Sorry to hear about your injury!


I've had the pleasure of dealing with recurring lower back pain for most of my life. Assuming that you've confirmed that your problem is muscular (as mine is) here's what works for me. I'm not a doctor, so your mileage may vary.

Early on, I was lucky to find a Chiropractor that also does ART and Graston as well as PT, electrostim, etc. In other words, he as a lot of "tools" at his disposal to deal with this when I need his help. What works for me typically is starting with something that loosens up the musculature (heat + electrostim) and then a LOT of ART and Graston, not just on the lower back but also glutes, quads, hamstrings, hip flexors, etc. It hurts like hell, but after several treatments (usually 3x/wk foe the first couple of weeks) it usually sorts itself out. I'm not a huge believer in some of the other stuff (laser, ultrasound, adjustments, etc.) for lower back pain but that's just because they don't seem to do as much for me.

As far as activity goes, I usually take a few days totally off of S/B/R but do walk a lot to keep things loose. Definitely avoid sitting for prolonged periods. Once the worst of it starts to subside, I can usually get back on the bike on the trainer for easy spins - mostly to keep myself sane and keep things loose. I try to avoid any level of effort that would result in any residual soreness or tightness from the workout, as that would be counterproductive.

Again, that's what works for me. YMMV. Good luck!

 Bad back started in early 20s, almost 50 years ago. Primarily basketball player who ran lots of stadiums with leg weights. Long story short used Chiro, massage & even facet injections. Chiro would help but adjustments were temporary as muscle imbalances are the likely causes of most of my problems. Thank God for internet and sites like Mobility Wod, now ready state, and upright health.

Being a desk jockey tight hip flexors are problematic as are for many. Also add aero position where pelvic tilt from extension or flexion can strain proper spinal alignment. MRIs showed bulging discs. Later in life lots of trigger points.

What I have learned that despite lots of jumping from basketball and running and poor posture on bike and running in my early and middle years, they can be overcome largely with better biomechanics (plenty on web & get PT to analyze) and keeping muscles balanced, especially working on glutes.


But it does require almost daily maintenance. Slack off and problems will return for sure.

Walking is good rehab. If you bike a good bit already, i wouldn’t think that a big problem unless you pointed toe a good bit. Assume boot is now off.

You may need to roll foot on lacrosse ball to get those foot muscles some help. Each foot is made up of 28 bones, 30 joints and more than 100 muscles, tendons and ligaments, all of which work together to provide support, balance and mobility. Ready state website has videos for all sorts of issues.

GP - I know you're an excellent swimmer so I would suggest just swimming, including lots of kicking and flip turns. The flip turns may hurt at first but I bet your back will loosen up after a few swim sessions and eventually your back will be fine. I fractured my L1 vertebra in a bike wreck a few yrs back and it hurt like hell to do the flips, but I kept doing them and the pain gradually went away, totally away in about 4-5 months. My neurologist advised me to keep doing the turns, and I was very lucky that he just happened to be a former college swimmer. :)

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

So as an update I moved the wrong way yesterday... a seemingly innocuous movement... and my low back completely locked up. Went to my hands and knees and it was almost an hour before I could get back to my feet. Anything beyond walking at a slow shuffle seems impossible at this point. Whenever I do get some functionality back swimming will be first on my list.

Wow, I am so sorry to hear it has gotten worse. On the positive side, you have swimming, at least once you can get to that point. I'll never forget that Amy Hall of The Race Club said "you have so much talent" for swimming. :)

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

How is your back today.

Sucks... I had an episode in July last year and it took me over a year before I was fully recovered. Every time I thought I was over it, I managed to re-injure it somehow. Along with a stubborn case of PF training for IMAZ last year through that was pretty draining mentally. I've haven't had a flare-up since April and was able to finally put together a consistent streak of training weeks over the summer and I'm finally at 2017 levels of fitness :) hooray

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What's your CdA?

I disagree with the chiro, probably not a disc. It definitely seems muscular. Find someone that goes ART or some other soft tissue stuff. Don’t stop moving, pain is not the enemy as long as its not getting much worse. Maybe find a Makenzie institute practitioner.

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ART, MDT, DNS, MPI, FST

Slowly doing better, I'd say I'm 15-20% better thank you for asking. Getting up in the morning is rough and so is getting out of my car. Actually, sitting in my car for any extended period seems to be the worst thing I do. Very mild discomfort while sitting in the car, getting into my car is not problem, but getting out of my car.... man. I basically have to use my left arm to do a partial pull up on the roof to take the pressure off my back so I can swing my legs out (mid size SUV fwiw). Takes me a little bit to get up to speed but once I'm walking I'm totally fine. No discomfort while standing either. I have noticed that my IT bands are crazy tight/inflexible at the moment. Very tight hamstrings too and this is coming from a guy who has, historically, always been able to bend down and put my palms on the floor.

