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Thread: Lower back pain

  1. #1
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    Lower back pain

    This is a cut and paste job I sent to a doc on an aviation forum I use. My real question to you guys that have had back trouble, does this sound like what you went through before being diagnosed? After reading another post, I am beginning to think I might have a herniated disc.

    .....

    History
    I am a former competitive cyclist who has been pretty healthy with no major health problems. When I was in high school, I did injure my back in a crash, but was better within a week or two and never thought much about it. Toward the end of my competitive racing, I was getting dull lower back pain at the end of a 2+ hour race, but didnít think much of it, other than being fatigued and beat up from the race. I stopped racing about 5 years ago and have ridden for fun since and have had no problems to speak of with my back.

    Current State of Affairs
    This year I started riding a lot more, you could even call it training, in hopes of racing my mountain bike again this year for fun. I built up my mileage and strength using a much lighter version of a training program I used to use. In other words, I played it smart and built up my endurance and strength steadily since the early spring being careful not to over train early.

    About 7 weeks ago I was out on a training ride on my road bike and did a short ride with some hard efforts. I did 3 intervals of medium-hard intensity and called it a night. The next day I woke up with some pretty bad lower back pain. I didnít think much about it at the time and thought maybe I twisted something maybe working in the garage the previous evening. I went on vacation, swam and hiked a little and my back - while still sore - wasnít doing too bad.

    About 3 weeks after the initial soreness I got back to riding and doing more things around the house and that is when I really started to have problems. I woke up one morning and could hardly move. I could only stand long enough to use the restroom and had to immediately return to the couch. I spent the entire day on the couch. This event happened again a few days later.

    I subsequently went to my AME who is also our family practice doctor. He had me do lots of bends and stretches Ė all of which I did with ease and little pain - but was convinced it was a sprain and nothing to serious. He asked if there was any pain in my legs, which there has never been, ruling out sciatic problems. I only have slight tenderness to the touch in one spot, but nothing too bad. He prescribed some Celebrex which seemed to help, but that has since ran out.

    This evening I once again tried to do a very easy ride on my road bike on flat terrain and still had pain. I came back to the house and switched to my mountain bike which has a much more upright position and it felt better although I wasnít feeling great. I rode around for about a half an hour in all and donít feel too bad right now.

    My real question is, should I see seek further help from a PT or nerve specialist? Or should I keep taking it easy and give it more time to heel? I am about to upgrade to captain and will be in training full time starting in a week. I feel this week might be my last opportunity to see someone else about my back for quite some time.


    Sorry for being long winded, I really appreciate any insight and help!

  2. #2
    Your bike is incorrigible
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    I'm going to follow this thread.

    I crushed some lumbar vertebrae about 15 years ago. I didn't think too much of doing the prescribed exercises, and this has led to pain every ride. It usually takes about an hour before I start to feel it, and it usually is a dull ache (like you describe). However, midway through the last ride I took, the pain got worse. I've been taking it easy (heating pad, muscle rub, stretches), and it seems to come and go now. What worries me is that something is wrong besides weak muscles.

  3. #3
    recovering roadie
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    Could be a herniated disc, but with back issues like this, you should really have it checked out by an expert to rule out issues that could cause you to do additional damage out of ignorance of the root problem. Nothing with your spine is worth any risk.

    I would advise you see a physiatrist, neurologist, orthopedic spine specialist, or an excellent PT with experience in spinal issues. I've had bad luck with multiple chiropractors and PTs in my experience - you have to find someone with lots of training in spine issues.

    I did additional damage to my herniated disc through the denial phase and through bad professional advice.

  4. #4
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    Obviously it's hard to say just based on what you've written, but you certainly need to get it checked out. I have been dealing with severe lower back pain for the past 3 months and back pain in general for years.

    My recommendation might be somewhat different from others, but I would suggest finding a PT that you trust and then asking them to recommend a doctor. I started out by visiting a doctor (DO) that was recommended by someone at work. He was extremely dismissive of any questions that I would ask and also seemed more determined to hear something crack during my visits than actually trying to understand/treat the problem. From there I went to physical therapy, which I found extremely helpful. After a few weeks of that, I was still having a lot of pain down my leg, feeling like an electrical shock or bee sting, especially in the shin area. They recommended a doctor at a rehab medicine place. He immediately ordered an MRI and, sure enough, I have a herniation of the L4-5 disc as well as slight herniation of the L3-4 and L5-S1.

