Chronic lower back pain sufferers - what works for you?
I've dealt with lower back pain for the last 25+ years. Sometimes it goes away for months at a time, and sometimes if I'm lucky I can put together an entire training season and have a great race. But I've also missed more races than I can count. I'm now coming off my latest bout of LBP, which has sidelined me for the last 4 months, and I find myself basically back at square 1 and incredibly frustrated. I feel like I've tried everything I can think of, and I can't seem to find any real correlation between any of the following things and an ability to get healthy or stay healthy. In no particular order, I've tried:
- regular core exercises (up to 5-6x/wk when feeling healthy in an effort to prevent flare-ups)
- stretching and foam rolling
- Normatec boots after anything harder than an easy workout
- Electrostim. Both Compex home machine as well as professional electrostim machine on loan from my PT.
- Physical therapy (Graston and ART)
- Theragun on glutes, hamstrings, IT band, hip flexors, lower back
- Teeter inversion therapy
There also doesn't seem to be any rhyme or reason to what helps and what irritates my back. Sometimes cycling helps loosen it up and other times my back is a mess after an easy trainer ride. Currently, my back seems to like running and swimming but not cycling. Other times, the exact opposite is true.
So, I'd love to hear from those that suffer or have suffered from LBP and what do you do to keep it from flaring up and what do you when it does flare up.
Thanks,
John
Comments
@John Katsoudas - timely post for sure!
I am a sufferer, almost always because I don't do enough core. Seems like yours is beyond that. Is it "muscular" or "structural?"
In my case, I herniated a disc(L4/5) a few years ago (2 days before IMLP) and it's never been the same. On top of that I fell on some stairs in 2012 and did what appears to be a long term issue to my left SI joint. Of course many people (a large % of the 50+ yo population) has herniated discs that don't affect them, I am one of the lucky ones.
When I herniated the disc in 2017, I immediately did a course of Prednisone, that kicked it down, but it came right back and I went for a epidural injection. That seemed to do the trick, I did 2-3x a week with a Chiro, no idea if what he did helped or not, but he was a strong advocate of common sense core work and that seemed to do it.
the last 6 months I fell off the core wagon and i tweaked my back on a gravel ride followed by lifting two heavy objects and could not walk for 3 days until I got the prednisone going. Now I have pain when I wake up, stand up, etc, not horrible and I've been able to bike. Biking indoors doesn't seem to affect me, outdoors it seems like the muscles all tighten up. if I get off the bike after 45' to an hour, walk around for 10-15', all seems to re-align.
Been getting back to core now and I think I've dodged the bullet. that said, 115 mile+ rides with 9k+ of climbing haven't helped.
seems like your situation is different. have you been to a spine specialist? sports focused chiro? you seem to be doing all the right things with no results, I get the frustration
Hey Scott. So sorry to hear about your issues, and glad to hear that you've hopefully "dodged the bullet."
I think you're right that a large percentage of folks, especially 50+, have disc issues of some sort that are largely asymptomatic. I just turned 51, but I've had issues on and off since my mid-20's. I can go for long stretches of time without significant back pain (I think I've just gotten used to the "usual" morning stiffness), but when it does flare up it seems like it's taking longer each time to recover from.
To answer a few of your questions, no I have not been to a spine specialist for this recently. A loooooong time ago I saw a specialist (back when I had some crappy health insurance) that basically told me to take some Motrin and rest for 8 weeks and it would be fine. This was when I was training for my first IM. As you might imagine, I didn't follow that treatment advice. Instead, I found a local PT/chiro who is also a triathlete. I've been seeing him on and off as needed since then. So my understanding of my condition comes largely from him. As best as he/I/we can guess, there is some sort of structural issue (either herniation or disc degeneration) in the L5/S1 area. It's usually asymptomatic, but atypical stresses, either hard WO's or other things (yard work, lifting something heavy awkwardly, skiing, working on cars, taekwondo.... pretty much everything I love to do) can cause muscle tightness in the lower back. That tightness will, in turn, increase the compression in the disc to the point that it will impinge on the nerves, which then locks up all the muscles in the lower back as in involuntary defense mechanism. It's sort of a vicious cycle between structural and muscular. Relieving the muscular issues eventually allows the disc to decompress, but that can sometimes take a long time. This is why a lot of what I'm doing is geared toward trying to stretch/loosen/relax the muscles in the lower back, glutes, hamstrings, quads etc. in an effort to try to get the pressure off the disc. Anyway, apologies for the long-winded explanation.
