This week marks a full year elapsing since the last time my lower back had a major meltdown, or a "flare up" as I usually call them. If you're struggling with back problems, maybe something here will be helpful to you. If nothing else, hopefully it'll serve as a reminder that it is possible to overcome this stuff, at least some of the time. I've been looking forward to writing this for a long time. Hopefully it doesn't jinx me. :)
When I was a kid, I remember my mom being laid up a time or two with back pain. I didn't really understand it at the time, but it does run in the family.
In my early 20s, I noticed that sitting in the wrong kind of chair for a long period of time would cause me to be very stiff when I stood up or just have general dull pain and stiffness in my lower back, specifically right at the base of my spine to the right between there and my right hip bone. I never gave it much thought - occasionally it would get bad and I learned a good brisk walk, especially with some uphills, helped calm it down. I also started to develop a way of moving that protected it. I never really noticed it but I tended to squat down instead of leaning over, or I'd only lean over to the right, leveraging the more functional left-side of my back. I'd do this without even thinking about it. Things persisted this way for most of my 20s and it wasn't that big of a deal. I often tend to put up with things if they're not a big impact to my life, which isn't always a good trait. In any case, it was a mild-to-moderate chronic issue.
In 2003, I went to the driving range with a friend of mine and hit a bucket of balls. Afterwards, my back was tweaky, and I ended up having a very long workday the next day - 12 or 14 hours. My back was bothering me more and more during the day. By that night I was starting to get very uncomfortable. The next day I tried my "walk it off" technique to little avail. In fact I noticed that if I flexed my core in just the right way, the pain would be so severe that my legs would start to buckle. I wasn't comfortable sitting or standing, and the best I could do to sleep was to lie on the floor. I still hadn't gone to see a doctor for whatever reason. I soon discovered that ice helped, and I started icing it like crazy. I was Best Man in a friend's wedding that weekend and spent a good part of the night going back and forth to the kitchen at the receptoin site to load up zip-lock bags with ice. I'd stick them down the back of my pants and then try to lean on something if I could. With a tux jacket on, it was totally hidden and made me functional. After a few days, this worked itself out and started to get better.
A few months later it happened again - but this time something was different. After the acute stage passed, I was getting constant dull, aching pain down my right buttock and leg. Constantly. It slowly got worse. Usually I had to sit down on the floor to get my right sock on. Doing it from standing was out of the question. At this point, I started looking for specialists to look at this thing. I was dating a woman who was a doctor of internal medicine and she had some good advice. One thing she said was "when they MRI you, they WILL find something wrong." Her point was that tying a physical issue from the MRI to pain/dysfunction wasn't quite a science. There's people with all kinds of bulges and whatnot with no pain. There's people with awful pain and no obvious phyisical issue. It's random.
I went to a Spine & Sports clinic and saw an orthepedic doctor up there. He seemed very bright and I liked and trusted him immediately. We did the MRI (which was awful by the way - laying on my back at that time was incredibly painful), and found a nice fat disc bulge at L5-S1, on the right side. He put me on a big-daddy anti-inflamatory (Bextra) and sent me off to PT. His prognosis was that these things tend to self-resolve in "6-18 months". I was a little surprised by this - that's the best you can do? I'll probably be better within a year or so? Y You went to how many years of school for that?
So I went through 6 months of PT that I found to be not terribly effective. Many of the things they had me do seemed totally random compared to what was going on with me. The Bextra helped take the edge off, and yes, after 6 months I was better. But I'm not super-confident the PT had that much to do with it. It was now the summer of 2004 and I started my triathlon "career". The back wasn't much of a problem for this fortunately.
In November of 2004, a friend and I took a trip to Australia and I had another flare up. Not as bad as some of the prior ones, but not what you want to be dealing with on vacation. I'd had enough.
When I got back, I asked around and decided to try out a chiropractor. People have all kinds of ideas about chiropractors, some of them based in fact and some not. In any case, I started seeing Dr. Michael Downey, who's office is very near to Microsoft so it was convenient. He did a full workup on me - took x-rays, took a bunch of measurements, and put me through a bunch of diagnostic moves. His conclusion was that the bulge in my disc was a symptom. I had a slight leftward curve in my spine (hence the bulge to the right) and very little of the forward-curve you're supposed to have. My body weight would tend to sit right on my spinal column rather than on the vertabre. All of the musculature of my lower-back had developed all this guarding behavior to compensate with that. Once triggered, it would spasm and lock up everything. Even at this point, this was *the best* medical experience I've ever had in my life. I always felt that Dr. Downey was personally invested in fixing me. He was always straight-up with me but also always very clear that we were going to nail this thing, come hell-or-high-water. He commented that my tolerance of this situation had allowed it to advance far past what most people are able to put up with, which meant we had a little extra work to do.