    I've been off the bike (and haven't really been able to do much in the way of exercise) for a bit over 3 months now. I really wish that I'd gotten all of this checked out last year, when I first noticed a lot of pain while riding. I have a feeling that if I'd gotten the appropriate PT at that time, I would have had a much better season of riding, and wouldn't now be dealing with the disc herniation.

    Bottom line: deal with it now, rather than later, because it will likely get worse if left on its own.

  5. #5
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    I really appreciate all the responses - thanks much!

    Those of you with herniated discs - how did it happen? Was there trauma to the area like a crash? Or did it sort of magically appear like mine has done?

    BTW - back feels decent today after my spin last night. I feared worse, but so far so good.

  6. #6
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    I'm still not entirely sure at what point I herniated the disc. It could have been something that developed over time or it could have been a singular trauma. Three months ago when I really injured it I was rock climbing and just sort of twisted the wrong way. That was pretty much immediate pain and it was another three weeks before I could walk without leaning heavily to one side. It certainly doesn't sound like you have a herniated disc to me, but that's just my impression.

    Even if you're feeling better, I'd still recommend seeing a PT to go through some stretching and core strengthening exercises. Tight hamstrings can be a huge contributing factor, pulling the pelvis out of whack and causing a lot of stress on the back. I have a feeling that's how this all started for me (doing the hamstring stretches at the PTs, they were bringing over other people so that they could all share in the awe that was my lack of flexibility).

  7. #7
    recovering roadie
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    Not really sure how I first injured my disc either. Mine is L5-S1. It started hurting 5 years ago in a mountain bike race, then got better. Then it would get bad after hard road rides. Now it hurts after pretty much anything. I've been treating it conservatively for a long time, and am researching more invasive procedures, like IDET. Wish me luck.

  8. #8
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    Last summer I had what can be compared to a slipped disc...it came out of alignment, and resulted in constant pain in my lower back and right thigh. I went to a PT/chiropr (with a lot of resistance on my part...not a fan of chiros), and after a month or two of 2x/wk visits got better and finally back to normal.

    Now I try to do specific exercises on a regular basis since I spend alot of time on the bike.

    My suggestion...seek out a PT or group that specializes in sports medicine ASAP.

  9. #9
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    The advice so far given is great. I have been dealing with a bad back since I was 17-18ish. I first herniated mine during football and was first laid up when I lifted a fridge into a truck by myself (yes, very foolish). I never took care of it then, kept playing ball and only did enough PT to keep me playing. During the off season I just kept lifting and kept everything around the waste strong and I did not notice the back deterioration. I think I herniated my second disc when I was about 27 by landing on my head while playing around. Over the years between the first and second injury I visited a few doctors who would only take x-rays and order PT. I did have a bone scan when I kept complaining and that is when they noticed some damage (at the time of the bone scan I only had one herniated disc). Fortunately for me all the doctors I went to were sports doctors and they said they would not operate until I was in severe pain all the time.

    Well, two years ago I was laid up for 3 days and not able to walk. This happened after I did a 32 mile road ride, it felt great after the ride but 2 days later the pain set in. I then called around looking for a spine specialist and a back specialist PT. I found both. At this point I found out I had herniated L4-L5 and L5-S1, had some lethesis and also have some arthritis. I have been battling pain for the last 2 years but feel I am getting somewhere now. Still no surgery and not expecting any. My doctors are working to try and find the root of my pain and see what starts it. I have had quite a few cortisone injections, 3 epidurol, 3 sets of 6 branch blocks (in the facet joints) and 1 set of radial frequency treatments which they use elctric to isolate the nerve ending then they burn it. During that time of very little pain I work at making everything in my core stronger, it has been very difficult to get stronger but the muscles are starting to work with me. THE BIGGEST THING I HAVE LEARNED IS TO STRETCH BEFORE AND AFTER EACH WORKOUT whether it is a ride or visit to the gym. The stretching is specific for the back and the surrounding muscles. My PT found out (immediately) that a few muscles were firing at the wrong times. She attributed that to my body working around the pain for some many years. I also have an at home e-stim machine and use it when I really have a hard workout or if I have back pain. I am thinking about acupuncture and yoga which were both recommended by my PT too.

    I am still no where near 100% but I am working towards it, I do have setbacks but have grown to know that with some rest I will get back out there. I do road ride and mtn bike now as well as ski (snow). I can't go as long as I used too but I think over time I will get back up to where I want to be. I did invest in a new mtn bike which had a better upright riding position, the next purchase will be a road bike with better seating position as the one I have now does not feel good after 20 miles.

