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Lower Back Pain - Soft tissue injury treatment
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By Paul Hunnicutt
From Boulder, CO
Dec 1, 2011
Half Dome

Two years ago I injured my lower back from overuse. I was using power tools on the ground, moving a lot of stuff in and out of a crawl space, picking up little kids, playing on the floor with them...many many activities that involved bending forward and pushing/pulling. Went to a doctor who ruled out any major structural problems and described it as a soft tissue injury on the ligaments/tendons/muscles in my lower back with muscle spasms. It is the muscles on the left and right side of my spine. Recommended muscle relaxants, vitamin I for flare ups, and PT.

The muscle relaxants knocked me out enough to be useless, vitamin I is not a long term solution and I never went to the PT - stupid I know. Two years later the problem still exists, but it is on/off again enough that I have not sought proper treatment. Finally I did have several orthopedic massages, which I think has helped and I am going to start PT asap.

I had been doing my own core exercises, icing, and going through several periods of not climbing and reduced activity in other sports. It has come and gone now several times, but this just isn't a way to live. I haven't climbed hard (for me) in two years and have not been able to put together any sustained period of good health since the original injury. However, as I said my self treatment has worked and I've been fine for months, then it comes back...I do another easing off and slowly building back and then feel better. It has turned into a chronic problem and cycle. The fact that I have two young kids in no way helps the injury (if you have kids you know). It isn't just exercise that triggers it...in fact almost the opposite. I can go climbing or cycling feel good, then come home and pick up a pencil and it goes. Just sitting in a chair some days hurts.

I'm writing to see if anyone else has had a similar injury and what treatments they have done to get better. Specifically:

Stop exercise until you are pain free? I can't seem to get pain free in any way currently (see the kids note)
Only do certain types of exercise until you are better?
Only do PT?
Do PT with a combination of lighter exercise - easy hikes, jogging, cycling maybe?, core/gym strengthening? maybe no climbing?
Icing? Heat?
Herbal treatments?
Acupuncture?
Diet? Gluten free? no or low sugar diets?

It almost seems like something that I have to work through. Work meaning core strengthening and actually activating the muscles. Not as in doing power deadlifts through the pain, but a gradual build up of strength and stretching over time. It would be really great to hear from someone who has had it and overcome it.

Thanks for any info. I'm in the north Boulder area and if someone wants to meet me locally to share their experience or has a PT therapist to recommend that would be awesome (have to be in north Boulder due to time constraints).


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By Luke W.
From Prescott
Dec 1, 2011
Avi

Pick up Healing Back Pain by DR. Sarno.

edit: If you are open minded and would like to give it a shot I will send it to you for free.


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By mattm
From TX
Dec 1, 2011
Grande Grotto

Luke W. wrote:
Pick up Healing Back Pain by DR. Sarno.

I've got issues with a book that says you can "think" your way to health... If there's something PHYSICALLY wrong with you, you need to PHYSICALLY fix it. Period

The renowned author of the classic Mind Over Back Pain has written a new guide examining revolutionary treatments to relieve pain without exercise, medication, or physical therapy.


You sound like you have issues similar to mine. I pulled something in my lower back participating in a company "olympics" and something akin to the "hammer throw" - don't ask. That tear/pull resulted in extreme spasming in my lower back. At its worst, I was nearly immobile, lying on the floor and even the slightest effort at movement would result in shooting pain. It took direct injections to the area to get the muscles to relax. Flareups would come every now and then, often from the most benign things (getting up from a couch a bit awkwardly, leaning over the sink a bit too long etc). The worst would require "the shot", many would require days of vitamin-I and muscle relaxants. VERY Frustrating, to the point of depression.

After A LOT of reading on my own I've found what I think is the answer to the issues I have (and hopefully you). The gist of it is you need to strengthen your inner core (not the 6 pack abs etc). The Magic words here are the Multifidus and Trans-Abdomial Muscles. These are what need work. They help to the support the (weak) spine, prevent injury and can shorten the recovery period when a relapse does occur. Since reading and starting on the exercises discussed in these books (along with finally understanding what the hell was wrong) my re-injury rate has PLUMMETED and the severity is much MUCH less. You still need to have the muscle relaxants and Advil around but you won't need them NEARLY as much. My last "injury" (After nearly 18 months with NOTHING) took all of two days to clear and involved me just taking it easy for a weekend. Far Far better than bed ridden for a week...

google back pain and the "australian method" as well...

book #1 - This one is more involved

Book 2 - Much more simple and really only a few exercises but this is what I used first and do 3x a week

There is hope and a solution! Seriously, I thought my climbing and even my love of participating sports might be at an end during the worst stretches. I still get PISSED when I get a re-injury but now that I understand what's wrong and know I can fix it, it is a WORLD of difference.


