Physical Therapy progress is going well. I've got a ROM in my lower back in about 3-4 weeks time that either had retarded or wasn't there.
Problem is now the pain in the extremes. Day to day movment is fine (vast improvement) however bending too far forward at the hip or bending too far back causes pain. May be just me increasing the range of motion over the coming weeks.
Does anyone have any exercise suggestions for increased lower back mobility? Exercises for increasing lower back strength? PT has me doing static holds right now which I plan to continue when I get back in the gym in about 2 weeks.
It would help to know the actual condition. That way, one can determine what the primary, secondary, and tertiary planes are in terms of aggravation of the injury. And, by strengthening the lower back, are you talking about functional strength, or the useless exercises that a lot of people use?
This is why you have a PT; express your concerns to him and make him work with you instead of for you. Hopefully, he'll know his stuff (or her stuff, if that's the case).
Sonny: bridging wouldn't be the problem for me. It would be bending forward.
Eric Cressey: I was never actually diagnosed with a condition. I'm rehabbing a nagging injury from a year and a half ago (think squatting a near maximal weight and someone coming up to you and forcing you out of proper form and then something giving in your back...not actually what happened but still gives you an idea). Before I began PT I could not bend my lower back. My PT says I've progressed a lot and I actually bend.
Let me see if I can clarify a bit. When I said increase mobility I meant bending forward. Currently I'm doing two yoga techniques as per the direction of the PT: cat/cow and child's pose/puppy pose. These really have opened up my lower back. Problem is there is now a numbness in my right glute that today crept down my leg during a meeting. It was pretty much throbbin in the joints only. I have told my PT about this though it didn't seem to raise any alarms. I will be bringing it up again tomorrow though.
I'm not sure whats going to happen beyond next wednesday though as its my last appt. On the one hand the PT has helped and on some days the pain I had was gone. But right now as I stand up the pain is gone but now there is a numbness where the glute meets the back that feels to encompass the whole glute and a little bit of the hamstring.
Not happy about this but like my coworker said its an HMO...i have to jump through the hoops to get the treatment I want coughART*cough* that may or may not be covered in the network.
I bought Pavel's Relax Into Stretch and Superjoints books and DVD's and honestly can say this is the best flexibility program I have ever come across. Superjoints is more about mobility whereas Relax into Stretch is more about flexibility, they are both fantastic and in my opinion well worth the money. NOW before all you "anti-pavel" weenies start hounding me, this is not a shameless plug. These two programs are fantastic. I have habitual lower back problems, but Superjoints and heavy deadlifts have done wonders for me. You can probably find a good deal on the books/vids at amazon. At least it will be cheaper than Dragon Door's price. You can read about the programs at dragondoor.com.
PTs usualy dont know a shit about this kind of stuff. They can cause more harm than good in this situation!
You should see a chiropractor or another backspecialist to make sure that you don`t have an herniated dics, ankylosing spondylitis or something like that! Does the "pain" radiate down in your legs (hams? calves? feet?)
DON`T try to increase your R.O.M before you have cleard things out!
Hi Darryl, I recently suffered a back injury which caused NO lower back mobility for about 3 months. I couldn't bend forward at all, not even over the sink to brush my teeth. I of course researched the heck out of spinal injuries and tried every treatment known to man, including ART (which I paid for out of pocket).
I am FINALLY doing much better, about 95% pain free, and can bend forward enough to skim my toes (not in the morning, though). My lower back still has limited mobility, though. I never get true flexion there.
It sounds to me like you may have injured your spine in such a way to cause compression of the sciatic nerve. It could be a disc herniation, or it could be muscle spasm in the piriformis. From my experience and research, I believe that spinal injuries that compromise the nerve are different from other musculoskeletal injuries. The spinal column is crucial to the body's survival, and the central nervous system (CNS) places highest priority on protecting it. The CNS sends instructions basically to lock up those muscles which normally allow spinal mobility. That's why you can't move. You don't necessarily want to override this lockout. The CNS is essentially enforcing stability sending those muscles into spasm.