I have had the "do I need surgery" discussion with my PT/chiro on more than one occasion. His perspective is that because my condition is normally asymptomatic, and as long as I can get it to return to being asymptomatic through non-surgical means, I should avoid surgery for as long as possible. But to be honest, being in my 50's now, I'm starting to weigh that against the question of "if I'm going to have surgery, are my chances of a full recovery better when I'm 51 or 60 or 65 or 70?"
It doesn't help that, in my frustration, I just want to do all the stuff that I would normally do. I just finished week 1 of RDP1 (back to square 1) and was thrilled to be able to run 6 miles on Sunday. We had a freak wind/thunderstorm here over the weekend, so I spent some time yesterday cleaning the yard and pool, with the predictable outcome that my back is a hot mess this morning. My son and I have also done taekwondo together for the last several years, and we're currently a couple of months away from testing for our black belts together. I'm so excited to achieve that with him that I just keep plowing through TKD classes, which always irritate my back to some degree. I think stubbornness is the hallmark of any triathlete.
All in all, I think you're right. It's time to see a specialist and see exactly what's going on. That's for letting me rant.
-John
At a younger age, I cracked L4, L5 and laid in a bed for 6 months then learned to walk and later run again. As a result have a propensity to suffer back/pain issues. However, when I religiously employ the above bullets, I stay back pain free and healthy.
I hope this helps @John Katsoudas
Paging @Ross Randolph ...
@John Katsoudas not sure I can offer a lot more than the WSMs above, but definitely have some lower back pain in my recent past. There's some posts out there from me including MRI and other details if you're interested. Mine was also herniated disk; cause unknown although it first presented from an infamous sneeze in late July 2019. Literally knocked me off my feet for about 4 weeks. Narcotics did nothing for the pain or mobility, just made me sick and a scary episode of syncope which I was lucky didn't injure me further. Resolution came after an MRI (confirmed the herniation diagnosis) and then a cortisone injection. Followed that with about 4-6 months of PT. Was told to avoid chiro (which I have). I still have some numbness & tingling on the spot of my foot and left side of my kinetic chain is still generally weaker, but I'm back to pre-injury S/B/R routines. Like @scott dinhofer I know core is important but also tend to slack as it doesn't give me the same adrenaline rush or feeling of accomplishment that a hard bike or run WKO does. I know that will come back to haunt me and so I keep my toys (foam roller, "The Orb" ball & Theragun) nearby as visual reminder of what I should be doing more regularly. Also agree with @Shaughn Simmons on the run intensity. I've dialed it way back. Where I used to chase 5:00 mile targets on the track I'm happy with anything in the mid 6:00 mile. Although I'm not running 5k's, I've found no impact on my fitness or ability to be competitive at the longer run distances. Best of luck with your recovery and if you're ever looking to explore North Bay routes with a teammate, give me a holler.
Hey @Ross Randolph thanks for the input! That's really helpful. Here's a quick update, FWIW. I met with an orthopedic/spine specialist last week. We did some x-rays, which revealed what I suspected - moderate/severe degeneration of the L5/S1 disc, which is impinging on the nerves. He ordered an MRI, which is scheduled for next Wednesday. In the meantime, I'm on Alleve twice a day and he also ordered some PT for me to try. His thought is that the likely course of treatment will be that the MRI will confirm the x-ray findings and then he will recommend an epidural injection of cortizone to try to reduce the inflammation and help with the pain. Fingers crossed that this will help. So far, I've been able to execute the first couple of weeks of RDP1 with the only change being to not do the tempo intervals and instead just do a steady TRP run. The Sunday long runs have resulted in a pretty sore back on Mondays but other than that things are OK.