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By Peter D.
Dec 1, 2011

Find a PT or massage therapist trained in Myofascial release and they should have been trained by John Barnes, PT. What most likely has happened over time is you are no longer in proper alignment in your hips/low back and sacrum. After the initial overuse some areas tighten and developed restrictions resulting in compensatory patterns which now need to be addressed. Core strengthening should only be done only when you are in proper alignment. Fascial restrictions require pressure over time to release. Stretching is fine as is yoga however you need to increase the hold times to 3 to 5 minutes for each stretch.


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By mattm
From TX
Dec 1, 2011
Grande Grotto

Pete Dorsa wrote:
Stretching is fine as is yoga however you need to increase the hold times to 3 to 5 minutes for each stretch.


False - Studies have shown that there is little to no benefit to holding a stretch for more than 30 seconds and may even be detrimental (increase the risk of spasms).


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By Paul Hunnicutt
From Boulder, CO
Dec 1, 2011
Half Dome

mattm - thanks for the response. just ordered the book (more intense one). your injury sounds like what I have (including the depression/frustration) and it is a relief to know it can get better. your initial injury is almost exactly what happened to me, except I just over did it and woke up one morning not being able to move. at least the flare ups have never been that bad.

honestly the only thing that has worked has been exercise. especially when it first happened I made a concentrated effort to strengthen the core, but I need a much more specific program this time around and someone to teach me the exercises.

resting, stretching, icing don't seem to do much in the long term. actually doing nothing seems to be the worst.


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By Adam B
From Wheat Ridge, CO
Dec 1, 2011
Middle St. Vrain

I experienced compression fractures in my T12 an L1 spine due to a fall. Needless to say my back was pretty bad off after that. In my experience, core exercise that focus of spine stability helped the MOST. I know... Fracture is not the same as muscle spasms, but with every fracture comes muscle and ligament damage. Here is a link to a site which may help.

www.spine-health.com/wellness/exercise/lumbar-stabilization->>>

Here is a book you could check out that the PT gave me.

www.amazon.com/Spinal-Stabilization-Science-Back-8596-2/dp/0>>>

Disclaimer... I'm not an M.D.

GO CLIMBING! Climbing doesn't hurt... it's falling that eff's you up. Climbing helped me out a lot! I even built a bouldering wall in my shed to get strong again (Guess I'm still working on that goal!). Just me $0.02... FYI, I experience minimal residual pain due to the injury, and I believe the muscle pain was the hardest thing to overcome.


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By Paul Hunnicutt
From Boulder, CO
Dec 1, 2011
Half Dome

go climbing...best advice yet. :)


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By Monomaniac
Administrator
From Morrison, CO
Dec 1, 2011
Insurrection, 5.14c.  Photo Adam Sanders.

I have some tweaked areas in my back that flare up every couple of years or so. Doesn't sound as serious or debilitating as yours; I seem to be able to climb through it most of the time. Anyway, my humble advice is:

  • Sleep flat on your back.
  • Avoid sitting or driving for long periods, esp. sitting in awkward positions, like slumped on the couch. I work at a desk but I try tpo get up several times a day and go for a 5-15 minute walk.
  • Figure out if there is a specific movement that triggers re-injury. For me its crossing moves while climbing (anything that brings my elbows really close together. If you can identify the trigger you can avoind the movement or learn to be careful (slow, methodical and well warmed up) whenever performing that movement.


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By CascadeKid
Dec 1, 2011

I was diagnosed with degenerative disc disease at the age of 24 (I'm 32 now) from my L3 - S1. Each joint (3 joints all together) has varying degrees of stenosis, but I usually find myself laid up for a week or so each year. That said, I found Scott at Peak Physical Therapy (used to be in Table Mesa Shopping Center/Southern Sun Shopping Center) to be really good with my back. After being laid up for a week last year and unable to properly stand up Scott manipulated my back and I was "normal" within a week/3 visits.

