Re: Anybody doing triathlon after a chronic back injury? [AndrewL] [ In reply to ]
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Best back advice I've seen. Do you have organizational lists of PTs who fit your description to help us find qualified folks in our individual locals? Thank you for your insight.

David
* Ironman for Life! (Blog) * IM Everyday Hero Video * Daggett Shuler Law *
Disclaimer: I have personal and professional relationships with many athletes, vendors, and organizations in the triathlon world.
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