Get an MRI.

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24 Hour World TT Champs-American record holder
Fat Bike Worlds - Race Director
Insta: chris.s.apex

+1.

I love Chiropractors.... crap... everyone hips are always a little out of alignment. I'd love to see a person with perfect symmetry That's the bread & butter of all chiros. It's almost like going to a tire place and surprise, surprise, your wheel alignment isn't perfect. However, sometimes an adjustment can kelp get your back on track. But in this case it didn't so it's probably time to go back to conventional medicine and see a orthopedist.

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TrainingBible Coaching
http://www.trainingbible.com

See a Physical Therapist. Tight hips and hamstrings make things worse. There are some simple exercises to loosen up the problem areas but talk to the PT folks first.

Already went the PT route. It improved some, but its not even close to where it needs to be.

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http://Everydadironman.blogspot.com

Myofascial release massage, resistance stretching, and strengthening exercises help muscle issues. You need to remember to work and balance the muscles in both directions, and up and down the line of your back. So that would include psoas, hip flexors, hamstrings, and glutes as well your back muscles-- for all three approaches. The PT you went to should have known this.

Otherwise, you've got something structural going on in my opinion.

There are good PTs, so so PTs and bad ones. It's tough to know which is which, and some PTs maybe got your buddy straightened out quickly but won't help you at all.

Assuming that PT is played out, then your next step is probably the injection route. That's where they inject cortisone around your spinal cord to relieve swelling. For some people, the relief from this can last 6 months or longer and they just kinda go get their injection every 6 months.

In my case it didn't work, but I think that's going to be the next step that is recommended.

sorta kinda sounds like my spinal stenosis. might not be but MRI would let you know. I just deal with it. add to list of things that I get as I age. list is getting longer all the time

As long as you do not have any neurological symptoms (weakness, radiating pain into legs/toes/buttocks, numbness in parts of legs/toes), just keep doing your PT exercises, be careful how you sit, stand, lift, bend, twist to avoid rein jury, and TIME will heal it. Most likely your back will never be the same, but with enough TIME you will learn to know what you can and cannot do and how. It typically takes 1-2 years for it to be truly better. 4 months is nothing.

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Two wheels good. Four wheels bad.

My pelvic instability, IT band tightness, calf and glute issues, and lower back pain eventually turned into a diagnosis of chronic ankle instability. Not pelvis. Ankle.

I did the chiro thing and PT with minimal progress. Had I had an MRI earlier I wouldn't have spent a lot of time doing stuff that wouldn't ultimately solve the problem. I ended up needing surgery as I had shredded my lateral ligaments. And wouldn't you know, instability in one place makes a lot of other things strain to compensate.

It's time to go see an ortho. Get an MRI and learn what you're really dealing with.

Did you see a PT who had hands on doing myofascial release, or just exercises? For me, I need both. No point to the exercises without the muscles being released first, so if your PT didn't have hands on you, find one who knows myofascial release.

What do you do for work? Are you sitting a lot? What about prior history? Prior back pain is the best indicator for future back pain.

Anyways, going through lumbar issues right now - for me it almost always comes down to a right-left imbalance in my core, a tight psoas that needs some serious release and then corrective exercises. It is much more manageable this time around (3rd lower back strain in last 6 years now) with a strong core program over the past few months, but there are clearly still muscular imbalances at work that will need correction via appropriate exercises.

Surgery should be a last resort.

what others said about your PT (same goes for chiros). You gotta find out what the cause is then fix (release) that and work on the other issues that will prevent it from happening again.

It might be tight QL.

Checkout this video on ways to release it. You can google tight/spasming QL for more information.

http://www.youtube.com/watch?v=OLHT8t5Fjms

Any suggestions once you do have "neurological symptoms (weakness, radiating pain into legs/toes/buttocks, numbness in parts of legs/toes)" - I have them all. I'm 36, I have had Sciatica pain for years, before starting Tri stuff - flares up with driving and increased training volume. I have visited to the "go to" PT, and he suggested some basic stretches to loosen up a few things and hopefully get me aligned, but it has not really worked. After a herniated disc last fall, I spent some time at the "go to" spine guy, and I am back there again trying to "stay" aligned leading up to IMTX in May - more preventative maintenance than anything. In any event, I'm probably up for another visit to a PT, but everyone seems to dance around the Sciatica issue as if they really don't know where to begin and just go through their bag of tricks hoping one works.

I would suggest you see a neurologist.

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Two wheels good. Four wheels bad.

Stretch. Then stretch some more. Then stretch some more. Every day, a few times per day.

Get an MRI and have either a neurologist or Orthopaedics Dr. take a look at it. Forget PT or Chiro until you can get an accurate look/diagnosis into what might be causing the problems. You may be causing more damage with PT and Chiro.

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"You can't win the race on the swim, but you can LOSE it."

I've had a similar issue for a while now as well. Did the PT route, etc. I had my bike fit re-adjusted to a more "conservative" position (tri bike) and have gotten much better. The sciatica the back pain was causing is almost gone. In my case, my back wasn't healing since I was continuously stressing it with my bike position.

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Andy Mullen
Team Zoot

I appreciate all the responses. I'm working on finding a good rec for a ortho doc in the western Chicago suburbs. I was hoping the chiro would be a quick fix (I'm not a big believer in it, but I know it works for some), and I think my PT did a pretty good job for what she was trained for. Plenty of exercises, lots of core work, and a good amount of massage. But I think several of the posters hit the nail on the head. Time to really get a look inside and see where the problem is stemming from.

Thanks for all the replies.

