Lower back problems - what next?

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Paul Victory
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Lower back problems - what next?

Post by Paul Victory »

Those of you who are long term members will know that I have struggled for a long time with lower back problems. These were just an occasional niggle from time to time, but became more of an issue in 2016 or thereabouts.

Looking back, I think my more recent problems are at least partly due to my participation in the 100k world record for a large 60-69 years old mixed team in January 2016. This was a team of 9 men and 5 women and consisted of jumping onto the erg and rowing like mad for about 45 seconds, then hopping off to let someone else do likewise and then doing this over and over again until we had completed the 100k in 5:37:41.7.

I have had three lumbar MRI scans that have confirmed degenerative wear and tear at various points along my spine. I have consulted two specialists, had two lumbar injections and have made dozens of visits to masseurs, physiotherapists, physical therapists and, most recently, an acupuncturist. Many of these came highly recommended by people who say they have had great results, but none of them have been able to resolve the problem, or even make it all that much better. I've also tried Pilates classes and I found these helped a bit, but unfortunately my instructor fell ill and I haven't looked for an alternative.

I've stayed off the erg at the behest of my most recent therapist (the acupuncturist), but I'm not convinced that erging is contributing to the problem. I find that I suffer a lot from lower back pain first thing in the morning or if I have been sitting for an extended period and I tend to walk around listing to the side until I walk off the problem. I'm generally (although not always) better later in the day.

I think I'm probably worse now than I have been in the past and I don't know whether to put this down to just getting older, although I suspect it may be at least partly due to additional weight that I'm carrying around my midriff as a result of not exercising quite as much as I used to (although eating and drinking too much may also be partly responsible for any weight gain).

I've now reached the point where I don't think the acupuncturist is going to be able to help me resolve the problem and I'm considering next steps. Doing yoga is not an option as I am completely inflexible, due in part to never having spent much time doing flexibility exercises before training in the past and rarely warming up properly. So I can only think of two other options that I haven't tried yet.

Osteopathy - a friend of Jennifer's has found this most helpful in dealing with a persistent niggle and has passed on details of the person she's been dealing with.

Chiropractic - this seems like a high risk strategy. I've heard of some people for whom it was the only thing that worked. Others have found that it made things a lot worse and I have a doctor friend who has counselled me most strongly against using one.

Apologies for the extremely long post, but if any of you have managed to make it all the way to the end, I'd be most grateful for your thoughts/recommendations/ suggestions.

Thanks
Paul
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Re: Lower back problems - what next?

Post by Kevinhorne44 »

Reading this Paul. It screams muscular to me.

I have suffered with a couple of back injuries in the past. All from doing movements/other sports that were not part of my training. Much to the annoyance of my coaches at the time.

The fact that pilates have helped just confirms this even more. A strong core is a brilliant thing to have. But its built painstakingly slowly and so easily lost if ignored. Using the erg will help your core IMO.

I think you know the answer already too. Take control of you calorific intake and exercise smart 👍 find another pilates class/instructor (hell I'm even doing a class every Monday nowadays 😳😂)

Dont give up !! I'm sure you have a large supportive group here rooting for you too 👍 count me in on that too please.
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Re: Lower back problems - what next?

Post by JonT »

Paul,

It is always difficult, and possibly risky to advise others, especially coming from a position of general lack of knowledge of your options and of your condition. So, here goes... :fssmile:

First of all, you have all of my sympathy. I know how much you enjoy rowing and to have that taken away from you because of this problem is a poor state of affairs.

If it were me I would definitely look at Pilates again, and yoga. There are a lot of yoga teachers and classes out there that start from a position of working with people who have done little or nothing before and who have very poor flexibility. You just need to find the right teacher and/or group to work with. Yoga has made a huge difference for me especially my back and knee, both of which I have had niggles with over the last few years. I'm a bit surprised that the physios that you have been working with have not pointed you in that direction. I had an excellent physio at Bath University who did a small amount of work with me on my knee (referee injury) but who ended our sessions pointing out that all of this could be addressed and avoided by some basic yoga and focussed strength training. (As an aside we are hugely lucky here in Bath to have one of the best Sports Physio departments available to the general public).

I would definitely but Osteopathy before Chiropractic treatment. But that is simple based on limited knowledge and the fact that Chiropractic treatment seems pretty daunting to me.

Finally, and hopefully not condescendingly, calories in <= calories used.
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Re: Lower back problems - what next?

