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JonA
Trad climber
Flagstaff, AZ
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Nov 19, 2013 - 09:22pm PT
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Well I wrote a novel on the subject. I usually write these things and never post them.....instead I use them to codify my thoughts on certain topics. But today I figured that if even one person benefits from my ramblings then it's probably worth the bandwidth or bytes or whatever. BTW I'm not associated with any of the products or companies I reference.
For those of us with episodic backpain after an initial accident there are really two main phases of recovery. The first phase is eliminating the acute muscle spasms. There has been a lot of great advice so far how to manage this. Heat, prolonged stretching, traction, muscle relaxants, chiropractic adjustment, dry needling are all good options. I also find that a natural ca-mg supplement called Floradix helps a lot of people and won't induce drowsiness.
But the more important phase by far is reducing and hopefully eliminating the episodes altogether and here we have to look at the work of Julie Hides about the importance of retraining the lumbar multifidus.
http://www.spine.org/Documents/Long_term_effects_stabilizing_exercises_1st_episode_LBP.pdf
First published in 1994 (and verified by dozens of subsequent publications) she found that the mudtifidus becomes weakened and inhibited after a single episode of acute back pain. More importantly, she found that patients who specifically trained the multifidus and transverse abdominus in rehab were 12.5 times less likely to have a reoccurence of pain in a years time and 9 times less likely to have a reoccurence in 2-3 years follow up. Since we highly suspect that each reoccurence of episodic back pain is accompanied by additional damage to the disc (which has minimal ability to heal) then it becomes even more imperative to avoid reoccurence.
The specific exercises referenced in the Hides paper are very similar to the superman and floor roll exercises recommended by tioga. I would personally recommend a single visit to a PT or pilates instructor to learn some of these exercises...the ability to isolate the multifidus and TA is not natural for most of us and if these muscles are inhibited and not firing then one must consciously contract them initially (they reflexively fire in healthy individuals with no history of back pain).
After a couple months of religiously performing these 'core' exercises then I agree that dead lifts are a great exercise to keep the multifidus and TA strong. The problem that I have with only performing pilates type core exercises is that they are not functional. Just the other day at the gym I watched a guy perform a 20 minute core strengthening routine on the mats. Once done he promptly walked over to the dumbell rack, bent over with a severely rounded back and picked up a pair of 35 lbers.
The beauty of the deadlift is that it teaches you how to lift. It teaches you how to differentiate hip flexion (aka hip hinge) from lumbar spine flexion. It's well accepted that shear stress is what causes most of us to damage our backs, and if one examines the deadlift it is apparent that a lot of extrinsic shear stress is placed on the spine in a deadlift. However, when performed with a neutral spine, the spinal erectors are perfectly oriented to counteract this shear and the multifidus are perfectly oriented to stiffen the motion segment (vertebra). However when performed with a rounded back, the spinal erectors are no longer oriented to counteract shear and the multifidus is in a weakened, lengthened position. The only structures capable of resisting shear in this position are the inert structures of the spine including the disc.
http://www.sfu.ca/~leyland/Kin201%20Files/Deadlift%20Mechanics.pdf
So the moral of the story: learn to deadlift but approach it like how most people approach learning the golf swing.....become a student of the sport. Watch youtube videos (here's a great one:http://m.youtube.com/watch?v=2cwGRCnmgag&desktop_uri=%2Fwatch%3Fv%3D2cwGRCnmgag);, hire a personal trainer for a session (again I like the FMS group: http://www.functionalmovement.com/experts ), post videos of yourself on knowledgeable forums. And start with a light weight kettlebell from an elevated position. Have realistic expectations of how heavy you should ever go. For someone with a history of back pain I would personally only recommend using kettlebells or a hex bar and always pulling from an elevated start position. And wait a looong time before increasing weight, as in a year or more to work up to body weight if this is your goal. Most will laugh at this notion because this is a relatively light weight but I would argue that for those of us who do not want to pack on muscle then there is no need to go much heavier.
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JonA
Trad climber
Flagstaff, AZ
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Nov 19, 2013 - 09:54pm PT
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It is thought that some people respond favorably to traction because it provides a very gentle, slow stretch to hypertonic muscles. For other people it is thought that the decompression of the disc is what provides the pain relief. The latter group can often benefit from taking several rest breaks throughout the day (lying on your side, pillow between knees for 15 min). Also, don't forget about DIY traction like floating in a pool with a noodle under your arms and with ankle weight for added benefit. Probably ony useful if you live somewhere with a pool.
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Gorgeous George
Trad climber
Los Angeles, California
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Nov 19, 2013 - 09:57pm PT
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No drugs, no chiropractor.
Acupuncture. Simple.