    If your in the MA area let me know I can recommend my doctors to you so you could get their opinions.

    Good luck!
    Last edited by skiierx; 07-09-2007 at 11:47 AM.

  10. #10
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    It's really interesting to hear from other people who have been through this kind of thing. I'm 27 now and I'm hoping to avoid more serious issues in the coming years. For sure it's something I'll be very aware of in all of my movements and activities for the rest of my life. I'm dying to get back to riding (or anything physical, really), but I'm trying to be conservative and keep my long term health as my primary concern. Easier said than done. My overall pain level and range of motion isn't all that bad, but in the standard "reach down to touch your toes" test, I'm lucky if I can get my knees. I'd probably have a hard time even getting into a reasonable riding position on a bike, but maybe I can start on a trainer in the near future.

    I had an EMG/NCS the other week to test for any loss of nerve function in my left leg (the side I've experienced symptoms in as well as the side that the herniation is mainly present). Because everything was normal there, I've started on a conservative path. I just finished a few days ago with a 6 day "dose pack" of steroids in an attempt to reduce the inflammation somewhat. It's hard to say whether or not this had a significant effect, but I am feeling slightly better each day, although there's still the bad one now and then. I'm supposed to go back in in a couple of weeks to go over my progress and possibly consider a cortisone injection or epidural. In the mean time I've been continuing with the PT and working like crazy to increase my core strength. If nothing else, at least I feel like I'm doing something positive, which can count for a lot.

    Skiierx, what was your impression of the cortisone injections/epidurals? I'm just wondering in case that ends up becoming a consideration.

  11. #11
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    Great advise folks. Before my recent tailbone issues I had herniated L4-5 about 10 years ago and went through lots of PT and injections to reduce inflammation and pain. Cortisone can be very destructive to the surrounding tissue and muscles. My Dr.s at the time really went aggressive with the cortisone trigger point injections which probably saved me from surgery but have done some permanent damage to the area.

    Your pain sounds like more than general stiffness/soreness. Get it checked out by a sports medicine doc and therapist. Stretching before and after any exercise will go a long way, and don't forget the hamstrings and quads if your back is bugging you. Once you get the pain in check try to work on your core muscles. Strengthening them will help reduce the strain on your back and future pain.
    Tomac 98Special in Classifieds

  12. #12
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    Quote Originally Posted by ebarker9
    Skiierx, what was your impression of the cortisone injections/epidurals? I'm just wondering in case that ends up becoming a consideration.
    The shots have worked well. I was worried that the cortisone was going to be damaging over time and have spoken to 2 Dr.s about it and each has said over a long period of time it can hurt me but since the amount they are using is so small there should not be any problems. What we have learned is that the facet joint treatments have helped more then the epidurals did, so it appears I will not be needing anymore of those. That is what they started with and they helped a great deal with bringing the pain down and putting it in check. The facet joint injections worked well for the first two sets of 6, then I went to RF and it worked for 8 months. I was very concerned that the RF would allow me to cause more damage but again both my Dr.s said that is was allowing me to stregthen myself and helping them determine where exactly the pain is coming from. Actually next Tuesday I go in for another RF treatment but only to one side then we do the other side 2 weeks later. This will allow them to see the improvement when I come back. I am still concerned that these treatments could cause more damage but it is better then being a drugged up zombie or having to go through surgery.

    Good luck!

  13. #13
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    I have often thought of trying Vax-d!
    http://www.associatedcontent.com/art...e_or_hope.html

  14. #14
    recovering roadie
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    Vax-D killed me. It was a waste, and way increased my level of pain. I did 16 sessions on it and told them I couldn't anymore. They must make bookoo bucks off of those things - I was out of pocket $1500.

    I knew it was a gamble and worth the try, but there was no one in there I saw it helping.

    I've heard that if you have an annular tear (I do, revealed by MRI), Vax-D can hurt a lot. Argh.

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    I hadn't heard of Vax-D, so I looked into it a little. Doesn't sound especially good...

    http://www.chirobase.org/06DD/vaxd/vaxd.html

    It also sounds a little too much like Steven Colbert's "Vaxodrin" for me to take it seriously

    The description my PT used was to think of the herniation like a cut on one of your knuckles. Each time you bend it, small tears will result and the scar tissue with have to reform. I'm focusing on keeping the back nice and straight and offsetting any leaning over plenty of bending back. That said...things are progressing slowly. I'll have to see where I stand at the doctor's next week.