So the Chiro does ART and he did some art on my back which was interesting in itself. His diagnoses was that a disc was slightly out of place and that the back spasms were my back protecting itself. I'm kind of not adequately explaining his diagnosis... let's see if I can recap it.

Based on past sports history (lots of golf when I was younger) I likely had several discs out of place but was asymptomatic and would have remained asymptomatic short of some sort of trauma.

Trauma was walking around for a week in a steel soled boot. That both messed up the patterns my muscles fired in and may have put a disc enough out of alignment to put pressure on a nerve and thus cause spasms making things even worse from a muscular standpoint.

I'll look up Makenzie Institute. I agree re moving. Back feels best when I'm up walking around. Feet are getting tired/sore but I guess I'll just deal with it.

Edit: also, I think ice is helping more than heat. Heat feels good when applied but when I first get up from having a heating pad on I'm actually pretty sore. I always seem to feel better after an ice pack.

A disc will almost always feel better seated, regardless of the diagnosis if what he is doing helps then by all means stick with him. Just don't get married to the diagnosis. Also if ice helps them keep icing.

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ART, MDT, DNS, MPI, FST

Just throwing this out there, with sciatic problems over the years an inverse gravity machine helped me tremendously. I do full inveresion crunches or just hang upside down

There is no such a thing as a disc out of place. It may have bulged, or ruptured, or compressed/degeneraged, but it doesn't slide out of place short of a catastrophic injury - and if that happens you will have more problems than merely an out of place disc. You should fire your Chiro, he is feeding you BS.

Your problem is muscular, and it needs time, and PT. If it continues to bother you after a few weeks, go see a real doctor.

Ah, interesting. See, that’s why I post on ST :) Combined with TBB’s response above it seems it is not a disc.

I’ve had a similar problem for years. I’ve had reasonable results from PT, so-so from a chiropractor, and pretty good results from reading https://www.amazon.com/...k-Book/dp/1523502967 . Good descriptions of the anatomy and possible problems. The book does not promise miracles, and expects you to do specific exercises for the rest of your life.

Thank you for the recommendation

Just my two cents... I had similar problems 15ish years ago with my back. I was just locked up and the slightest weird movement set it off. Doctor prescribed pills but the only thing that actually worked was the chiropractor. He cracked my lower back by pushing down my hip then they put electrical stimulation in four places near the problem area along with a wet warm towel. Sounds crazy but I walked out feeling 100%. From then on I just went back to the Chrio for the same regimen whenever I felt symptomatic. Sitting still and letting it get stiff always made it worse. I think it's going to be different for everyone but basically you want those back muscles to let go. Good luck.

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MLB

Go to a doctor who specializes in the column if you can, don't wait. Wish I had.

I had similar issues and ended up with two herniated discs.

For me it was degenerative dehydration or basically degenerative disc disease.

It sucks.

But I'm managing. Knowing what it is has made things easier to manage.

I tried to power through and wish someone had stopped me, your back is serious business.

Accepting your back is critical to day to day life is hard, but will help make better decisions.
I had my first DNF this year in a full but wow was the med tent proud of me, walked in and walked out and didn't reinjure myself. Made it to KM 5 of the run and was fresh enough but the back felt off. Back home doctor said it was the right call. (Add insult to injury, Garmin only gave me a 23 recovery period)

i've been completely effed for 4 days. i don't even want to talk about it. in bed typing right now. can barely walk. no ambulatory person of any age would lose to me in an all out 100 yard sprint right now. in fact, more like a 100 yard marathon

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Dan Empfield
aka Slowman

Common issue with psoas or QL spasm. Could be a multitude of things that cause this but its something I personally see a lot with patients. Degenerative disc disease is a common and normal thing with aging, but current literature is steering away from disc related issues because of the prevalence of disc herniation and degeneration in asymptomatic patients.

If you talk to most chiros they will say you need an adjustment, most PT’s will say exercise and most surgeons will want to operate; they want to do what they have learned will help and also get paid. The special ones are going to be the guys that are more modern with there approach with multiple modalities and take a bit more time to explain the issue...not just “x,y,z are out”

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ART, MDT, DNS, MPI, FST

My Chiro mentioned to me something very similar to what you are saying about asymptotic patients having disc issues and even mentioned that he himself had plenty of disc issues that most surgeons would “be able to buy a boat from”.