Post by Wolfmiester »

Hi Paul, sympathies from a fellow sufferer! I have an almost constant niggle around my bottom two vertibre, also exacerbated by extended sitting or worse in the morning. I'm told it's muscular and nothing to do with the discs themselves.
Kevin and Jon have already stated what I was going to say, so I'll endorse their thoughts. Which is pretty close to your thoughts as well thankfully.
a) sounds muscular, anything worse would be even more debilitating.
b) erging, at the correct level, is good. But it's very important not to over do it at any stage
c) A strong core is vital. So ANY help you can do there will help long term. This will be by doing regular (daily) core exercises, at home or Pilates classes, AND reducing the extra weight around the midriff.
d) I'd also vote for Osteopathy before Chiropracty. Osteopaths will focus on the muscular treatment, where a Chiropractor will focus on spine/bone alignment.
e) aging is almost certainly a factor, so point c becomes even more important.
All the best, Steve
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Re: Lower back problems - what next?

Post by Kevinhorne44 »

Just seen this and thought of you Paul.

Agree with you Jon & Steve.

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Re: Lower back problems - what next?

Post by Paul Victory »

Thanks folks. I forgot to mention one other suggestion by my acupuncturist - Tai Chi. Has anyone tried this?
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Re: Lower back problems - what next?

Post by JonT »

Paul Victory wrote: Tue Jun 22, 2021 12:31 pm Thanks folks. I forgot to mention one other suggestion by my acupuncturist - Tai Chi. Has anyone tried this?
I have done Tai Chi Paul. While I enjoyed it immensely, and I can see it might help slightly with core through the need to balance and move slowly, I really don't see it helping a great deal. For me it was more of a physical alternative to meditation than anything else, but that's just my experience of course.

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Re: Lower back problems - what next?

Post by Kevinhorne44 »

Paul Victory wrote: Tue Jun 22, 2021 12:31 pm Thanks folks. I forgot to mention one other suggestion by my acupuncturist - Tai Chi. Has anyone tried this?
👍 slow movement, breathing, balance. Working that core too. What's not to like 🙂
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Re: Lower back problems - what next?

Post by Iain »

Sorry to hear of your continuing issues Paul.

I have suffered in a small way since stopping regular erging in 2012. Re mornings, I found getting a new mattress made a difference. Also recently have found using a swiss ball rather than supported chair during my long sedentary days has helped my core. I appreciate that these will not solve your problems, but might provide a small amount of improvement. i also found reducing DF helped (for a while was using 100 rather than my usual 120) and making sure of starting slow and building up. Might I suggest adding some stretching to every session as well. My flexibility has improved a lot from this.

Best of luck

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Re: Lower back problems - what next?

Post by Draggon »

Unemotional recommendations:

1. Start a stretching routine. It will suck for some time since you don't have one now, but you can learn a safe stretching routine pretty easily & inexpensively online. Be methodically slow and GRADUAL! Do not push into painful states.

2. Lose weight. It doesn't matter how you do it, you must do it. You don't HAVE to exercise to lose weight (but it sure helps - even just well-paced walking). It's all a math (and willpower) problem. Calories in must be less than baseline calories to live plus exercise calories. Always underestimate your exercise calories for good measure. Everything counts - the meal, the drinks, the preparatory oils, etc.

3. Core strength (already mentioned) is about the only thing you can count on to help low back pain without taking drastic measures that may or may not help. My dad had 3 different back surgeries and each one debilitated him worse than the last one. He's now (at 80) in a wheelchair. One easy (as in simple to understand and execute) way to start building core strength is to start doing planks three times a week. Even if you can only hold it for a few seconds at first, you can SLOWLY build up time.

4. Other strength exercises - muscle degeneration as we age is unavoidable, but you can slow it down by incorporating some strength exercises into your routine (i.e. weightlifting - starting SLOWLY and LIGHTLY and GRADUALLY increasing resistance).

5. Erging - stop feeling like you have to perform to any old standards you have in mind. Be flexible in your approach. Try several weeks of GRADUALLY increasing duration from even 5 minutes initially with the drag set at MINIMUM. You can still get a good aerobic workout in with minimum drag (once you've built up to 20 mins or more), and it will also help your core strength. Do not touch drag until you're comfortably doing 30 minute rows pain-free. (It's possible this may never happen) Even then, it's not necessary to increase drag. These days, you need healthy, not competitiveness.

If you do all these things for say, 6 months, and you're still having noticeable issues, then carefully consider the more intrusive approaches. I would not recommend intrusive first off the bat.

Source: Just a guy on the internet who's had a lifetime of interest in healthy physical fitness
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Re: Lower back problems - what next?

Post by Wolfmiester »

Wise words Ron
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Re: Lower back problems - what next?

Post by Paul Victory »

Wolfmiester wrote: Mon Jul 05, 2021 10:13 am Wise words Ron
Yes indeed. I've only just seen Ron's post now and the advice is much appreciated. Not all I have to do is act on it!
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Re: Lower back problems - what next?