  16. #16
    MERCURY
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    The Thing About Backs Is Everybody's Problem / Solution Is Different.
    The Most Important Thing You Can Do Is Posture. No Slouching. No
    Saggy Chairs. Stay Moving As Much As Possible. When You Have Back
    Pain It Can Really Take It Out Of You. Don't Take Pain Medication Unless You Haven't Been Able To Sleep. I Have 2 Herniated Discs. 4 Out
    Of 5 Neurosurgeons Said Surgery Or You Will Be In Pain The Rest Of
    Your Life. The 5th One Examined Me First Then Looked At The Mri And
    Said You Probably Shouldn't Even Be Walking But Keep Doing Whatever It Is You Are Doing. After 10 Years Mostly Pain Free, I Had
    Another Episode ( All Twisted, Stabby Pains ) And I Finally Had Gotten
    My Nerve Up To Do The Pacific Coast. Well I Went And Did The Coast
    And In The Last 9 Years Did 6 More Long Distance Trips (including North
    Tier, Southern Tier, Gdmbr ) I Don't Train Much But I've Been Virtually
    Pain Free For 9 Years.

  17. #17
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    It's great to hear from people who have been through this (and are still active!).

    Any core strengthening recommendations? The PT has me on the swiss ball doing various things as well as doing planks and the abs "bicycle exercise", minus the crunch motion which is sometimes incorporated. I've been doing 5 sets of 20 reps of the bicycle deal, 5 sets of 40 seconds of the planks on my elbows, and 5 sets of 20 pushups, alternating between the three exercises. I think I'll pick up a swiss ball so that I can do that stuff at home as well, in addition to sitting on it watching TV etc.

    I feel like, if this is going to be helpful, I'll go all out with the core stuff. I imagine it will help me once I am able to get back on the bike as well. Plus, I find it a lot easier to work hard at this stuff than I do to keep correcting my posture all the time. Still working on that.

  18. #18
    MERCURY
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    To ebarker9: I ruined my back when i was 34 and I was in great shape ( 1987 ). I hurt
    myself working too hard. doctors, pt's, were no help. i was scared. thought it was all over. the advice then was pain pills, rest, and surgery. wrong, wrong, wrong. If I knew then
    what i know now i would have healed much faster. i herniated L3-L4, L4-L5. For me it's
    all about lower back muscle strength and abdomenals. I had a friend who 2 yrs before me
    had back trouble, then surgery. he ballooned to 300 lbs. so first thing ( especially if you
    are overweight) change eating habits. if you are inactive ( hurt ) caloric intake should be
    minimal. eat 1 or 2 meals a day. large servings are cut in half ( 2 meals ). by doing this
    i was able to still drink lots of beer and not gain weight. my weight stabilized at 160-165
    and has stayed that way for 20 years. i do not overeat. when i'm on a long distance ride
    i should eat 3 meals a day but i find it hard to because i don't look at food the way most do. i did a north tier ride lastsummer. it was hot. trouble eating. i was down to about 140 lbs. 2nd thing. POSTURE, POSTURE, POSTURE. You can do all the exercises you want, but if you are slouching in that chair. Your back will hurt. Stand straight and tall,
    you know, shoulders back, chest out, gut sucked in. a lot of lower back support is in the abs. don't forget the gluteus maximus ( your butt ). lay on your back and clench both
    cheeks. lay on your side and work them 1 at a time. i do minimal stretching. i am looking for a proper range of motion, not doing splits. overstretching can cause more pain. i didn't become " mostly pain free" until i started doing long distance rides.
    i don't train much (last years trip was 4000 miles) i did 2 rides of 40 miles for training.
    it would be better if i could do more training but its not necessary. much of all this is
    attitude. ATTITUDE IS MORE IMPORTANT THAN FACTS.

  19. #19
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    Thanks, Mercury. (And to the original poster, sorry if we're a bit off-topic, but I think this is all valuable for anyone with lower back issues.)

    I think it's largely been a posture issue for me, as well as strength. Standing isn't so much an issue, but it's a constant struggle to maintain posture while seated, especially at work. I'm looking into getting a different chair that at least doesn't encourage bad habits like the current one. The diet advice was interesting as well. I'm way towards the skinny side (6'0 140lbs) so I certainly don't think it's excess weight that's giving me trouble, but with my body type I probably don't have enough muscle supporting my somewhat long torso. I'm working on it. Most of the stretching I've been doing is to try to restore range of motion and then, eventually, retain it. At the moment, reaching anything beyond my knees is a dream.