It's very hard, if not downright impossible, to override this mechanism directly through stretching. This is not normal, garden-variety muscle tightness! Not at all!
You have to convince your CNS that your spine is stable and safe, supported by the network of stabilizers that are doing the jobs they're supposed to do. So work on core stability, choosing exercises that are dynamic and don't require much if any spinal flexion. Also, keep the intensity low and work on endurance of these stabilizers. For a severe injury, walking is the perfect "workout," I've found. Once your CNS believes your spine is stabilized and safe, it will allow those lower-back muscles to move.
It may be helpful to continue to see doctors until you get an MRI for diagnosis. Yes, you have to keep going in and complaining. You may even have to insist on MRI, and even that may not be helpful. Do not have surgery. My insurance massively increased office visit co-pay (500%), and I had to pay for chiro/ART out of pocket. But think about what you'd be willing to pay for a new car. A healthy, pain-free body is more valuable than any car, IMO.
Lastly, be PATIENT. It takes time, on average around 6 months, for an injury like this to heal significantly.
Chiroman: The increasing R.O.M. wasn't my idea. I'm just taking it from my PT and continuing it since my last appointment is next friday. Since its been almost 8 sessions and I've gone from pain, to no pain, back to the exact same pain PLUS numbness in my right glute radiating down my right leg I may end up having to schedule another appointment with my doctor so I can get the referral for the back specialist and MRI.
Andersons: Deadlifting is how I know my back is out of whack. It was strong and had a full range of motion. Now I don't even have equal horizontal rotation. The main problem is that my doctor I feel doesn't believe me because I "dealt with the pain" for over a year. But like you said the body will react so that the back and spine is protected and I was "fine" for a year but the pain was still there in my lower back. I never had the radiating numbness down my right leg though which only started after the PT.
I'm honestly at a point where I feel my doctor is like one of the many in the profession that will get you feeling better but better isn't 100%...just functional.
That isn't acceptable for me. I was functional for a year without a doctor's help and it was a detriment to my personal well being and mental health because I was limited in the activities I could do. I'm sorry...walking around a track (what my prior doctor suggested) is NOT a workout in my book. I'm not some geriatric former suburban soccer mom. I'm a T-man dammit. I want to squat!!!
How far down does it radiate? Below the knee? inside/outside of the calve? the feet? toe? Or just down in your glute, hamstrings?
You may be just fine, maybe its just referd pain from muscles or a hypomobility in your sacaroliac joints or from the thoracolumbar spine. But the pain can be due to a problem like central canal stenosis due to a herniated disc or a spondylosthesis, or spinalnerv compression due to 10000-reasons
Im sure youll be just fine with the rigth kind of treatment! I don`t know how it works i your country, but here in Sweden patients can just call the local chiropractor or osteopath for an apointment. sorry about my bad english
One more thing: If you have told your PT about this radiation down in your leg, and that didn't seem to raise any alarms, I think your PT needs to wake up! But at the other hand PTs often dont know a shit about anything, thats my opinion.
Darryl, I just re-read your post. I was away from the forum for awhile, so I missed any description of your original injury. And in general I think it's a bad idea to diagnose back pain online, BUT for goodness sake! What is your PT doing? Your symptoms could be caused by other things, as chiro said, even something as "simple" as a piriformis spasm. BUT your symptoms are also consistent with a herniated disc compressing nerve root(s). If so, the exercises you're doing will cause FURTHER injury to the disc. It certainly seems like that's what's happening. Your spine doesn't want to flex, but you're forcing it to. An injured, vulnerable disc is injured further during spinal flexion, hence the following pain and numbness. The first rule is "do no harm" and until you can rule out a disc herniation causing this nerve pain and numbness, you have to avoid spinal flexion.
I really would ditch that PT and keep going back to the doctor to try to get a diagnosis. Do not do those exercises you described until an MRI rules out disc herniation. Do NOT try to increase your ROM in your spine. Injured spines need stability, not flexibility.