That’s about where I was last Friday. I get it. Never understood how bad back pain could be but... I get it now.

couple times a year i get this. doing nothing. i bent over. didn't pick anything up. just, wham. usually i'm good in 2 or 3 days. i think something bony pinches a nerve. but hell, i don't know. this time, it remains. 4 days later, no different. my actual biggest concern now is that i'm going to screw up my knees by the funky movements walking (like a crab), and trying to get out of bed. unnatural movements. the back will eventually clear up but i will have injured something else.

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Dan Empfield
aka Slowman

https://www.mckenzieinstituteusa.org/method-providers.cfm#

Might be worth some of your time to find a doc close to you

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ART, MDT, DNS, MPI, FST

Yeah, I agree with NealH.

It could be a disc, but not in the way the chiro described it.

Chiropractic "medicine" has no scientific basis. Go see a spine surgeon. I had a similar thing, went to see a surgeon, got some MRI's and I see a few things that might be causing my problems. Hopefully won't need surgery any time soon, but I need to have a more focused approach to strengthening my core. She also gave me some new drugs to take next time I have an episode. Will go back again in about a year to make sure things aren't getting worse.

A chiro might get some things right, but not because of any science behind it. Your best bet is an MD followed possibly by a trained PT.

Good luck!

My normal routine in these situations, after that many days of hell, is getting some assistance while flat on the back to stretch out the hamstrings. It usually provides a release in the QL as well to at least get moving enough to go buy a gallon of IcyHot.

A muscle relaxant can also be of service here, just to get the edge off enough to let you actually recover. Everything is so guarded/tensed up that you can’t release from the position.

There’s a chance you’re on a nerve from having it pinched, or you’re sitting on a disc herniation that is causing the same effect. The latter is what laid me up last winter while moving some gym equipment out of our basement.

<pink> Perhaps we should get you some Pure Spectrum CBD lotion. </pink>

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Editor-in-Chief, Slowtwitch.com | Twitter

We are similar age and both doing tris a long time. I started in ‘86. My back would go out just as you describe but later in life hard to bounce back. I found Kelly Starrett’s couch stretch really helped plus other hip openers and glute activators to take load off back.

Here’s a clip and Starrett has own website and free YouTube’s too. You may not be ready for couch drill yet given your pain, but give it a look when feeling better.

https://www.menshealth.com/...27185/couch-stretch/


Ps maybe sitting on flights to IM Kona got those flexors tight causing pelvic tilt...pain

Welcome to the club.
Had similar problems about 4 yr ago. Days of crippling pain. My Dr. missed it. Chiro completely f’d up and made it worse. The PT literally put his figure on the problem and got me going again.
Point is to use the professionals. There was good reason to think each should have an answer and solution but only one did.

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Life is tough. But it's tougher when you're stupid. -John Wayne

Sorry to hear about the back pain. I had some pretty bad back pain last year right before race season, and missed the first half of the season. I couldn't run, had sharp pains on the bike, and swim was tough too. Even getting up could be excruciating
One thing was that everyone I asked about back pain had a different go to exercise/treatment to recommend (this or that stretch, this or that topical, this or that treatment). Everyone has had back pain. Just throwing all these recommendations at it though did nothing, but what finally ended up working well for my case (after trying all sorts of stuff), was simply focusing on extension. I did cobra pose/sloppy push ups regularly through the day, and tried to eliminate any forward flexion of low back. Sitting I used low back support, and bending I either squatted or used something to avoid flexing forward. Then slowly reintroducing flexion after a week or so until range of motion was back to normal
I've kept up regular extension exercises for the past year, and had no relapse, so it was something that worked well in my case.

It's ass end of the world (Australia) based, but this site was launched recently & might be helpful -: https://mybackpain.org.au

Back pain can be very tricky and like most things, typically asymptomatic despite MRI findings. Of course people only get an MRI when there is an issue and that is when they discover they have some disc issues. There is some school of thought that back pain is all stress-induced. I can say this, the body is complex, and removing stress is a good thing.

My own back issues started when my left glute / piriformis started to develop some issues. This then translated into an acute back throw out on the lower right back I have since reinjured it numerous times, most recently playing 2 on 2 hoops which I had't played in about 15 years. As an aside, I told the guys I didn't really want to play, just wanted to shoot, but they insisted saying they just wanted to get a workout. Oh they got a workout all right. Huffing and puffing in Florida summer, sweating like they would never believe.

But that aside, move as much possible (walking), swimming is great as well. Just hop in the water, don't bend down as you are probably too stiff. Once the pain and tightness has subsided try to do some more core exercises. Make sure you don't have any anterior pelvic tilt going on to excess as well. You could also explore traction at your Chiro as well.

