I’m a 39-year-old triathlete with a very active lifestyle, having competed in 5 half Ironmans over the past two years as an age grouper. Recently, I ramped up my training for a first full Ironman and after my last race that involved a lot of elevation on the run + OWS, I was diagnosed with minor facet joint arthritis. Despite six weeks of conservative treatment (PT, chiropractic care, and reduced training volume), I haven’t been able to fully recover.
While I’ve always had some lower back soreness after open water swims (was probably facet joint related) — the lack of stretching this season (very tight hamstrings and lats) and poor swim mechanics (incorrect flip turns and excessive spine twisting without core engagement) have contributed to this condition.
While the pain was initially quite severe (3/10, spiking to 7/10 during swimming), it’s now a constant dull ache (1-2/10) that flares up after prolonged sitting, walking, or running. Both doctors I’ve consulted confirmed the diagnosis and mentioned that my X-ray and discs look generally fine for my age.
I’m reaching out to see if any fellow athletes who are actively training for races have experienced similar issues and what long-term remedies worked for you. I’m now prepared to significantly reduce my training (even down to zero) to address this, as it’s the longest-lasting injury I’ve had. Is this something I have to live with for rest of my life and give up long distance triathlon for or can I continue to do what I love?
All said I value longevity and want to avoid further joint issues given I’m barely 40, so any advice or shared experiences would be greatly appreciated.
I generally avoid responding in injury threads because they get so muddied with everyone’s anecdotal advice. There’s so many things you mention that would need unpacking, so I have some general thoughts below:
-Six weeks is nothing. It feels like eternity with the psychological baggage of pain and its impacts, but think about how small six weeks is in the big picture.
-Imaging can, sometimes, be helpful when conservative care fails OR it’s an acute injury. Otherwise it’s often just a means for people to chase a “diagnosisâ€. Remember, imaging can’t see pain, as much as we would like it to. Symptoms and radiographic image findings don’t correlate, lots of good research supporting that. Our bodies are not a carpentry project that follow a nice set of directions!
-Modify one to two small variables at a time. Just like we should assess our training periodically, to ensure we are on track via benchmarking testing, one should assess changes they make when assessing a nagging injury. Don’t throw the kitchen sink at it….
Vague advice? It should be. As someone who works in the sports med space I see a middle aged guy who ramped up his training for a big event and came out of it with an issue that’s been bugging him for a month and a half. By his own admission it’s better, but lingering. He’s consulted two doctors who have seemed to rule out anything super concerning.
Best of luck. If you have specific questions I’ll do my best to give insight. I’ve had “this†conversation 1000’s of times with patients. The ones who “get it†don’t always improve faster, but they suffer a lot less on the road to 100%.
I generally avoid responding in injury threads because they get so muddied with everyone’s anecdotal advice. There’s so many things you mention that would need unpacking, so I have some general thoughts below:
-Six weeks is nothing. It feels like eternity with the psychological baggage of pain and its impacts, but think about how small six weeks is in the big picture.
-Imaging can, sometimes, be helpful when conservative care fails OR it’s an acute injury. Otherwise it’s often just a means for people to chase a “diagnosisâ€. Remember, imaging can’t see pain, as much as we would like it to. Symptoms and radiographic image findings don’t correlate, lots of good research supporting that. Our bodies are not a carpentry project that follow a nice set of directions!
-Modify one to two small variables at a time. Just like we should assess our training periodically, to ensure we are on track via benchmarking testing, one should assess changes they make when assessing a nagging injury. Don’t throw the kitchen sink at it….
Vague advice? It should be. As someone who works in the sports med space I see a middle aged guy who ramped up his training for a big event and came out of it with an issue that’s been bugging him for a month and a half. By his own admission it’s better, but lingering. He’s consulted two doctors who have seemed to rule out anything super concerning.
Best of luck. If you have specific questions I’ll do my best to give insight. I’ve had “this†conversation 1000’s of times with patients. The ones who “get it†don’t always improve faster, but they suffer a lot less on the road to 100%.
Carter
Thank you Carter! If you don’t mind some quick questions below along with some additional new symptoms that I will run by my sports md next check in
I’ve subtracted the swim significantly towards 0 and seems to have helped. I’ll try running next since that seems to be the next logical “load†exercise esp if walking long distances seem to flare this up. Any modification you’d recommend on running aspect aside from shorter distance? Tread mill or track only? No incline or hills? Softer/foamier shoes?
For someone with minor arthritis what’s the typical road to 100% vs having constant flare ups or chronic pain for rest of my life assuming I stay compliant and integrate all the PT and lower back exercises? Realize it’s a condition that cannot fully heal but I’m assuming many triathletes live with some form of arthritis as they age and learn to deal with it or minimize it.
Opinion on sports Chiro? I wonder if mine has made things worse vs better. He seems great and is more manual but I’m always sore in other parts of my back after. I may just subtract out here also.
What makes for a good sports PT? I’ve been doing all the exercises but mine primarily seem to work with the elderly vs active folks. Should I ask my sports MD who he recommends?
On this note, I’ve been doing extra stretches on my hamstrings and now I seem to have some nerve issues on my feet (slight tingling) and also other parts of my back are also sore (realize back pain can be cascading). Is there such thing as being too compliant to a fault?
Any other general advice you’d give aside from what I’m doing now if my goal is to get to 100% as soon as possible and not letting this come back in the future?
It is quite difficult to localize pain to a particular structure in the spine unless one has quite specific symptoms. For instance if you had pain going right down your leg on the right side and a disc on an mri pressing on your L5 Nerve root okay your have sciatica from a disc prolapse. There are additional physical signs of sciatica but that is an aside.
Minor facet joint arthritis likely could be quite commonly seen on all sorts of spine xrays even as young as under 40.
I see MRI and CT scan reports all the time in people who are 50 and 60 who have minor facet joint arthritis pretty at most levels of the lumbar spine doesn’t seem to be causing much in the way of problems. So imaging very frequently doesn’t explain the pain people are having.
But most people (like more than 80 percent) with rather non specific low back pain get better with time and physio. I have been doing family medicine now for 30 years.