T Nation

Lower Back Injury, Need Advice ASAP


#1

Hey guys,
First a little back story...when I was 18...roguhly 3 years ago....I injured my lower back doing a heavy set of sumo deadlifts with improper form. I hjadto take 1 year off from lower body training all together, and then ease back into things slowly. I have just now gotten my lower body strength to respectable levels again, but now the worst has happened all over again. I benching on Monday and got in a hurry and set my arch too fast and felt like I hyperextended my back a little. Alight discomfort, but it was fine throughout the workout.

Well...I get home, and I bend over to put the toilet seat down and bam...sharp pain in my lower left sacral region. Two days later the pain has gotten worse. I'm trying to avoid any medical billsright now, cause money is extremely tight, and the last time this happened, I spent hundreds of dollars on doctors visits and never got any answers. So I as wondering if anyone could give me a few exercises to determine severity of injury or tests or just something. Any help is much appreciated.


#2

I'd be glad to help if you would kindly PM me a few of SoutherGirl's pics from your private collection. :slight_smile:

Just kidding, hopefully you have been using ice and anti-infl. for the past couple days.

Well, if the intial injury mechanism was hyperextension, you could have irritated a facet joint, which then when you bent forward caused stretching of the capsule and reflex muscle guarding. Obviously, it is impossible to know without examining you.

To help you a little more it would be helpful to know a little about your symptoms at this time.

What movements/positions increase or decrease your symptoms?

How is sitting versus standing, walking, laying down, bending, squatting, etc.?

Also knowing how it responds to repetitive movements would be useful. Does it hurt to bend forward and if you bend forward 5-10 times does the pain stay the same, get worse or get better with the reps? Does the ROM increase with rep. You also want to bend backward in the same fashion.
Then lay down on your stomach and do some repetitive press-ups, similar to the cobra yoga position. Answer the same questions.

Once we know how your back symptoms are responding to loading, some more specific recommendations can be given.

Keep using ice 15-20 minutes every couple hours throughout the day. Anti-infl should help for a few more days. Try to keep moving and stay active without doing any activities that place your back under significant load. Don't sit for more than 20-30 minutes without standing up and moving around for a few minutes. Try to maintain the lumbar lordosis during all you daily activities. A rolled up towel placed in the lumbar curve when you sit will help decrease LB strain.

Hope that helps and once you give me more info, I'll see what else I could recommend.

Take care,

Ryan


#3

Sorry. I wouldn't wish back pain on my worst enemy. Same thing happened to me... worked out with some cable rows and felt a strain. The next morning while bending over to brush my teeth, WHAM! My only method of transportation at the time was bicycle (5 mile one way trip). That seemed to make my back feel much better; don't know why.

If you feel a solid muscle knot in your lower back, try rolling over a tennis ball or golf ball to loosen up the solid mass. Then ice, then heat, then ice, blah, blah. Hot tub then ice again. You get it. When you feel the pain start to lessen, try and stretch - just a little! Take your bent leg and cross over your other straight leg, stretching the piriformis (hip/glute/lower back). Better yet, google piriformis stretch and get pictures.

Also, while laying on your back, flip one leg across your body, catching your knee in the opposite hand. Just an old school football stretch, remeber? My excuse for the info? Two lower back surgeries. I've learned everything I could to prevent any more back injuries. Just don't lay around prone. You have to take an active approach in recovery. Good luck.

k


#4

Oh, lay on your back and try to bring your knees up to your chest and hold it (if you can). Deep tissue massage may help after some loosening. Just ask for your sweetie's elbow.


#5

Hey Dr. Ryan,

If you could alleviate my problems I'd gladly send Southerngirl to deliver those pics personally. Walking causes no pain, sitting for long periods of time, however, is irritating. I cannot bend over at the waist or create any kind of arch in my lower back without pain. Strangely enough...bending backwards is not much of a problem. I tried slightly arching my lower back and doing a RDL type movement, and the pain was worse with every rep. Squatting causes a lot of pain in the lower left region still.

I did go see a chiro earlier today. He helped the pain alot, but definitely didn't heal me or anything, which I would not expect with one visit, but I was extremely impressed when I mentioned the reverse hyper and he immediately started raving about Louie Simmons, so I don't think this one is a scam artist. He did take an x-ray and he said my left side was out of alignment and could be causing the pain, and he also pointed out that my neck was not curved at all...straight as an arrow, but that's not the problem right now. Anyways...i you need any more info please let me know.


#6

I have a leg length discrepency due to a car accident many years ago. This led to hip imballances, knee problems, lower back strain etc. My posterior chain is a mess. Anyway, squats, DL, well just about anything that puts load on my lower back gives me a fair chance I am going to tweak something. As I am sitting here right now I have the same problem as you, this time from carrying my comatose dog up some wet Seattle stairs after her surgery. Tweak there goes my back and the next thing I know I am walking like a broken robot.