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Johnny K.
climber
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Nov 19, 2013 - 10:08pm PT
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So much can be said about back problems. Great advice already mentioned above. My 2 cents,take your time in understanding what damage is really done to your back,do not rush into anything(coming from someone who has received 3 lumbar epidurals and regrets it)
Get an MRI done,research what is causing the pain. Find what works best for your specific situation,try to avoid using pain medications,unless its beyond emergency. Focus on staying active even when it hurts like heck to sit down or walk. Healthy eating,positive mental outlook,breathing exercises,stretching,heat,water,inversion and deep tissue massage therapy have helped tremendously.
Also for myself I take Turmeric,lysine and Echinacea instead of 800mg Ibuprofens for regular daily inflammation.
More info along the same lines
http://www.supertopo.com/climbers-forum/143689/Lumbar-Disk-Rupture-L5-S1
Hope you keep feeling better Weston,cheers!
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Gorgeous George
Trad climber
Los Angeles, California
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Nov 20, 2013 - 12:54am PT
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I usually pay about $60-80 with two sessions about one week apart. I have two herniated disks (L-5/S-1) and went through both treatment with medication (pain relievers and muscle relaxers) and chiropractors, neither of which gave me relief as quickly and as thoroughly as acupuncture. I now ride a horse (Andalusian stallion) about 3-4 days per week, and coach and ref youth soccer, which involves a lot of running and quick movements, and am fairly pain free. When it does flare up, I go in to see my guy (Chinese) and he fixes me up.
I do agree that some sort of stretching and moderate strength training help prevent injuries, as does refraining from basketball, volleyball, and bailing from high-ball boulders.
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Truthdweller
Trad climber
San Diego, CA
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Nov 20, 2013 - 01:17am PT
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Almost became a plegic after a chiropractic adjustment last year, seeking relief from a suspected back spasm. It resulted in a 50% occlusion of my spinal canal from a posteriorly herniated C6-7 disc. Although a prior proponent of chiropractic therapy, I, for obvious reasons, can't recommend them now.
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Truthdweller
Trad climber
San Diego, CA
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Nov 20, 2013 - 02:01pm PT
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tioga...
Mine came on next to the spine and shoulder blade, a typical sore spot, after waking up one morning. I mean, who hasn't had one of those one time in there life, attributing it to "just slept wrong"? It lingered over almost two months, to the point where sitting exacerbated it too much, and standing with my right arm over my head was the best POC. I FINALLY, through the advice of my RN wife, saw my PCP, wherewhich his PA rx'd me flexeril, Tramadol and PT. I started all of the above, but the PT was making it worse, so with my "stinkin' thinkin'" and chiro right next door, I made an appt. to begin treatment...pain control was a serious issue at this point.
The female chiro assessed me and wanted xrays and a CT before proceeding. So, I hopped over to the imaging center for an xray, but the CT required an appt a few days out. I brought the film back and the chiro, who didn't see anything obvious, but still preferred the CT results. She then renigged on her decision and offered an adjustment. I was all over it.
To make a long story longer, the next day I experienced a sudden onset of numbness that started near my right armpit and radiated around my chest, then down my right arm, putting lots of pressure in my elbow, then down to my finger tips, after pulling into a parking lot to get a coffee. I'm an ex Paramedic, and this freaked me out... I knew something was wrong. I was in a neurosurgeons office the next day with the CT results up on a laptop, and it didn't take rocket science to figure out what I was looking at. I had an anterior approach discectomy a week later. That week wait was brutal. I hope to never relive that. My neurosurgeon said after the surgery, "You could have been paralyzed young man. But, you're out of danger now." When he turned to leave my bedside, I dropped my face into my hands and cried, at (50) years old. Praise God.
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Bruce Morris
Social climber
Belmont, California
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Nov 20, 2013 - 08:25pm PT
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I think a lot of positive results from these 'therapies' come from mild form of hypnosis/mind conditioning, which is a very powerful healing force, but not from any kind of mechanical action on body.
I believe this "mild form of hypnosis/mind conditioning" is known as the "placebo response" or the "placebo cure". Can actually be quite effective (if only temporary).
Your bucks are better spent on a "Happy Ending" from Miss Kiki at the Lavender Lounge AAMP.
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rottingjohnny
Sport climber
mammoth lakes ca
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Nov 20, 2013 - 10:17pm PT
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I couldn't find Miss KiKi on Nancy's list or the AARP Signature Approved web.site ?
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Jan
Mountain climber
Colorado, Nepal & Okinawa
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Nov 20, 2013 - 10:53pm PT
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A good chiropractor will do X-rays on you before they ever do an adjustment. If they don't do X-rays - run!
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johntp
Trad climber
socal
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Nov 20, 2013 - 11:05pm PT
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+1 on gentle walks. Fricking back pain sucks; sciatica even more. walking got rid of them for me.
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Skeptimistic
Mountain climber
La Mancha
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Nov 20, 2013 - 11:28pm PT
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Some very excellent research bears out the orthopedic PT mantra-"motion is lotion!"
A well applied Theracane is worth the price of admission too.
