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.

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CB
Physical Therapist/Endurance Coach
http://www.cadencept.net

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.

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....

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Spaniard. Sorry for my english for the sensitive ones :P

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!

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

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Spaniard. Sorry for my english for the sensitive ones :P

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.

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

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Spaniard. Sorry for my english for the sensitive ones :P

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.

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.

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.

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Training Tweets: https://twitter.com/Jagersport_com
FM Sports: http://fluidmotionsports.com

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.

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.

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- I do all my own stunts

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.

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.

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Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede

  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.

Yup, cervical stenosis, arthritis in cervical and lumbar regions. Chronic pain sucks, but I won't let it stop me from living.

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.

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.

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2024: Bevoman, Galveston, Alcatraz, Marble Falls, Santa Cruz

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.

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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.