how to fix muscle imbalance in back

[backpainmom]

I'm a 48 year old woman. I'm only slightly (10 lbs) overweight, and in generally good health.

Two years ago, I was getting into better shape by joining a gym (I had been exercising at home for years before that). I was going to the gym a lot, doing aerobic machines and getting back into light weightlifting for the first time in many years. I was doing great until I did some light weights (2 plates) on the leg press machine (where you lie down and press with your legs). Something happened...my back didn't feel right. Note that I had slowly been building up to the 2 plates for MONTHS on that machine...and had done that same weight before!

I have a history of a herniated disc at L5/S1, so I assumed that something had aggrivated it. I was very careful for a month. But then one morning, when trying to clear some food that got stuck in my tonsils, I had a severe gag reflex and then my lower back went into severe spasm (esp. on the left side). It was painful as hell and wouldn't let up. I had to take narcotics and Prednisone to make it go away.

Like I said, that was two years ago. When the initial terrible spasm subsided, I was left with pain near the SI joints, and sitting was painful. As the months progressed, I went to PT, had acupuncture, tried Egoscue exercises, and osteopathic manipulation. As the months went by, each of these modalities would help a little bit, but ultimately the problem would not go away. A few months ago, I had some epidural cortisone shots, which have helped take the edge off -- but my back muscle still feel tight.

Now I believe that what is wrong with me is a muscle imbalance. The left side of my back feels tighter than the right side, no matter what I do. I often feel very stiff, and the stiffness moves around. Sometimes it's in my lower back, and sometimes in my mid-back. Daily I do various stretches for piraformis, hip flexors, hamstrings, and quadraceps. I also do some Egoscue exercises. I do a lot of walking (both on an outdoor track and treadmill) and some cycling on a Lifecycle. I take anti-inflammatories sometimes, and use a lot of heat to keep the muscles feeling loose.

One thing that really bothers me, which I believe is related to my muscle problem: I noticed that often when I stand, I am involuntarily contracting my gluteal muscles. For instance, if I'm standing at the sink brushing my teeth, I notice that my glutes are very tight and try to consciously relax them. This is not normal, and I don't remember doing this before my injury two years ago. I think that it is some sort of muscle compensation, but I have no idea what the real problem is, and my PT doesn't seem to have a clue, either. He did some movements on me and it only made me feel much worse for a week. I don't know if I'll go back to him. I had seen another PT, but she was only keen on doing core exercises. I'm not ready for those yet. I tried some for a few weeks and it flared up my pain very badly.

I would appreciate suggestions that anyone could offer regarding my problem. None of my practictioners seems to be able to truly help me. I can't lift or carry anything heavy because immediately my middle to lower back begins to hurt. I can't even push a halfway heavy shopping cart in the store without my back beginning to hurt. I HATE THIS!!!!

My core is totally out of shape, but if I try to do core exercises it hurts my back. McKenzie back extension exercises usually hurt me, as well. The most success I've had in these two years has been with a few Egoscue exercises and some treatments from the osteopath. But I'm reluctant to go back to the osteopath, because often my back will hurt worse for weeks from his treatments (eventually it feels better, but again it doesn't seem to cure my back pain). The osteopath has told me that I have very tight facia on the left, and that my sacrum is often twisted. The orthopedist who gave me the epidural injections laughed at that statement and said that there's no way a sacrum could get twisted. WHO DO I BELIEVE??!!

Lately I'm "functional." I can go to the gym and do my little aerobic workout (treadmill and biking). I have some pain and discomfort but I just deal with it "as needed." But I'd really love to be normal again and do the other things I used to. I hate this cycle of waking up every morning and wondering how my back will feel today...will I be able to do the things I want to do....and feeling like a semi-invalid, relying on my kids and husband to do the "heavy" work around the house that I USED TO be able to do!

[UConnJulie]

What's your flexibility like?
Do you have a foam roller? If yes, are you rolling regularly?
What have you done that has helped the back the most? What has bothered it the most?
Have you had any imaging done (x-ray, MRI, CT Scan)?

Care to post a photo? Shoulders to feet (barefoot) ... relaxed standing ... front, side, back views.

[backpainmom]

I've always been very flexible. I can touch my palms to the floor. Side to side sometimes may hurt a little (lately it's OK, but sometimes the left side feels very tight). Bending backward seems OK now, but sometimes that may hurt a little, as well. I've never been very comfortable bending backwards and often avoid it.