The back is involved in everything we do, so it's one of those things you do not want to seriously screw up or damage any further. If you haven't had an MRI, then I would suggest you get one as it picks up things an X-Ray does not. Also, I cannot point to one injury or instance that screwed up my back.

Currently, I practice yoga 2-3 times a week and may be able to get through this year without lying in bed for a week straight. The feet still go numb when I sit, but I can live with that. I found a strong core to be critical to a happy and active lifestyle.

Best of luck with your recovery. Feel free to contact me at any time.


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By Morgan Patterson
Administrator
Dec 1, 2011
Stoked...

My PT folks have always stressed the most important thing to resolve back pain is proper posture... focus on that one and stretching and massage.


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By ErikaNW
Dec 1, 2011
Rapping off the Matron October, 2010

Hi Paul -
Not all back pain is the same, and you need to be assessed and have an individualized program prescribed. It sounds like you already have a good idea of what will work for you (you do better with exercise and core strengthening) but just need some more specific guidance. A good physical therapist would be able to assist you in that process, and can also provide direction in what you should/shouldn't be doing along the way.

A book can give you a good general strengthening program, and may have some great ideas, but it is not the same as having a hands on evaluation and a program that is specific to your needs, your diagnosis, and your personal goals.

Send me a PM if you would like info on good PTs in your area that treat spinal issues.

Disclaimer: I am a PT and professor in the School of Physical Therapy at Regis (research area is in spine biomechanics). We are also currently conducting research investigating movement patterns/muscle activation strategies in people with LBP (one 2-hour data collection session, get a $25 gift card to King Soopers or Starbucks) that you might qualify for if interested....

Good luck with whatever path you choose!

Erika


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By Peter D.
Dec 1, 2011

mattm wrote:
False - Studies have shown that there is little to no benefit to holding a stretch for more than 30 seconds and may even be detrimental (increase the risk of spasms).

True and not true. Plus you really need to look at how the research was conducted. Most studies look at intervals of 5 10 15 and have stopped at 30 seconds, I believe there was one done holding to 45 seconds.

What I am referring to is getting into the connective tissue or fascial restrictions that accompany many of these types of recurring problems. Yin yoga is gaining popularity due to lenght of time in one posture 2 to 5 minutes. As someone else wrote: proper posture is key, that is if you can get there on your own. Muscle imbalances are prevalent in low back injuries,key ones to look at are the: psoas - attaches to the front of the spine, the multifidii and parapsinals (back), the piriformis in the butt and the transverse abdominus (deep abs). All of these work (overwork)to help stabilize an injured area. Fascia or connective tissue is present in all tissues and forms an extensive network throughout the body. Osteopaths in particular are one of the few groups that have paid much attention to this system. Due to the viscoelastic properties of the fascia increased time with sustained pressure is required to attain a release. This can be done either thru manual therapy or maintaining a stretch for 3 to 5 minutes. Stretching for 30 seconds only begins to lengthen muscle being stretched and it will return to previous length shortly after the stretch is released. That is what most of this research has been about.

Paul: Like ErikaNW said "not all back pain is the same and you need to be assessed"
Thats a good place to start and there are a number of good PT's in Boulder.

Disclaimer: I am a PT in private practice in NY (17+ years clinical experience treating all sorts of things, lots of spine related injuries)

Pete


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By RMT
Dec 1, 2011

Luke W +1. I've given away at least 8 copies of his book. And no you don't have to fix it physically.


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By Smokemonkey
Dec 1, 2011
spot fire city

Ironic I looked at the forum today, I'm basically in a mirror situation. Years of smoke jumping and then abuse of my body cycling, climbing and other body destructive activities has left my 42 year old body broken.

My most recent episod was after hiking and the climbing grey rock in a record sprint. It left me a decision away from surgery. Three herniated and a majority of the other disc degenerating rapidly. Anyway, I got turned onto to a doc up in FTC from my surgeon, of all people. As he cautioned that surgery was about a 50% success rate.

Anyway, all of your mentioned treatments are great but I suggest you try this: www.spine-health.com/wellness/exercise/what-mckenzie-method->>>.

Outstanding drug and surgery free !

Email me if you want my docs contact info. He is one of the docs for the us judo team and knows how to help active and motivated people...