I agree that doing core work feels like a chore compared to S/B/R, but I'm grinding away at my simple 15 min. core routine 3-4x/wk. Definitely dialing back the intensity, both on the bike and run. I like my chiro, so I'm still seeing him once every couple of weeks. I think the term "chiro" means a lot of different things to a lot of different people. He's not much into the whole spinal manipulation thing, so I'm not sure that chiro is even the best term to describe him. Treatment is primarily ART and Graston, which is aimed at breaking up adhesions in tight muscles, and I feel like this helps me a lot, as tight glutes, hamstrings, and quads definitely contribute to my lower back pain.
Once I get some bike fitness back, I'd love to get together for a ride some time.
@John Katsoudas - the Chiro guy sounds like THE right guy to get advice from. Your original Spine guy telling you to stay off the bike & Run for 8 weeks was a guy saying, if you leave the disc alone, everything will lose it's inflammation and fall into place. NOT horrible advice FWIW.
I think I did a version of that. I happened to hurt my hammy end of June and stopped running, then the back a few days later. 2 weeks later I got on the bike. and I did something really not advisable, six gaps, a 130 mile 11,000' ride in VT, on my own, own pace, etc.. I did have one moment on a 23% climb where my back was screaming, but I mostly got through it. A couple of weeks later, I found that if I took a break 30-45 minutes into a ride for 5-10 minutes, my back would loosen up for the rest of the ride.
this past weekend, I did do solid rides of 80 & 50 miles with lots of climbing and virtually no back pain. I've now put in 2 short treddy runs as well. So I am hopeful it's coming back.
i am still not doing enough core and need to change that today.
Per what @Shaughn Simmons said above, if you do a lot of self care, on a daily basis once you get to a point that things are good, you can keep them there.
thanks for posting, a relevant topic for sure!
Great thread as I am suffering from LBP right now - but mine appears to be more muscular than nerve/structural. We believe mine is due to my glutes not firing properly and everything else taking up the slack - my back gets SUPER tight. I have been dealing with this in races for years but now it is daily. It got so bad this year that even just walking the dogs around the block was enough to end with me not being able to stand upright, or doing dishes would have be hunched over clinging onto a counter to support myself as I loaded up the dishwasher. Grocery shopping? Only if I clung onto the cart! I am now able to do major work and lift heavy things etc without pain but the tightness is what is getting beyond annoying!
I am going to employ some of the ideas from above - operation save the back in action!
@Jenniferlyn Kryvicky thanks for posting! Your experience sounds a lot like mine.
I thought I'd post an update. Several weeks ago I had an MRI which confirmed disc degeneration at the L5/S1 joint, along with an annular tear. However, both my doctor and chiro believe that my current problems are primarily muscular so they both suggested I hold off on an epidural cortisone injection unless I start experiencing the type of pain that is radiating down my leg again. Interestingly, they both independently told me that if a random collection of 50 year olds had MRI's of their lumbar spine, the majority of them would show signs of disc degeneration, but that it is normally completely asymptomatic, so this diagnosis in an MRI is not, in and of itself, a reason to do an epidural cortisone injection.
I've been continuing to see my Chiro for ART/Graston treatment, and I've also been doing PT for 4 weeks now, along with a lot more stretching and core work. Like @Jenniferlyn Kryvicky my issues seem to be due to lack of glute engagement. The PT clinic that I go to does 3D motion capture running gait analysis, and the results for me were very interesting. The video shows that I run very upright and sometimes even with a slight (1-2 degrees) backward lean, as opposed to the desired slight forward lean. I also don't have a lot of leg extension and have low feet on the recovery. In short, very little glute and hamstring engagement when running. since then I've been focusing on running with a forward lean, and running in what seems like an exaggerated "butt kicker" running style. When on the treadmill I'll start off at an incline of 5-6 for a few minutes to get that feeling of a proper forward lean, and when running outside I'm running more hills. The result is that my glutes and hamstrings are absolutely wrecked after longer runs. I take this as a sign that they were not being recruited at all before, as this feels like a very different style of running for me.
PT is also focused on things like squats, deadlifts, single-leg hip bridges, elsastic band side steps, and assorted other exercises that I've never really focused on.
In terms of training, I'm wrapping up RDP2 this week and I'm pretty excited that I've been able to train for 8 weeks now. I won't say it's been pain-free but it's been a gradually decreasing level of pain and I feel like I now have a good team around me and have a good understanding of the issue and a solid plan to address it.