We set about addressing these issues and within weeks I was no longer getting pain down my leg and my mobility had improved significantly. I was still "tweaky" but much better. As a phase two, I did several deep-tissue torturemassage sessions with an LMP in the area. The combination of these two things made a big difference and I was on my way. We tapered off the chiro appointments as time went on until I was down to one a month. My day-to-day state was much better, though I had a small flare up in May. I wasn't sure what to make of that.
As of early in November 2005, I hadn't been in for an adjustment in several months. I was doing some core-work one morning and I kind of moved wrong and felt my lower-back tweak a bit. No big deal - I just tried to stretched it out. Within an hour it was clear that I wasn't going to work that day. Within three hours the pain was so bad I couldn't do much of anything - talk on the phone, watch TV, nothing. I was constantly in pain and if I moved wrong it was unbelievable. You know how if you have to do go the bathroom *really* bad, it's hard to think or concentrate on anything? Yeah, it was like that, but for days.
The muscles in my lower back had spasmed so bad that if I stood relaxed, my shoulders would be offset about 4" to the left of where they should be. It looked freakish, I should've gotten a picture. My girlfriend (by this time I'd started seeing Deb) came over the next morning to take me in to Downey's office who was going to squeeze me in. The look on her face when she saw this posture was, well, frightening. She tried so hard to hide the shock, but it didn't work. It took me 12 minutes to get a pair of warmup pants and socks on (I refused to call down to ask for help). 12 minutes. Standing straight and flat footed, I could only raise my right leg forward by about 4" - basically I couldn't get my right heel past my left toe. In contrast, I could raise my left leg all the way up so it was parallel with the ground. Downey did some X-Rays (no herniation or anything) a little bit of work on me but told me I was going to have a "long weekend". See, he's honest. By Monday I was starting to be able to move around again, kind of. I missed a few days work. This was getting old. This was happening every six months. That had to stop.
It was seeming more and more like a muscular issue - basically with the right stimulus, a cascasde of spasms and inflamattion would happen and it seemed to be unstoppable once it got rolling. I went in for some more work then tapered off again. Again I had a flare up - one year ago, the week before Memorial Day - in May 2006. It wasn't a terribly bad flare-up (nothing like the prior November) but it was bad enough.
I had a heart-to-heart with Downey about what's next. His take was that my structure was fine now - everything was stable and was in the right place - but the Psoas Major just didn't want to play nice and was causing all these issues. He had been telling me this all along but I never fully "got" it until then. He suggested a few possible routes. One was a 10-week Rolfing program to get that Psoas to be a team player. But that would be 10 weeks of no training as well, and it wouldn't be covered by insurance. I didn't want to take 10 weeks off training unless it was guaranteed of fixing this. The other option was acupuncture, which I was open to.
In addition to this, I did a bunch of research on my own. Many people had talked about the linkage between hamstring flexibility and lower back problems. I also tried to find as much I could about the Psoas and how it can be stretched, what it's antagonist muscles were (I think that's the right word - like bicep vs tricep, engaging one shuts down the other), etc. So I got some books with some Yoga stretches for the lower back and started doing those stretches every day for 10 minutes plus a bunch of work on my upper hamstrings. I developed a little sequence of stretches that I would do every morning after my workout.
This made no difference, at least immediately. But a few months later I noticed a few things slowly happening. I was no longer bound up when lifting my right leg. I could comfortably lay on my back. I wasn't uncomfortable sitting straight-legged on the floor or after sitting for longer periods of time. This paid other benefits as well for me. I was able to raise the saddle and lower the handlebars on my time-trial bike which means better aero. Last time I was at the PT and they did hamstring stretches I got a "good" for the hamstring flexiblity test instead of "poor". Yes! That's right - I went from a chronic, major back problem to fully functional with 10 minutes a day of stretching.
And so now it's been a full year. I've done an Ironman without my back being a factor. If I slack off on my stretches, I'll start to notice things. Sometimes my lower back will feel tweaky - but now I can stretch it out and it's better. I think I've actually had "flare ups" - but now they're so minor that I hardly notice anything but some stiffness that passes. I haven't had leg pain in well over a year.
My sense is that the work I did with Dr. Downey fixed the structure and allowed me to get to the muscular issue. It's also allowed me to do a bunch of other things people along the way told me not to. More than once, people said "maybe you just can't do all that training/running/biking". I never listened to them and now I'm glad I didn't, because they didn't know what they were talking about.
If you're struggling with back pain, consider the following:
1) Be open to alternative treatments that don't involve drugs or surgery. Pick what's right for you. Get multiple opinions.