Listen to Andersons, I've delt with the same shit and it has been hell. Back injuries suck, and in my opinion never really heal. I went to a PT who hurt me more so don't beleive all you hear from them. Get an MRI, insist on one, if they say no, get pissed and demand one. Show them you are serious, its your body.
All: Disc damage was "ruled out" by having me touch my toes, lean back, left, and right. No pain no disc damage so they say. But I think pain to them means me screaming on the ground like a little girl. I think I'm just going to do these next to sessions, scrap doing the exercises at home since I've gone back to square one while doing the exercises with additional sypmtoms, and I'm gonna schedule an appointment for a week from now with my doctor and take all the info in this thread as ammo.
Darryl: Try the bridging dude. It can really help you out. It stretches and strengthens at the same time.
I recently stopped bridging for about 3-4 weeks and wouldn't you know it, my stiffness and slight pain had returned.
Before that, I had reached the point where I had NO stiffness at all, even upon waking up!
Last couple of days I bridged, and today I got in an AWESOME bridging session. I started out by getting a lower back stretch over the Swiss ball, basically doing a bridge over the ball. All the tension drains out of your lower back
THen I did 3 sets of back bridges, 2 sets of front bridges, and knocked off about 10 reverse pushups which also stretch the back. Sweet, my back feels great right now!
You should also be doing standing abdominal exercises, to work more stabilizers than you otherwise might hit. Your back is involved so much more doing them that its not even funny.
If his back is bothering him, standing flexion exercises (or any flexion) could cause more problems, especially if its a disk problem. Oh and don't believe your PT when they have you bend and since you have no pain you don't have a disk problem.....they did the same shit to me, and guess what, i had a disk problem. I might sound like a broken record, but get an MRI to be safe. Also, if his QL is strained, excessive flexion exercises that cause his last rib to pass the axis of rotation will strain it more. Be careful.
Darryl, that was a ridiculous way to "rule out" disc problems. There seems to be a lot of confusion at the level of medical practice about disc problems.
When I scheduled my first doctor's appointment for back pain, I had had minor pain, only when bending forward, for about 8 months. The pain suddenly had become much more severe and consistent, almost debilitating, so I went to my doctor. Of course WHILE I was there for the appointment I had no pain during any movement whatsoever. The previous day, I couldn't even sit in a chair for the pain. This experience illustrates how variable the pain can be. Many doctors, unfortunately, do not understand this variability or what causes it.
Pain caused by discs actually comes from three sources: 1) the disc itself compressing a nerve; 2) inflammation surrounding the tissue damage; and 3) muscle spasm responding to protect the injury. I suffered from severe, debilitating pain for 3 months, and 90% of the pain was caused by muscle spasm. If you start to pay attention to your pain, as it comes and goes, you can learn to identify the source of the pain, and to use appropriate strategies to (somewhat) reduce it.
Muscle spasm causes incredible pain, but can change literally in a moment, which is probably why you didn't have much pain during the appointment. With muscle spasm, your ROM will be dramatically reduced, and you will be quite weak. Muscle spasm will also increase disc compression and worsen the pain from that source!
The disc itself is also quite variable. Discs are conformable and change quite a bit during the day and with certain movements. An MRI in the morning can show a different picture than an MRI in the evening, or after a workout or certain movements.
I realize that I may seem arrogant, essentially implying that I know more than doctors or PTs. I do research in motor control and cognitive science. My department is known as one of the 2 or 3 most rigorous, quantitative, and mathematical in this field. When I hurt my back, I put my research expertise to work researching back pain. I strongly believe that the missing link in understanding back pain is in understanding the motor control issues and higher-level cognitive processes that affect spinal control. Unfortunately, most current treatment models assume a static, unvarying, structural problem that can be easily seen with limited current diagnostic technology; but back pain occurs in a DYNAMIC, highly variable system controlled by the brain. The research in this area is out there; I'm not making stuff up. T-mag actually pointed me to some of the best research out there, done in Stuart McGill's lab. I'm simply applying what I know about motor control and cognition to the best-quality research on lower back function and injury. Unfortunately, none of my doctors or therapists have a clue about any of this research. There is a huge gap between research and practice here.