    I'm also glad to report that the medical world does seem to have gotten better about dealing with these issues. I took painkillers initially when it was really unbearable, but since then it's been posture, strength, and keep moving. I wouldn't put any faith in someone advocating bed rest for any more than a very short term.

  20. #20
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    No apologies needed ebarker9! This is all great info and I greatly appreciate everyone's response. My dilemma is, I cannot get to a doctor for awhile now. I go to class next week with my airline and there is no escaping class unless you are on your deathbed.

    I will start core strengthening exercises and give it a few weeks. Then if I haven't seen solid improvement, I will get myself to a PT or spine doc stat.

    Thanks again to everyone, I have learned a lot! If anyone can PM a pdf or info on specific exercises you do - I will buy you a beer one day! (or give you a discount on a lamp! - shameless plug)

  21. #21
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    I have not read the entire thread, but...

    The most helpfull docs by far for me in my long back issue struggle have been physiatrists. They specialize in non surgical rehabilitation medicine, and were the first docs that I saw that would take my pain seriously and had some procedures to help get me going again (get me into PT, get my pain taken care of, follow my progress, and get me to a GOOD surgion when that time came, etc).

    Long stoy, I have had two spine surgeries in two and a half years..last one a fusion due to complete colapse and shifting/insability of my L5/S1 joint. I have just started getting getting back to activity after 5 months of nothing physical and a little over a year off the bike (and now feeling the best I have in 4 or five years).


    I will read the thread fully later and post some more, but if you have any specific questions, shout.

  22. #22
    MERCURY
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    To BIke21 and ebarker9. If you can't reach past your knees, try this as a stretch. If you have a herniated disc, there is probably a point at which when bending over the pain will
    just about put you down. well, i would get in the shower, as hot as you can stand, and just lean foreward, right up to that spot. the phrase i came up with was. " Say hello
    to your pain ". You are only stretching microns. overstrecthing will cause pain later. Hopefully you have a safety rail to grab onto as you don't want to fall. i did this for a long time till i could lean on the edge of the tub. if the tub /shower is a bad idea, use a chair.
    you must gauge your flexibility. it will be different on different days. don't overstretch.
    another stretch ( i don't know what to call it) sitting on your heels, hunkerin down. really
    good lower back and leg stretch. instead of sitting on the comfortable couch, i hunker
    down in front of it, back against the base. i did this for a long time when i was really hurt.
    i have had no luck with doctors, chiro's, pt's or anybody. i met all kinds of people who had
    surgery, many bad tales. i vowed i wouldn't have surgery. i have abundant faith in the
    healing powers of the human body. the reason you don't take pain pills is that the pain
    is telling you something. each of us has a different set of problems. what seemed appropriate for me L3-L4, L4-L5 may not be appropriate for L5-S1. you must check out
    you own range of motion, find exercises you can do, stay moving, you can't hurry this.
    walking may be the best. even if you are all twisted. try to walk straight.

  23. #23
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    I had a herniated L4-5 from years of abuse on the tennis court. I treated it conservatively for a year before opting for surgery. There were periods of three days to a week where I'd be in excruciating pain and wouldn't be able to get out of bed (would have to roll off the bed). I also experienced a lot of weakness in my lower right leg. So much that I stumbled down the stairs a couple of times. Anyway, I had a microdiscectomy last October. Immediately afterwards, I noticed a huge difference in my leg function and elimination of pain while twisting my torso. I went pretty hardcore with my rehab and was riding the trails again in mid Feb. So far, so good! I'm riding at least three times a week, playing basketball and hitting the gym regularly.

    Best of luck w/ your condition. Back injuries suck!

  24. #24
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    I can happily report that a swiss ball is a great investment for those with back problems. I've been having good success using it as a chair in the evenings, which forces me to keep good posture, rather than being on the couch which generally leads to horrendous posture. Kneeling on it for shorter periods of time also seems to be beneficial and is a fun challenge. Anything to keep those muscles working and stabilizing the spine.

  25. #25
    MERCURY
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    Hey ebarker9: it's all about figuring out what works best for you. the ball idea sounds great.
    be creative. try different things. that HEALING THING takes time. it takes consistency.
    it takes patience. it takes a really positive attitude. it takes facing your pain. hey wait,
    that's what bicycle riding is all about. well then, given time, all should be well.
    Last edited by MERCURY; 07-18-2007 at 02:29 PM.

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