Bill - low back problem, need advice

[phizer]

Hi Bill (and others),

Here is my situation: I have had minor and intermittent low back pain for several years, and a few months ago, I hurt it by losing form when doing dead lifts. I have been going to a chiropractor regularly, and she ordered a bunch of x-rays. The report says that I have a "Mild disc space narrowing of L4-5". I asked my chiropractor if she though that I should take any special precautions while working out or playing sports, etc. and she suggested that it may be wise for me to avoid/limit heavy compression of and impacts on my spine, in order to slow any degradation of this problem. That kind of puts a damper on a bunch of exercises, like squats, dead lifts, and most explosive lifts, and most contact sports.

In a somewhat related issue, my flexibility in my hamstrings/posterior chain sucks.

Do you agree with this recommendation, and can you make some suggestions about what kind of things I should and shouldn't be doing in my training? My main goal is athletic performance.

Thanks for any advice,
Phil

[Bill Hartman]

How old are you?

What sports are you involved in? at what level?

Bill

[phizer]

I'm 23 years old.

Currently, I am not involved in any sports outside weight training and running. In the fall, I will probably join a martial arts club (intramural), and next spring, I would like to play club rugby, and try out for the varsity team in the fall.

[Bluevan]

I have had back trouble for years. A MRI last fall revealed a herniated disk between L4 and L5. I would recommend "The Back Relief Book" from Health for Life. My doctor said I didn't need to go to Physical Therapy, just follow this book. It has helped me tremendously. It explains what can go wrong and how to fix it. It is full of routines for atheletes, bodybuilders and the common man. Hope this helps.

[Owen70]

Lay off the back, at least deadlift-wise, and any squats over %90 percent intensity for a while. Just let the disk recover a little. Meanwhile, consider doing some reverse hypers, light good mornings, and hyperextensions. Stretching will also help, dynamic and static, though mostly static. If you have a tight posterior chain, then your hamstring with tighten, which will cause a pull on your back, which is the cause of most back pain. Also, lay off the leg press, as excessive loads on this cause compression of the sacroliac joint(low back area.) And consider a change to front squats, as these will allow you to remain more upright throughout the lift, therefore less risk will be had of hyperextension of the spine and therefore excess compression.

[Jean-Paul]

My first (unsolicited) advice would be to quit going to a chiropracter. They can't tell you crap about your discs based on an Xray. But they can charge the crap out of your insurance to do it. Do you know how many people have "compressed discs" and even "herniated discs"? If you put an MRI at the exit of a crowded theater (a nice, random sample of the average public), probably over a third of them (if not more) would have herniated discs. Fact is, even if it is, that doesn't necessarily mean you have to have it repaired surgically. In most cases, some form of physical therapy is what is needed. Whatever your problem is though, it probably does not require bi-weekly adjustments to keep you out of pain. I honestely wonder if half the chiros out there can actually accurately read an Xray. They know how to look like they know what they're doing so they can scare you into showing up ad infinitum for adjustments that will never make your problem go away.

Sorry to sound so cynicle. I would advise going to an orthopod and getting some real tests done if it is that severe. If they say it is muscular, then find out how much a round-trip plane ticket to Indianapolis is, and go pay Bill for some active release therapy. You will feel a turnaround in your pain very quickly, and you won't waste thousands of healthcare dollars lining the pockets of a chiropractor.

Aside from that, pick his brain about proper lifting form and start slowly building your back strength back up. There may be a weak link somewhere else in your posterior chain that is causing or referring pain.

[phizer]

Yeah, JP, I don't rely solely on the advice of my chiro, but I have had good experience with their services. I have found it to be a quick method of pain releif - but I know it is not a long term solution, and that there is probably some obscure cause that needs to be addressed in order to improve my situation for good.

One other comment: It wasn't actually the chiropractor who did or read the x-rays...the report came from the radiologist at the local hospital.

I really do agree with your suggestion to go see an orthopod, though...I have terrible balance, and it's mostly due to weak ankles. Perhaps I have bad mechanics that could be corrected.

[russ]

Quick comment re:MRI for low back pain. There was an article in a major Radiology journal about 2-3 months ago discussing this issue. Current thinking seems to be that MRI's main role is for patients with 'radiculopathic ' symptoms (basically, something is putting pressure on one of the exiting nerve roots of the lumbo-sacral spine) who are failing conservative (i.e., non-invasive) therapy after 3-6 months. Other uses for MRI in low back pain are in patients whose pain is unusual in character or patients who fit into the small group that will benefit from surgery (surgery should be reserved for a very select group of patients).

Chiropractors can be helpful for low back pain (though I've gone to a physiotherpaist when I've had spine-related problems), but if the pain isn't resolving after about 1 month of visiting the Chiro, then Chiropractic treatment isn't likely to be of further benefit.

[tones]

I have had back problems for almost a year now. I'm only 23 and its big unnerving to say the least. I believe the original cause of the pain was from a fall I had while playing baseball. I was running to first and I hit the bag, then slid across it (it was wet) and my foot/leg became fully extended when I hit the grass. The fall led to some serious hip flexor pain, which I still encounter and eventually low back pain.

The pain is current a severe tightness above my glutes but still below my back. Its the area directly above the muscle and it expands around to the hip. Unfortunately I haven't found much relief except for the occassional adjustment by a chiropractor. I have been to an ortho and he has put me thru numerous tests. MRI, bone scan, ct scan and x-rays. All of them were negative and he basically told me that there was nothing more I could do.

Has anyone experience pain in a similar area and found relief?
Can someone suggest a different method of treatment?

I've found the massaging the area and breaking up the knots seems to help but only for a short time.

As for the original poster...chiropractors have been beneficial in my experience but be weary if you do not feel better almost right way.

[Bill Hartman]

I certainly can't diagnose the cause of symptoms via forum, but at 23, back pain should not be an issue. Get a solid evaluation by a qualified practitioner and try to find out why you've been having ongoing pain for several years or at least address what appears to be the cause. A "quick fix" via chiro is not the answer (not that I have anything against chiros...some of my best friends are chiros ). You'll most likely find that you have some form of longer-term adaptation of flexibility, movement patterns, gross asymmetries, or whatever that are of greater influence than losing some disk space which is most likely asymptomatic.

For instance, your tight posterior chain may be an anterior tilt of the pelvis

You may also need to address some lifestyle issues that may be adding to the stress on your spine (like prolonged sitting).

Get those issues taken care of and then you can worry about deadlifts, squats, etc.

Tones,

Find a chiro or PT in your area that can address soft-tissue injuries (you can search for ART practitioners on www.activereleasetechniques.co m)

Bill

[tones]

Bill, the scenario you just described in that last post is very similar to what I have been experiencing. My chiro even noted that my pelvis is tilted. I also noticed that the problems got much worse when I began working 50 hours a week. I sit all day and it is very painful by the end of the day. Should I seek help from a new ortho? Are there any exercises that can be done to fix assymetries, etc?

[phizer]

Bill,

Sitting has definitely been a problem for me. As a student, I'm constantly sitting in class, or studying, and most of the jobs I've had in the past required seated work.

I've been doing physio for my ankles, but other things have taken priority in the last few weeks. I should probably get them to look at my back too when I resume appointments.

Thanks for the advice, Bill.