I respectfully disagree with the advice to try bridging. If you do have a disc problem, and I think it's quite likely, there is a "magic" position that is least painful and least harmful. Not too much extension, and definitely not too much flexion, but some neutral position in between. This position varies, depending on the nature and location of the disc and what it's pressing on. Find that neutral position and stay in it as much as possible. Any movements you do, for now, should keep your lower back in neutral.
Andersons: I totally agree that that was a horrible way to "diagnose" a disc problem. My last PT appointment is next Wednesday and I plan on setting up an appointment with my doctor so I can get an MRI. I mean this morning my PT just had me do the same exercises that I told him had me back to square one last Friday. So he had me do flexion/extention of my spine. Just as I touch my toes I get a pain at my lower back if not the SI joint that increases as I raise up at the hip. The pain is in the same place at the extreme of extention and it is very precise.
I personally feel its a disc problem and I don't think the therapy right now is addressing it. But I honestly feel the therapy wouldn't be much different post MRI.
Essentially after 8 weeks of PT there has been no change. And I don't care if a doc says its gonna take a couple months...there should be some difference after 8 weeks. Granted it did seem to "disappear" after a few weeks but shouldn't have stayed gone? Plus if it was something muscular, wouldn't it be tender to the touch?
What you described in regards to back spasms sounds exactly what happened to me immediately after the injury yet this seemed to get ignored by both docs I've been too.
Surgery doesn't seem an option for me nor will I let it be either. But at the same time I'm frustrated at this lack of treatment and precise diagnosis. I guess this is what i get for dealing with an HMO.
Wow, Darryl, when I read your story I feel like I'm reading MY story. I understand completely how you feel about the lack of diagnosis and the PT. I ditched my PT after 2 sessions. I knew more than she did. They had required me to book 8 sessions in advance (!) and I cancelled them.
I have a little update that I hope will be encouraging to you and anyone else with this type of problem. Yesterday, my appointment with an orthopedic surgeon finally arrived, scheduled back months ago when I was in severe pain. I debated cancelling it, because I felt 90% certain in my self-diagnosis (herniated disc), and I've had virtually no pain for 3 weeks now. Also, I had researched disc surgery and judged it not to be worthwhile. So why see a surgeon, right? But it's hard to get these referrals, and I would really like a diagnosis, so that I can feel more confident in my self-treatment. So I decided to go.
As luck would have it, my doctor was awesome. It's really amazing to finally see someone with knowledge about your injury! It's frustrating to be in severe pain, not able to function, and have doctor after doctor find "nothing wrong." Stuart McGill said it best: many doctors reach the "limit of their expertise." Yesterday, my ortho walked into the room, glanced at my X-ray on the computer monitor (these networked medical info systems are awesome!), and said, "I know what's wrong with you." He proceeded to measure my discs precisely, not just eyeball them, showing me that not one but two are damaged. And he rotated the image to show me the bones of my facet joint that are grinding together. Two other doctors, a chiro, AND a preferred-provider ART with Spine and Biomechanics certification all saw nothing wrong when looking at the prints of these same X-rays. Anyway, the ortho then started to predict, correctly, what my symptoms had been. He also predicted, then demonstrated, that my right toe flexors are inhibited. I wasn't even aware of that. I challenged him with many questions, including questions about the Swedish study on disc surgery, and he knew all the answers.
So, it's great to find a doctor like this. I highly recommend you try to find one. I like my other doctors, but they didn't have the expertise to diagnose my problem and I knew it. Cancel any and all remaining sessions with that PT. Really. It's your body, there is no law that says you have to do a stretch! Why listen to the PT when the therapy is clearly not working? The pain is a crystal-clear indicator that the "therapy" is causing harm, not good. If you have a disc herniation, and it certainly sounds like you do, every time you flex or extend the spine to cause pain, you're prolonging your recovery by reinjuring yourself.