All of that is to say, after years of searching I found a PT who utilizes a technique called "strain - counter strain.". I can't speak for the technique outside of his hands, as he is the only one who I have had do this to me, BUT I am seeing him today for that very reason. 10-30 minutes with him and I will be leaving his office today walking fine and feeling good. Maybe a slight ache but after some sleep, I will be feeling great. It is amazing!

So if you can find a practitioner that utilizes 'strain - counter strain" I highly reccomend giving it a try. He has raised the quality of my life in so many ways concerning pain from my injuries from my car accident using these techniques. It is amazing after 17 years of daily intolerable pain, how one can get lucky in finding something like this and learning that I don't have to live in pain everyday at all.

Hope that helps.


#7

I've had L5 disc surgery. I'm going in for another MRI soon.

Rules I learned from Doctors over the years:

  1. Lay on a HARD flat surface on your back. This relieves pressure.

  2. Bend with the knees.

  3. ice first 24 hours after aggrivation.

  4. Stretch On back, knees to chest 30 sec. each. Then do both.

On back, hold one hamstring and stretch the hammies 30 sec each.

On left side, put right leg over and reach your right arm to the right and the opposite direction of you leg, the slowly twists and stretched the back...I awlways get a few pops with this one.

  1. Vicodin, Flexeril and Lodine!

#8

Problems like you describe are most likely not going to show-up on an X-ray. The X-ray just gives us a look at the underlying anatomy to assess for any underlying conditions or structural problems.

If your low back muscles are tighter on one side than the other right now due to muscle guarding, that will make the vertebra pull to one side and thus creating a curve on an X-ray.

If bending forward hurts and leaning back doesn't then I would suggest that you do a set of 10 press-ups (Google McKenzie exercise) every hour. Make sure to use a towel roll behind your lumbar curve when you sit (take a bath towel, fold it in half length-wise and then roll it into a a nice firm roll. Next, place your arm in the small of your back. Lean back slightly and move your arm up and down the small of your back. You should feel where your arm fits nicely in the curve of your back. That is where you place the towel when you sit). Make sure to sit all the way back in the chair.

Get up and walk around every 20-30 minutes. Do not sit for extended periods if you can help it. Try to stay as active as possible without putting your back in the positions you mentioned that aggravates it. When going from a sit to a stand, slide to the front of the chair, make sure the lumbar lordosis is maintained and lightly perform an abdominal brace. Then place your hands on your knees and stand up using the strength of your legs. There should be limited back movement when this is done correctly.

Keep icing and using the anti-infl. The chiropractic should help as well. Did they do any therapy other than adjusting you?

If you can't find the press-up exercise, let me know, I can try to send you picture or fax.

Keep me posted and let me know if you have any other questions. Also, let me know if SG needs direction to my house. :slight_smile:

Take care,

Ryan


#9

Wguitar. How is your gut doing? Any inflammation or irritation from food allergies in your gut can affect surrounding musculature such as the TVA and cause instability in your lower back. What your describing sounds similar to that. If the TVA isn't stablizing properly it makes the lower back very vulnerable. This is what people are targeting when they talk about the abdominal vacuum exercise. I've been saying this to a lot of people around hear lately, but it might work for you... go to the Chek institute website and look for at least a Chek Level II practitioner. He will evaluate postural flaws, test TVA coordination, etc and develop ane xercise plan specific to your problem to get you healthy. But you said money was an issue and they can run around 50-90$/hr. They can help restore coordination to the TVA and stabilize your lower back. If it is a muscular thing, I'd also look for a Neuromuscular therapist to work out trigger point's that might be related to some of the pain. Not saying this is the solution, just somehting to consider.


#10

I've suffered from something similar and I'll vouch for the once hourly mackenzie press-ups (not that Dr. Ryan needs any vouching)it relieves the pain like nothing else. Something else my physio had me do was take some surgical tape (some breathable athletic tape works too) and run some strips along my erector spinae on either side of my spine (about T10-S1). As long as you apply the tape when standing upright it will prevent you from any forward flexion in the spine. It sounds silly but it will pretty much gaurantee you keep your spine out of that painful forward flexion thing, especially when you sleep. Hope it helps.

(The pic I've attached is obviously for upper back pain, but it was the closest one I could find.)


#11

Other than adjustment, they put the electrodes on my lower back for 10 minutes, which was quite therapeutic, but in reality, about an hour after my visit my pain is exactly the same or worse than it was before, so I'm still trying to figure out if I want to go back tomorrow or not, cause insurnace does not cover this.


#12

I found this to be the case with me too. I actually left with MORE pain than before I went. The towel roll is an important thing I forgot to tell you but it looks like the dr. is in the thread, so that's cool.

I sit infront of a computer and drive a lot, and back support sitting is crucial.


#13

If you know of or can get the name of a good massage therapist they can help quite a bit.

Alot of the muscles in your hips like the piriformis as another poster mentiond; can cause alot of pain in your low back. I personally have messed up the muscles in my hips like that squatting and whatnot and as a massage therapist I've helped out alot of low back pain treating that area as well and the rest of the low-back.

Dr. Ryan-just curious, what's your specialty?