2) Invest in flexiblity. Start small. Do it religiously. Consider Yoga from a well-qualified instructor who understands your limits (it's my understanding that studies have shown Yoga to be more effective in treating back pain than any drugs or surgery - I haven't seen these studies but that doesn't suprise me if true).
3) Do research and ask questions. The more you can understand the mechanics of what's going on with your body, the better you will be able to address it and understand the advice others are giving you.
4) Be wary of people that advise you to stop doing things. Your back problems won't go away if you stop golfing/skiing/line dancing. They'll just show up somewhere else. Focus on fixing the problem, not avoiding the symptoms.
I was slow on the uptake, but I simply refused to allow this problem to control my life. I'm fortunate that I was able to win that battle but I see so much out there about people suffering with back pain that I truely wonder how many could get past it with the right help and the right motivation. Maybe if you're reading this, you can too.
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UPDATE: Because this wasn't long enough already :). Matthew asked about my stretches, so here's the progression I use. Disclaimer: I'm not a doctor and I have no real training in this other than my experience, etc. Based on what's going on with you this may or may not be the right thing, so be careful, go slow, and listen to your body.
Recommended reading: Relief is in the Stretch by Loren Fishman
In the meantime, here's my progression. For ALL of the hamstring work I focus on upper hamstrings, meaning I keep my lower/mid back straight and my shoulders back. I don't hunch forward. I originally learned this stretch because it's specific to the position on the bike - think of how you bend forward at the hips on the bike, not throught he spine.
1) Single-leg hams. Sit on the floor with your right leg extended and your left leg bent so the arch of your left foot is against your right lower thigh/knee. Lean into this stretch with your back straight. If you can go very far, and you're not a ballerina, you're doing it wrong. I usually do this for about 30 seconds, just past the point of tension and just try to relax into it. Repeat with the other leg. An alternate of this is standing. Just put your heel on some stairs or a chair, keep that leg straight and lean into it. I do this at work when no one is looking.
2) Both leg hams. Same thing but with both legs out. I still can't go very far, but the BIG differnce for me is that this used to really hurt my lower back and I could feel it bind up. One of the first thing I noticed when I started "Breaking through" was that I could do this without pain (other than the normal stretching feeling).
3) Butterfly stretch. Sit and bring the bottoms of your feet together with your knees out. Put your elbows on your inner thighs and lean into a it a bit. Again, keep that back straight!
4) Pretzels. These are good lower back stretches. Sit with one leg straight, and bring your other leg over it bent. So if your right leg is straight, your left OUTER ankle bone should be against the OUTSIDE of your right knee. This is like crossing your legs in a chair but your knee is pointing up instead of to the side. Now take your right elbow and put it on the OUTSIDE of your LEFT knee so your chest/shoulders are pointing LEFT. Now relax and turn at the lower back, using your right arm as leveage against that knee to turn yourself as you relax and get more flexible.
5) A Yoga stretch called "Ardha-matsyendra". This one is really important I think. It's similar to the pretzel but it opens up the SI joint and stretches the piriformis muscle. Really breath into this one.
6) My Modified Warrior. If you're a Yoga person, this is similar to warrior. Basically, put one leg forward and the rest on the other knee, like a lunge. My goal here is to really stretch out that hip joint by leaning into that knee that's on the ground - I push forward with the hips and keep my upper body upright. You should feel this in between your hip bone and your groin. I love this one - when I do it right, I usually get a little "pop" on my right side and feel a bunch of pressure release. You can do some other things here. One is that you can put your weight backwards onto that knee and get a good hamstring stretch on the leg that's forward. You can also strecth your calf achilles on that leg if you keep your heel down.
7) Quad stretches. From (6), you can reach back and grab the angle of your down leg and pull that guy up. That'll stretch your hip and quad. Otherwise, just stand up, lean on the wall and to your normal quad stretch thing.
8) Standing hamstring - usually I just do both leg, again keeping the back straight and leaning over. At this point, I'll usually do a deeper, lower hamstring stretch allowing my back to relax and my upper body weight to pull on the stretch. This is the classic Yoga thing.
9) Finally usually I'll interlace my fingers and put my hands straight above my head with my palms facing up (again, classic Yoga move) and then lean right and left which gives a great stretch through the obliques, lats, and middle back.
That's basically it. I'll often throw in an IT band stretch or some light calf stretches. I could probabably stand to do more of that. I'll also mix some core work in here - alternating between crunches and stretching.
This whole progression takes about 10 minutes if you really do it right, and you can speed it along to make it faster than that. I try to do it every day, and it's best done after some other kind of workout when you're nice and warmed up.