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By mattm
From TX
Dec 2, 2011
Grande Grotto

Pete Dorsa wrote:
mattm wrote: False - Studies have shown that there is little to no benefit to holding a stretch for more than 30 seconds and may even be detrimental (increase the risk of spasms). True and not true. Plus you really need to look at how the research was conducted. Most studies look at intervals of 5 10 15 and have stopped at 30 seconds, I believe there was one done holding to 45 seconds. What I am referring to is getting into the connective tissue or fascial restrictions that accompany many of these types of recurring problems. Yin yoga is gaining popularity due to lenght of time in one posture 2 to 5 minutes. As someone else wrote: proper posture is key, that is if you can get there on your own. Muscle imbalances are prevalent in low back injuries,key ones to look at are the: psoas - attaches to the front of the spine, the multifidii and parapsinals (back), the piriformis in the butt and the transverse abdominus (deep abs). All of these work (overwork)to help stabilize an injured area. Fascia or connective tissue is present in all tissues and forms an extensive network throughout the body. Osteopaths in particular are one of the few groups that have paid much attention to this system. Due to the viscoelastic properties of the fascia increased time with sustained pressure is required to attain a release. This can be done either thru manual therapy or maintaining a stretch for 3 to 5 minutes. Stretching for 30 seconds only begins to lengthen muscle being stretched and it will return to previous length shortly after the stretch is released. That is what most of this research has been about. Paul: Like ErikaNW said "not all back pain is the same and you need to be assessed" Thats a good place to start and there are a number of good PT's in Boulder. Disclaimer: I am a PT in private practice in NY (17+ years clinical experience treating all sorts of things, lots of spine related injuries) Pete


Interesting Pete. I haven't read THAT much about it but what you say makes sense. Is this related to "trigger points" in any way? Agreed that DOs seem to be more familiar with this stuff than most. I've had a general practice doc tell me I looked like I had "spinal fusion" of the vertebrae or something like that. Riiiggghht. Any more reading on the subject? I've found education helps filter the in the know people from the quacks...


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By Brent Apgar
From Out of the Loop
Dec 2, 2011
Me and Spearhead

Paul, Erika is right on the money. Given that the spine gets involved in anything we do physically, back pain can be a complicated problem to sort out.
Since yours has been going on for so long I'd say that some outside help is warranted in giving you some different ideas in solving the problem.

I haven't been in the therapy game that long but one thing I keep seeing in active people is that sometimes the problem is one of poor movement organization. It's not a strength problem it's that we can all learn poor movement patterns due to injury, overuse or simple repetition through training. If a poor movement pattern is the problem then you need to ID the problem and go through the process of re-learning(through practice) the correct/better movement pattern. Figuring out the problem and getting a program to correct the poor pattern(s) can be greatly expedited with the help of a good therapist.
Good luck solving the puzzle,
BA


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By Peter D.
Dec 2, 2011

mattm: Trigger points are essentially small fascial restrictions. If you apply pressure and hold it for 90+ seconds it begin to melt. Less then 90 you may feel small movements under your finger but this is just the beginning of releasing the elastic portion of the fascial complex.

Your spine appearing to be fused is most likely due to excessive tension in the musculature over time that has created a straight jacket like effect in the fascia. We can sustain a number of injuries or traumas but they accumulate until the one extra insult sends us over the edge. These restrictions can be "broken" down, released but it can take time.

if you google John F. Barnes PT, myofascial release there is more information there. I have studied with John since 1994 and repeat courses when I can. He (Barnes) and John Upledger developed similar ideas early in their careers and then branched off into developing there own methods. A lot of people say they do myofascial release therapy but (and I am generalizing here)they miss the principles. Many conventional PT's (and this is not meant to be judgemental) dis John's work. Admittedly there is some esoteric stuff but once you have experienced it yourself as a therapist its easy to realize he is on to teaching people how to help others heal. One of the main tenants in this work is you can only take your client/patient as far as you are willing to go yourself. Needless to say when a therapist gets to an advanced level of practice (taken all courses and repeat them as well) you have gone thru the gamet of experiences that your patients may only touch upon. We get into somatoemotional as well as mind/body aspects of healing. Like I said earlier, I have been at this 17+ years and treat as many as 35 people a week, in short I have seen some very remarkable recoveries. I view this work from the perspective of a continum from purely structural to energetic and all points in between. Its fasinating work.

Obviously I could go on, hope this answers some questions,
Pete


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