How do you deal with your back problems?

[hikingfish]

Hi All,
Lately, I haven't been hiking as much and haven't been around on VFTT a whole lot. I moved farther away from the Adirondacks and in the last year, I managed to pull 2 sprains in my lower back (they call 'em entorse lombaire in french). I fear I might have a hernia or something of the sort, although I'm supposed to meet my doctorb (the b is for bargain! hehe gotta love the simpsons) next week about an MRI I passed a month back.

I managed to get 2 outings in this winter, mostly on flat terrain or relatively easy terrain. It didn't go that well. My back was tired and aching after a couple of hours of walking. I had one kick arse outing planned: 2 nights of winter camping, one of which was supposed to be on the summit of a mountain the Charlevoix that doesn't get that many visitors in the winter. The second the going got a bit harder, my back wouldn't cooperate and we had to turn back. Still had a great time, but it made me realize that it might be harder than anticipated to deal with my back problems.

I was wondering if anyone else had such problems and how they dealt with it? I'm doing a lot of physiotherapy and I still keep going to the gym as much as I can. However, the one thing I love doing is going deep in the mountains for several days and then coming back out to civilization. But it seems I won't really be able to do that anymore

Cheers,

Fish

 

[redsock]

I too have had a lot of lower back problems. I would strain my back a few times a year and would be miserable for about a week each time.
I finally went to acupuncture to help with the pain. I then went to a Rolfer (http://en.wikipedia.org/wiki/Rolfing). The rolfing helped tremendously. I went once a week for about 10 weeks. Since then (about 3 years) I have not had any more severe lower back pain.
Last bit of advice that you have probably heard before is to stretch out your back and legs every day.

 

[dug]

All back pain is different. I would be leery about soliciting opinions on a message board. One suggestion from someone may cause a much bigger problem for you. That being said, I "cured" my back problems by becoming a stretching zealot and dropping a few pounds. I still stiffen up on occasion, and have missed a trip or two. However, stretching (back, neck, arms, chest, butt, hamstrings, thighs) is a good place to start.

 

[cbcbd]

All back pain is different.

I agree.
I have a bulged disc in my lower back. The pain (in my feet) goes away whenever I'm out hiking and bothers me the most when I'm just sitting working at the desk. Physical therapy and the related exercises didn't do much.

I've heard people have success with various things... yoga, stretching, acupuncture... once you find what works for you, stick with it.

Backs are too quirky to have an all encompassing answer. Good luck

 

[giggy]

doesn't sound the same as you - but here is my story.. I think back problems are all different and not really understood by the ole MD's

After 34 years of being injury free, this (my 35th ) I had an odd back problem that the doctors couldn't figure out what was wrong for months. I had pain more on my right lower back side/flank that felt not so much pain - but sore swollen (felt - wasn't wasnt actually swollen) type of stuff.

I got tested for liver/pancrease, gallballder, etc... tests always came back fine. At one point - he told me I was constipated

In the middle of this - I stopped all running, hiking, etc..for 6 weeks. - I felt worse - when I don't run, I get depressed, etc.. I need to work out an hour or so a day.

Eventually, I got sent to a physical therapist and she started me on core body excerisies. I finally started putting 2 and 2 together and I think it had to do with me sitting for probably near 10 hours a day at work and commuting. At the end of 8 or 9 visits - she was stumped as well and sent me back the my MD - which I never went.

long story short - I stopped going to the PT and continued on my core exercises, crunches, leg lifts, etc..anf finally getting back to my nromal running rountine (5 to 10 miles runs, 3 to 4 days a week) and I am still not 100% -but probably 80 to 90% - bottom line - I found once you stop excerising - thats when things go south fast - got to keep it up. I started putting on weight becuase of course - the eating and beer drinking didn't stop!

I am not at the hiking level I once was - but I am getting back and I am hoping to be back to normal this summer. I am pretty sure it has to do with sitting and once I figured out my core muscle needed working - I feel way better. I just did 6 days in baxter and it didn't bother me at all, but now back at work - hint of the soreness comes around every now and then - but not like 6 months ago - nowhere near, so I think the PT did help as did stretching.

 

[Pig Pen]

I'm not a doctor and I don't play one on TV and I didn't stay at a Holiday Inn last night. However:

I had back spasms about 15 years ago that bugged me for over year. After trying a bunch of stuff I finally started swimming laps for 30 minutes per day about 4 times a week. It may be a coincidence but my back problems disappeared soon after I started this activity.

 

[Snowflea]

bottom line - I found once you stop excerising - thats when things go south fast - got to keep it up.