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darkmagus
Mountain climber
San Diego, CA
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Nov 22, 2013 - 04:39pm PT
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I'm a chiropractor. A "sports chiropractor" if you will! There are good ones and bad ones, just like there are good and bad dentists, lawyers, medical doctors, etc. X-rays are not absolutely necessary in all cases. I'm strongly on the "evidence based" side of the coin, so think about that, scientific evidence related to chiropractic! Yep, it's a thing! Chiropractic is a definite art and science, so it does not require the patient to "believe" in order for it to work. It ain't placebo... that is all! If anyone has any questions, please please hit me up, I'm here for you, friends of SuperTopo.
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Sierra Ledge Rat
Mountain climber
Old and Broken Down in Appalachia
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Nov 22, 2013 - 07:16pm PT
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back spasms
Go to physical therapy and get electronic stimulation
Fries the back muscles into submission. Works wonders. Electrical stimulation causes tonic contraction of back muscles, causing them to relax, and stop going into spasms after the treatment is complete. Is it truly an amazing treatment - if you are truly treating muscle spasms and not anything else.
Avoid quack-ro-practors, seek real care.
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Sierra Ledge Rat
Mountain climber
Old and Broken Down in Appalachia
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Nov 22, 2013 - 07:26pm PT
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Structural meaning.....?
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darkmagus
Mountain climber
San Diego, CA
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Nov 22, 2013 - 07:42pm PT
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Avoid all healthcare advice from internet forums made up of laypeople. Seek advice from the healthcare professional of your choice.
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JonA
Trad climber
Flagstaff, AZ
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Nov 22, 2013 - 09:53pm PT
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Chirogeek is a good website full of evidence based research.
http://www.chirogeek.com/
I'd suggest starting with the page on internal disc distruption. This has been found to be the cause of at least 40% of chronic back pain and up to three quarters of all severely acute non-specific back pain so statistically it's the most likely scenario. Plus all back pain is 'stuctural'...your symptoms might be muscle spasms but these spasms are in response to structural damage in your spine. A lot of doctors don't like to say this because it freaks patients out (and poor outcomes have been correlated with certain fear avoidance behaviors adopted by some patients) but if you're an educated person then I believe that the more you know the better.
As good as that website is it doesn't address conservative care very well. I'm still a big believer in addressing the acute spasm and then strengthening like crazy to avoid exacerbations. If the heat and stretching and traction aren't cutting it then try dry needling (or acupuncture if you live in CA). Lots of evidence supports dry needling as a very effective method to address muscle spasms.
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Johnny K.
climber
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Nov 22, 2013 - 10:35pm PT
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Everyone on the internet seems to be a professional physician. If you have decent medical coverage or cash,try to get an MRI/CT done, forget your normal doctor,they arent back specialists. Forget the internet quacks. Get recommendations from your DR or local DR's,if you will. An MRI or CT scan can help you understand whats happening to the structure of your spine and inside your back,to make sure its not anything to do with any nerves.
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Ken M
Mountain climber
Los Angeles, Ca
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Nov 22, 2013 - 11:20pm PT
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Ok, some comments from a physician who has treated thousands of people with back pain:
-first, back pain is not a diagnosis, it is a symptom.
-if a problem is caused by trauma, it probably deserves immediate ER evaluation (not the situation described)
-the only worrisome problem that falls into the emergency category is an actual neurological abnormality. That has not been described in this case.
-all methods of imaging have limitations. You have had plain x-rays, which should generally rule out broken bones or eroded bones by tumors. You can spend thousands on imaging studies and learn little or nothing.
The most common value of an MRI is in evaluating a pressed nerve...I already know that you don't have that, because you have not described that problem. That'll be $3,000, please. :) Point is, imaging is not always needed.
-What you are describing is classic positional muscle spasm....very common.
It responds well to rest, heat, traction, meds. I always liked having people sleep on the floor.
-I found Chiropractic to be very useful in this syndrome. Getting a recommendation from your doctor will often separate the good ones from the poor. Hopefully you have access to a good doctor.
-recurrences, particularly in the recovery phase, is very common.
-I generally recommend very simple, conservative, and low cost measures for this problem, as you described it. I'm not sure that I saw you describe it, but I've found stretching to be very important. Give it time to heal.
-episodes of this often indicate poor back mechanics. A program that works to strengthen the core muscles, particularly the deep abdomen, seems to be very preventative going forward.
-I've had it, and it is miserable when you have it. Hope you get better quickly!
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can't say
Social climber
Pasadena CA
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Nov 23, 2013 - 09:50am PT
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The only advice I have to offer that I don't believe has been talked about on this thread is to find a good sports massage therapist. Then when you've found a good one (not an easy task) find out if they are good at trigger point therapy and active release. This is not to take anything away from chiropractic et al but my time as a climber was characterized with many episodes of back muscle spasms.
IMO most issues like this stem from muscle overuse then any structural factor.
YMMV of course
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