In general the Chiro probably won't do much otherwise, but I like Chiros for the most part. Mine actually does a great job of listening to me about what is going on. I know you said heat is not working. Odd that ice is working. For me heat usually loosens things up quite nicely. On that note, I love my Thermotech Heating Pad. It is an outstanding heating pad.

Other than that when you are feeling better, let's go for a ride. Riding with ST buddies is always a good time!

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How are you feeling now?

I’ve had on/off excruciating back pain for about 4 years now ... went to get an MRI which showed tears and bulging discs but others have already said that some ppl have bulging discs but are asymptomatic.

After years of refusing to quit sports and take painkillers .. I’ve been on my best stretch yet (8 months pain free - woo hoo!) The largest contributing factor I realised was most likely stress as a hard training session didn’t affect my back, but a few very stressful days did.

Also, I worked on my core a lot. I promise you I’d have a 6 pack except for all the cakes and ice cream that I eat. Lots of yoga, planks .. when I can’t do yoga I use the 30 day plank challenge app. Sitting and not moving has aggravated it. When I feel another episode coming on .. I lighten my training but remain active. Roll the hell out of my glutes and do a lot of stretching particularly to open up the spine. In my opinion it’s muscular issue and a weakness on the one side.

You’re best off to see a doc first, esp to confirm that you don’t have degenerative disease then go from there .. I’ve gone to a few PTs but do my own thing .. so far so good .. good luck!!

So, my back has been barking at me the last couple of days. Just took a look and did this exercise this morning.

Holy shit. Immediate release on my back.

Thank you for this.

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Editor-in-Chief, Slowtwitch.com | Twitter

Glad it helped. Sitting tightens those hip flexors and puts your glutes to sleep. 3 minutes each side each day does a body good. Fire those glutes.

Strengthen core and explore other hip openers. Running & biking in same plane over and over really creates muscle imbalances which impacts discs, facets, nerves etc. and as we age they come to the fore. Plus in our youth we probably kept those imbalances at bay by playing multiple sports and different muscle use.

We are all a bit different but don’t give up in quest for relief. ReadyState and Upright Health are just a couple of websites that are good.

I wouldn't do that either.... surgeons do surgery.

E

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Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

I like this answer.

I get this once every two years or so. What seems to help functionality best is to relax, lie down, and use some heat along with anti-inflammatory or muscle relaxant. The nerve that is angered needs to be calmed.

E

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Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

Hopefully this doesn't get too long...

I'm coming up on two months of marked symptoms from nerve impingement in the left sciatic... Actually started in February, where I thought I'd pulled the left hamstring slipping on a frosty driveway. That hamstring kept feeling tight all through the summer, actually getting worse in spite of loads of stretching and massage. At the end of August I started a tae kwond do class with my daughter. In the second class we were running lines for warm-ups. I noticed my left foot was dragging after cutting back. Hmm... Then on the next repeat everything cut loose and I had pains down the entire back side of that leg. Chiro visits for two weeks with no relief, got an MRI.

The results (edited to just the "Impression"):

Impression:

1. Degenerative findings in the lumbar spine are discussed in detail level by level above (the detailed laminar analysis from T11-S1).
2. Moderate to large left subarticular disc extrusion at L5-S1 displaces the traversing left S1 nerve root.
3. Moderate size central disc extrusion at L1-L2 displaces the traversing right L2 nerve root and contributes to the mild spinal canal stenosis.
4. Small right subarticular/foraminal/extra foraminal disc protrusion at L2-L3 contacts the exiting right L2 nerve root and traversing right L3 nerve root.
5. Small central disc extrusion at L3-L4 approaches the traversing bilateral L4 nerve root without nerve root displacement, and contributes to mild spinal canal stenosis.
6. Multilevel moderate to severe neural formainal stenosis is worst at L4-L5 bilaterallly and L5-S1 on the left.

Officially, my lumbar spine is "messed up". I'm in PT now, two weeks, with basically no improvement (PT had expected some marked improvement after the first round of therapy). It's kind of a precursor to guided injections, which if any of this is effective, will buy me maybe 5 years. The only actual permanent cure is fusion. I've talked with several folks who have said that the L5-S1 fusion was the best thing they ever did, with immediate relief. While I don't relish the idea of the surgery and fairly lengthy recovery, I don't just want to kick the can down the road to where my ability to recover is further diminished.

I'm still able to ride, though it takes 15-20 minutes to loosen up, still able to do the TKD with no kicking drills.