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http://Everydadironman.blogspot.com

I've got recurring back problems as well. I would definitely try to get an MRI, it's important to know if there are problems with your vertebra or discs. Another thing to look at is your lower abdominus, it can also get really tight and pull on things causing issues. If you have stenosis or a bulging and/or herniated disc, you could try inversion therapy or decompression therapy. I did decompression therapy for a while and it really helped.

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LLLEEEEEEEEEEEERRRROOOYYY JEEENNNNNKKKIIINNNNNS!!!

I was exactly where you were last April. My chiro told me it was not a herniated disc (no MRI) but rather an alignment issue. I keep training through the pain and finally ended up with a full herniated disc around the holidays last year.Unbearable burning nerve pain shooting down both my legs; landed me in the hospital and on a morphine drip for 2 days. I finally got an MRI and a good treatment plan from my doctor to hopefully avoid surgery (4 months and I am starting to swim in my masters group again still no run / bike). You sound early on so I think if you stop (yep, no training for a while) and rest for 4 - 6 weeks you should be fine.Also, there is a massive economic engine around exploiting people with back issues; their interests and yours are not always aligned. My advice:

1. Don't mess with your back. Get an MRI
2. Work with a spine doc at a university hosp. - his / her interest is helping you; not operating on you to make the next BMW payment
3. Rest, paitence, time. I would walk for 4-6 weeks and work with a McKenzie specialist once you have an MRI.

Hope that helps and cheers.

This is wonderful advice IMO.

Step #1 should always be an MRI. The scary part is the MRI might tell you more than you want to know. I have friends that have spend years and THOUSANDS on PT and chiro because they don't want to know (refuse to get an MRI). I get that 100%.

I had back issues for years. I didn't know better so spent the thousands on PT / Chiro. I let it get so bad that I could barely walk (2006). Had I been smart about it earlier I may not have suffered the (likely) permanent nerve damage I have today.

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24 Hour World TT Champs-American record holder
Fat Bike Worlds - Race Director
Insta: chris.s.apex

I am also a low back pain sufferer who has an MRI, which according to a Spine specialist is, "awesome for a 44 year old male". In other words, many (and some severe) low back pain issues do not have visible findings on an MRI consistent with your symptoms. Good docs and smart people treat symptoms not MRIs. I was in bad shape about 18 months ago. And now, I'm about 80%. I credit riding a bike (especially climbing long, sustained hills) and lifting weights for helping me "manage" my symptoms better. PT, Yoga, stretching, ART, massage and visits to numerous practitioners didn't do squat for me. Swimming also bothers my back and running is fine for 4-5 miles and then things get a little bothered.

My personal theory and diagnosis is simple...I have really weak back muscles. A year ago I got notification that my lottery app for LOTOJA (Logan Utah to Jackson Hole, WY), a 203 mile single day road race, was accepted. How would I do this with so much back pain? The team I trained with climbed about 8-10K vertical every week. About a month before I started riding with them I went out and did my own climbing workouts - short stuff, long stuff, etc. And I spaced these workouts 2-3 days apart. During and right after a climbing ride my low back was in pretty rough shape and I'd spend a good 30 mins stretching after. Over the course of a month my back was doing progressively better. I trained all summer climbing a ton. I had a stretch of 12 days off the bike while I was sorting out a knee injury - 4-5 days into my layoff my back started feeling sore and painful. I actually strained it pretty bad just bending over to pickup something light off the floor. The downtime was not good for my low back. As soon as I started riding again, my back was better.

After LOTOJA and the riding season was over I got into the gym and started lifting weights semi-seriously. I ran into one snag where I strained my back a little and had to deal with that for about a week. But for the most part, lifting really helped my back and I didn't really focus that much on low back lifting. I would do some Supermans (which isn't even lifting) and 1-3 sets of Good Morning's per week - that's it. BTW - All the PT exercises (except for Supermans and Planks) I found to be totally and completely worthless. I plank everyday.

I'm pretty convinced that what's been wrong with my back for so many years is that it's just weak. And as we get older, the tendency is to baby it because we think it's going to get hurt. What my back really needed was some real weights and the right kind of stress to make it strong.

Several people gave some pointed advice on this thread, so I thought I would update my experience.

At the suggestion of the masses, I went in for an MRI. What had been diagnosed as SI joint issues by two chiros and two PTs turned out to be a fairly bulged disc in the L4-L5. One round of cortisone shots actually made the pain a little worse (the doc said she thought that the shot actually aggravated the nerve and sent me to a spinal surgeon). Two surgical opinions later and a last ditch effort working with a well respected McKenzie method PT (who seems to have worked wonders for half of the cycling and sore back community in the western suburbs of Chicago), and the pain had gotten worse.

On July 21st, I went under the knife for the discectomy, and after the quick procedure, the Dr. told me the bulge was much worse than the MRI taken a few months earlier. I certainly wasn't surprised seeing as the pain had increased dramatically in that time. I'm four weeks out, and just hopped on the bike trainer for the first time yesterday. All I can say was the half hour I spent trying to just go slightly below my Ironman wattage had my heart rate spiking pretty high. It'll be a long road back, I'm sure, but looking forward to a few weeks from now when i get the all clear to start other activities. While getting fat has been fun the last several months, I imagine its going to make these next few months interesting.

Anyways, just giving a big thanks to those who responded with their personal stories, and hopefully I'll see you toeing the line next spring.

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http://Everydadironman.blogspot.com

This is quite a coincidence. I had back surgery on July 23. The spinal surgeon said the damage to L3 - L5 was worse than the MRI showed and he expected. I have started walking upto 2 miles day with no adverse effects. I hope to be released next Monday to swim and bike with running in the future.