I've had 2 MRIs in the past few years. The most recent one shows that my herniated disc has gotten a little bit worse. I apparently have some arthritis in my spine and the normal spinal aging stuff you'd expect to see in someone my age (discs beginning to degenerate, etc).

I do have some foam rollers. I have tried doing the rolling of my back, hips, glutes, and legs for a few weeks (got instructions online), but it didn't seem to do very much for me.

I have investigated the trigger point stuff, but doing it myself with a tennis ball was extremely painful, so I had to stop.

What has helped the most in the past two years was some of the Egoscue exercises (static back, static wall, and wall sitting particularly), and the osteopathic manipulations....but as I said, I'm hesitant to go back to the osteopath, because (at least in the beginning of treatment) he makes me feel much worse for a number of weeks, which is both alarming and depressing.

Four years ago, when I hurt my back lifting furniture, acupuncture and a series of very painful shiatsu massages made my pain go away like a miracle, and it stayed away for almost 2 years. I think in the shiatsu massage, she was massaging my trigger points. It hurt like hell and left me with some bruises. So although it may have helped, it was quite an ordeal to suffer through.

Before that, when I'd hurt my back doing something (probably lifting something heavy), PT exercises helped me within a few weeks, and the pain stayed away for several years. I continued to do the PT exercises regularly, but hurt myself again, despite supposedly being strong from them.

But now....I've tried all those things again, and they didn't work like before. The acupuncture had only a limited success. The shiatsu massage was again very painful and I just couldn't stand it so I had to stop. The PT had some limited success, but ultimately it made my pain worse, so I stopped doing it. Exercises that used to help me (bridging, for example) now only hurt me. So I was left very confused and frustrated. Every time I thought I'd found "the way" to correct my pain if it came back, that "way" no longer worked as well the next time....or at all.

What does NOT help is anything that involves lifting a weight. In the most recent PT I tried doing (core strengthening that the orthopedist suggested), the moment they put even a light ankle weight on me, my SI joints began hurting again (big painful flare-up).

I think that I just need to correct this muscle problem before I do anything else. Otherwise, it seems to me that I'll be strengthening the problem, not creating a solution.

The newest treatment I've come across involves Joseph Hanna and his Somatic exercises. I'm trying to get in touch with a practicioner in my area. Someone also mentioned a book about the multifidus muscles, and I saw it online....they are mainly exercises I had done LONG ago, but had forgotten about, so I may explore that, as well....although I'm extremely hesitant to do anything that involves ankle weights (which the author has you doing after a number of weeks).

I will try to post some photos in the next day or two.

I appreciate your help.

[UConnJulie]

I meant leg flexibility (hamstrings, quads, hip flexors, glutes, calves, etc.) ...

Regardless ... what you describe is most likely trigger point pain. The fact that it hurts so much to do with a tennis ball (or the Shiatsu massageg) says that your muscles are screaming for some relief.

I highly recommend you get the book Amazon.com: The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition: Clair Davies, Amber Davies, David G. Simons: Books He does a great job at explaining the "whys" as well as the "hows" of self-treatment.

I can also highly recommend Maitland practitioners ... I'm not sure where you live, but any of these practitioners would be able to determine the source of your pain and help to systematically identify things to do to make it better. MAPS: Maitland-Australian Physiotherapy Seminars

[backpainmom]

Thank you for the info about Maitland. I've never heard of it. Through the website link you gave me, I have contacted a therapist in my area to investigate it.

I'm hesitant to do any self-trigger point treatment, because of the extreme pain I had with the tennis ball (although possibly I wasn't doing it totally correctly). But perhaps I'll get the book to better understand the information. I often wonder if the Shiatsu massage was so successful several years ago BECAUSE it hurt so much -- because ultimately, the massage therapist was able to "release" what was tight.

Regarding leg flexibility....it's hard to say. Some days I am extremely flexible and other days I seem a bit stiffer. I've always done a lot of stretching. I know that flexibility in the quads, hip flexors, glutes, and calves is important to help prevent back pain. But lately, even if these areas seem very flexible, I still have pain and discomfort. I do stretches for these areas every day.

[UConnJulie]

Get the trigger point book (your local bookstore likely carries it and it's less than $20 I believe) ... it will explain a lot about trigger points. It will hurt a lot in the beginning, but as you work them out, they become less painful.

The Maitland therapist will help ...