So... TL:dr ==> pay attention to that hamstring tightness.

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Some are born to move the world to live their fantasies...

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Much like everyone else. I will start with I am not a doctor. But after breaking C4, 5, 6, 7 T1 and T3 (apparently my T2 is a boss) and having disc issues for 5 years. I feel like I am close when it comes to the back.
Every one has great advice here. One simple one I would add that one of the DR told me about is try to find a way to sleep with your hips dropped for 1 night. Imagine if you had a mattress that supported your back but had your butt 2-3 inches lower (you can do it with foam or pillows) His thinking was it provides a gentle stretch for a long period of time, when the body is relaxed and healing. I have never heard another doctor give this advice, so maybe he is a quack. But whenever my back gets tight I do this and it pretty much always works.

I’m measuring my progress based on pain and stiffness when getting up in the morning and when standing up from a seated position. Interestingly... and this may be TMI... but I was much better getting on and off the toilet today.

I have identified anterior pelvic tilt as a major contributor to my back discomfort. When standing if I deliberately correct my natural (bad habit) anterior pelvic tilt any discomfort or pain just disappear. I’ve spent the last two years working crazy hours which means a lot of sitting. Sitting while driving (50,000 miles), sitting in my car while waiting for someone, sitting on a plane, sitting at my desk.... so I’m confident that tight hip flexors and poor posture are at least part of the battle.

I have another appointment on Thursday morning and will update then. I’ll likely see a couple of other specialists as well in the next few weeks just to cover my bases.

Question on your last point: is riding ok to do? I haven’t tried yet. A few days ago swimming seemed impossible but now I’m tempted to get into the pool and try some vertical kicking while working on my posture (anterior pelvic tilt specifically).

https://www.youtube.com/watch?v=ZkzFT6rRMhQ

Plus aforementioned above "couch stretch".

If your pain level permits

But they can also evaluate when surgery is or is not necessary.

Not TMI at all .. I know that exact feeling .. and getting out of the car .. the movement of going from sitting to standing is the absolute worst...

I’ve spent a week lying on the floor on several occasions as it gave me the most relief. Have you got a stand up desk at work? I can’t recommend it enough ..

I know others have mentioned it here but please only consider surgery as the very last resort ... it may require a bit of patience to finding then working on resolving the issue (bearing in mind that everyone has back pain for different reasons and there are so many different things that can be done ..)

 
First 40years as ortho PT Second 6 IM's : Suggestion: order and read Robin Mackensie's treat your own back. Then find a certified Mackensie PT to guide you through your focused rehabilitation. Lumbar Spine disc problems are a bugger and can be treated effectively if approached with the same discipline and dedication we all train with. Go for it

I suffered some years from LB pain. I tried many many things. The only thing that worked was a neurologic approach, IOW...I was experiencing pain but there was not a major injury that was related with that. I worked with a guy who guided me to reset. Many doctors look for injuries when a big percentage of us have bulged or proper disc herniation. So the brain says "oh, you have an injury and it will hurt". I started to do some training after years, little by little, but not stopping and I can say that now, I am painfree...
This could me more related to chronic pain, but if you are interested, take a look at any video of Lorimer Mosely in youtube.

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

Yeah, I agree with this,

In my experience keeping moving is the best thing in this situation ( asuming no bulging ruptured discs etc but you'd know if they were as you'd likley nearly sh** yourself when you move). I fopund the best thing was streches, lots of them, like 3 times a day. one particular stretch that helped a lot was sort of downward dog, but against the back of a chair/railing so i would move my feet forward and put some tension/stretch into my back, a little like hanging from somthing by the arms.

+1

Motion is lotion in general. Hard to say on your specific case in regards to bike, I can't say I recommend it, swimming and walking are probably better. But the first time I hurt my bike was on a Monday and then I did a Sunday Ironman. I was actually fine on the bike, but noticed I was favoring some stuff on the run, causing some imbalances all over the place and I could feel it all tugging on my Achilles so I didn't complete the marathon. Hopefully your back is feeling better. Sorry for the delay. I switched my Slowtwitch notifications out of my Inbox a while back and I am no longer as good about replies.

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just to add -- you might want to consider getting a Swiss Ball and lying on it belly down, rolling very gently through all axes, finding space between the vertebrae.

This signals the back muscles to activate but the spine is completely supported, so the brain can ease into the idea of using them again.

Not a cure by any means but a way to treat an unhappy back.

Once it's a bit better you can gently work the psoas (if they're locked) by lying on your back, ankles on top of ball, and rolling in/out toward bum, single leg or at the same time.