Low Back Pain

If you’re hanging out with a group of “older” triathletes and you ask if anyone has ever had a problem with their back or currently suffers from low back pain, you’re likely to hear more than a few positive responses. Historically, low back pain has been associated with getting old, as people become weaker, less active, and the tolls of life add up. One day they try and pick up something heavy, or twist funny, and boom, their back goes out. In the conversation involving triathletes it’s not just age that’s a factor, it’s time and years spent hunched over riding a bike, the pounding of running, and almost universally, sitting all day at work, Who knew that sitting was such a strain on their backs? I’ll bet most chiropractors do, as well as physical therapists, and anyone else that has tried to cash in on our low back issues.back-pain1

 

So a full disclaimer here, I don’t have a degree in physiology or sports physiology, I’m not a doctor, orthopedic surgeon, chiropractor, physical therapist, personal trainer, licensed masseuse or Pilates instructor. I’m just a guy who tried to ride his bike hard and over time wound up with low back pains and saw any number of the aforementioned professionals for help. This is what I’ve learned and tried to apply to myself and athletes that I’ve coached. And also to be clear, I won’t be talking about structural issues with the back, down to the bone and cartilage level, but only about back pains related to muscular imbalance or weaknesses.

 

Triathletes live by the motto that if a short workout is good, a longer workout is better, or if an easy workout is good, a hard workout is better. As we progress in our training and physical adaptation, going longer and harder is natural, but at some point we tend to run into what we call limiters, muscles or muscle groups that we’re not training correctly or possibly not even at all, even though we think we are training them. The low back muscles tend to fall into this category, there to support us, literally, but most of us don’t think about trying to strengthen them outside of our usual swim, bike, and run workouts, and this causes many of us to run into problems.

 

My own experience has been that in the last 10 years, starting about 15 years after I began racing triathlons, I’ve had four incidents where my back (or another connected muscle group) went out and I couldn’t function normally in life, not to mention go out and train. Prior to this my low back would get tight on longer bike rides, so I would have to stretch it while I rode, and then it would take a long time to get loose on my brick runs. For years I’d suffer hamstring cramps on the run during my races, not thinking they were related at all to my low back issues, but I eventually learned how they were all connected. And of course I continued to train harder and harder, thinking I could just get stronger and make the problem go away; typical hard-headed triathlete response!

 

I added yoga to my training regime about 12 years ago, knowing that relaxing, stretching, and getting some core workout would be beneficial, but in hindsight I always felt like there was something not right in my back that would compromise my position in some of the poses, so I’d just keep trying to stretch it out more to resolve the issue. I finally had my first real issue during a local 15k run where my psoas popped (but I continued to run anyway!) and I wound up seeing a physical therapist after wards. That was very painful, but I managed to finish out the season of racing with their help, and then took a break to let things settle down. My solution was then to get some deep tissue massage to loosen up my quads, hamstrings, psoas (a.k.a. hip flexor), glutes, and back, which worked for a while.

 

Lessons Learned, #1: I knew there was something not right, but I didn’t seek help until after I injured myself. A physical analysis with a physical therapist or a good personal trainer could have revealed the tightness in my psoas and the weaknesses in my other muscles that were leading to this; listen to your body.

 

While training for multiple half-lronman distance races each year and an lronman, I continued to get deep tissue massage, typically every three weeks, continued doing yoga, and eventually with advice from another physical therapist, added strength training to my weekly schedule. They gave me a list of exercises to do to strengthen my glutes and low back, while I incorporated a set of other exercises that I’ve done over the years to build the other muscles I was sure needed work, my quads, hamstrings, and upper body. I was working out seven days a week, doing 8-9 workouts, plus yoga, plus hitting the gym, while still suffering from a sore/tight back.

 

After completing my lronman I decided to do a local marathon, where I joined a local running group to train on the course and for the first time focus on running a marathon for a fast time. I backed off the triathlon training, but I still swam and rode each week for recovery, while incorporating strength training, yoga, and massages in my plan. After a very successful run I took four weeks off hard training to recover then slowly started training again for a half lronman. About four weeks into that program my back went out again and I wound up seeing a chiropractor who also incorporated physical therapy and strength training in his practice. Here’s where I learned a lot about my problem and really started to understand why my back had been giving me such problems over the years.

 

They determined that the gluteus medius muscle on the right side, one of the three gluteal muscles, was “stuck” (technical term!), effectively locked in place, atrophied, and was not being engaged. I did physical therapy and was shown exercises that I needed to add to my regime to focus more on my glutes and less on my quads. And specifically I learned that the kind of squats and leg exercises I was doing were not helping my form, adding to the strain on my back. So I had basically run a marathon, a fast marathon, with 1/3 of my right glute not engaged. How does that work? I guess in the long run, not very well!

 

Lessons Learned, #2: Where I thought my strength training was helping strengthen my muscles and low back, I was actually just adding another layer of stress. The lesson was that I again needed a better physical assessment to really focus in on not just the specific muscle group, say glutes, but to make sure that each muscle in the group was actively engaged.

 

Since then I have come across a physical assessment modality called MAT, Muscle Activation Techniques, http://www.muscleactivation.com/, which includes a very specific assessment to determine how and if each muscle is working or if it’s even engaged, and then recommendations for specific exercises to focus on one muscle at a time, making sure it’s active and engaged. If I don’t do these exercises on a regular basis, or don’t incorporate something like them in my weekly strength training sessions, I can start to feel the old weakness in my back and glutes return, a reminder that I’m only as good as my weakest link.

 

I have also since been introduced to another training philosophy from Dr. Eric Goodman called Foundation Training, http://www.foundationtraining.com/. Eric was a chiropractor who wondered if there wasn’t a way to prevent some of the people he was seeing from ever having to need his services. Over time he developed a host of exercises in positions that remind me mostly of the chair pose in yoga, with variations, and low lunges. Focusing on what is called the posterior chain (your hamstrings, glutes, and low back), understanding that these are all connected and provide the support for the other muscles to work against. We (as humans) have tended to work on the muscles we can see in the mirror (biceps, chest, stomach, and quads), while ignoring the side we can’t see as easily. As a result we’re out of balance so the Foundation Training technique teaches us to engage these other muscles groups, strengthening them, so we can continue to bike and run hard without fatiguing and straining our backs.

 

Lesson Learned, #3: Being open to new ideas, like MAT, like Foundation Training, and moving away from the traditional body building style of strength training, even with an aerobic/distance mind set, versus that of a pure power lifter, has brought strength and balance to my entire body. Being an endurance athlete no longer means I have to suffer from low back pain as I used to experience, but it does require that I perform regular maintenance exercises as I continue to swim, bike, and run hard.

 

Through all of these experiences and lessons learned, have I forever banished low back pain from my life? No, of course not, I’m human and getting older, while continuing to push the boundaries of my training. But I am in a much better place to stay in touch with my back issues, with more tools in my toolbox to help me without having to see a professional on a regular basis to get right again. I also know now that if what I’m doing isn’t working that I can go see a physical therapist or chiropractor and within a few sessions they can get me right again.

 

The Final Lessons Learned: The bottom line is that we each need to do an assessment, or have one done, to understand the issue we’re having with our backs, and to then follow up on the treatments even when our backs feel strong. We don’t want to find ourselves in the constant cycle of having back pain, feeling good after being treated, only to find ourselves in pain again. Life is short, we shouldn’t be living in pain, and with some work, admittedly hard work at times, we can work through our issues.

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