Post by Mike Channin »

I'm no expert, but it sounds like some long-term permanent damage that you can hopefully work around, plus a set of issues related to alignment, posture, muscle tone, core strength, etc. and exacerbated by a bit more weight than ideal. So I guess you have to find a way to make some small positive steps and changes, and gradually work forward. And probably try NOT to get sucked into rowing too competitively until you've got some more core strength - work in gradually - slowly but surely.
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Re: Lower back problems - what next?

Post by Paul Victory »

Thanks Mike. After the issues I had following my visit to the osteopath, I decided to talk to my GP about it. I took him through my full history of the various therapists I’ve visited and we discussed the report I got from the specialist I saw last year. In his letter, the specialist recommended that I try physio and that, if that didn’t work, I should consider facet mapping. My GP thinks I should follow up with him on that option.

I haven’t done anything about it yet. I think that losing some weight and getting fitter might lead to a considerable improvement in my back (as you have suggested) and I don’t really know a lot about facet mapping. If there’s anyone on the team who’s had it done, I’d be very interested to hear about their experience.

I actually got on the erg today for the first time this month. My plan was to do a gentle warm up, followed by the IRL 4 minutes and the CTC 12 minutes. I did the warm up (just under 800m at 2:22 pace) and then tried to see if I could do the IRL at around 2:05 pace. I blew up pretty quickly and struggled to keep the pace under 2:10, finishing with 932m @ 2:08.8 pace. That left me pretty shattered, so I abandoned the idea of attempting the CTC. I think I need to do several ‘just row’ sessions before attempting any more challenges.
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Re: Lower back problems - what next?

Post by Mike Channin »

Paul - you gotta start somewhere, and anything which avoids aggravating your back is a good session.
Trying to do the IRL AND the CTC on one session is either very brave, or very stupid ;-)

I had no idea what facet mapping was (other than in geometry) - I found this: https://static1.squarespace.com/static/ ... 100219.pdf
Depends on the actual source of your issue as to how much this will help, I'd guess.

Maybe we could consider theraputic rowing as a form of physio?!?
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Re: Lower back problems - what next?

Post by Paul Victory »

Mike Channin wrote: Fri Oct 01, 2021 3:16 pmTrying to do the IRL AND the CTC on one session is either very brave, or very stupid ;-)
The latter, I’m afraid!
Mike Channin wrote: Fri Oct 01, 2021 3:16 pm I had no idea what facet mapping was (other than in geometry) - I found this: https://static1.squarespace.com/static/ ... 100219.pdf
Depends on the actual source of your issue as to how much this will help, I'd guess.
Thanks for finding that Mike. It’s somewhat underwhelming and sounds like throwing darts blindfolded and trying to hit the bullseye. And the benefits seem to be minimal, at best. I’ve already had two lumbar injections a few years back and these provided hardly any relief - maybe for a week or so the second time around.

I’ve been somewhat less than diligent in doing the various exercises recommended and I think I’ll try to stick at it for a week or two and see if I notice any improvement. I’m going to park the facet mapping for now.
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Re: Lower back problems - what next?

Post by Mike Channin »

How are things going, Paul?
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Re: Lower back problems - what next?

Post by Paul Victory »

Mike Channin wrote: Thu Oct 14, 2021 12:52 pm How are things going, Paul?
Thanks for asking Mike.

Things are still somewhat problematic, I’m afraid. In recent weeks, I’ve found that the pain in my back is persisting throughout the day instead of disappearing after I’ve walked around for a bit. Motivation is pretty non-existent and I need something to get me kick started. While I’m very appreciative of the advice that has been offered in this thread, I have been some less than diligent in following this advice.

Jennifer thinks that my back was a lot better when I was seeing the physiotherapist earlier this year. So I’ve decided to go back to him to see if I can at least get back to where I was when I was seeing him regularly.

I called last week to make an appointment and the earliest one I could get is next Tuesday, though I’m also on a cancellation list. I’ll post an update after I’ve seen him.

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Re: Lower back problems - what next?

Post by Mike Channin »

Where exactly is the pain, what kind of pain is it, and what causes it/aggravates it?
Good luck with the physio!
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Re: Lower back problems - what next?

Post by Paul Victory »

Mike Channin wrote: Wed Oct 20, 2021 3:26 pm Where exactly is the pain, what kind of pain is it, and what causes it/aggravates it?
Good luck with the physio!
Hi Mike

It’s mostly across my lower back, but recently has been spreading upwards and from time to time I get shooting pains down my leg or upper arm. It’s tends to be worst first thing in the morning or if I have been seated for a long time. I can be particularly bad after a long drive or a flight.

I saw the physio yesterday and he has given me some exercises to do. I got a video from him late last night, but haven’t looked at it yet. He has advised me to stay off the erg for the time being.

I’m heading over to Alvor on Saturday and will be away until November 17th. I’ve an appointment to see him again a few days after I get back.

Paul V
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