Strongly agree w/Giggy here. Generally speaking, it's very important to try to keep active and minimize the use of meds if you can after, of course, being evaluated by a health care professional.

Perhaps your plan of being out x two nights was a bit aggressive, however. (That's a heavy pack!) Better to start off with shorter dayhikes.

I also highly recommend that you find yourself a good yoga instructor and a class you like.

And remember: lift with the legs, not with the back!

Good luck.

 

[king tut]

My back gets stiff if i stop working out for a period of time, not the severity of what you are describing though. I have found that by lifting upper body weights, I.E chest, biceps, shoulders, it tends to make an amazing difference and my back feels tremendous. I am not a doctor nor do I play one on t.v., but i think the general rule of buidling up the muscles in the back and around it help out a lot.

 

[Paradox]

Definately time for Neil to check in! A well intensioned MD had me on vicoden (addicting, constipating and not much help, and flexeral (a mouth drying, misery inducing, and highly addicting benzodiazapine) and told me not to work for a week. After 46 years of listening to people tell me to never go to a chiropractor, I finally went to one for my lower back pain. I was in so much pain it took me 5 minutes to get into my car, when I got to his office it took me 15 minutes to get out of the car and get into his office. He did his thing (which hurt like hell), then showed me how to do some exercises. I walked out of his office, got in my car, drove home, got out of the car, and walked in the house. No useless drugs, and I did not miss another day of work. It was great! His name is James Pamplin and he is in Plymouth NH, but I am sure Neil is much closer.

 

[bikehikeskifish]

I'll say it for Neil -- I LOVE MY CHIROPRACTOR! Oh, and stretching is a huge benefit too. 2 or 3 nights per week, minimum, I stretch for up to 30 minutes, while watching TV (mostly)... helps a lot.

Tim

 

[Karst]

Whatever you do, before you do anything drastic, I suggest you read "A Knife in the Back" by Jerome Groopman from the April 8, 2002 issue of the New Yorker. It is easily Google-able and is an eye-opening description of potential solutions to back problems.

This from a long distance hiker and cyclist with disk herniations at L2-3, L3-L4, L4-L5, L5-S1 who has tried just about everything except invasive procedures; including acupuncture, chiropractic, physical therapy of various forms, every possible ingestible, including: flexeril, robaxin, vicodin, tramadol, soma, oxycontin, roxicet, percocet, vioxx, bextra, celebrex, neurontin, prednisone, and all the over the counter options.

I earned those herniations legitimately and stupidly 20-30 years ago when I was superman and worked construction to pay for college, and in the several years afterward when I was still immortal, and I regret it all now.

What I have learned over the years since is:
get as light as possible - that gut is a killer,
stretch, stretch, stretch,
do all those core strengthening exercises you hate doing (because they seem so silly) - that physical therapist knows what they are talking about and can help.

And I was told by a back surgeon to never opt for surgery until you have one or more of three symptoms:
loss of strength in one or both legs;
loss of sensation in a leg;
incontinence.

I have hiked for weeks with a 35 pound pack on my back and cycled centuries with these disks(certainly not pain-free, but recovery has been sweet). The most enjoyable thing I have ever done in my life has been to hike with my family. My youngest is only in 9th grade so I'm not ready for the easy chair yet.

Disks have a remarkable ability to heal themselves. But that happens slowly over time. So give them a chance - get fit and light and agile. You always have the potential to recover. Once you opt for surgery however, you will never progress beyond a certain point of recovery(which, depending on circumstances, may be all you can hope for).

But read that article.

 

[prino]

I agree with Giggy and Stinky feet here, a moderate level of exercise is the key. I re-injured my lower back last week lifting something heavy out the back of the car and after a couple of days of (painful) rest decided to go x-c country skiing.

I took it easy at first but within 3 evenings of steady workouts the pain went away. I personally think hard cardio-vascular work stimulates the endorphins to kick in and alleviate the pain. It worked for me anyway.

The two worst things I find, are sitting or standing still for long periods. The back muscles stay or go into spasm.
Lying flat on the back with the lower legs supported on a chair or walking with no pack are the best.
There again all back pain is different and you should get it checked out first.

Good luck!

 

[Neil]

After more than 20 years of treating patients with spinal problems I have this to toss out:

The single most important barrier to a successful treatment outcome is the patient himself. The things people get into their heads and believe about their problem (almost always inaccurate- and I'm being very diplomatic) is the single most important factor that sabotages an otherwise excellent treatment protocol. I see it every day.

Every case is different and every case is a bit of a mystery. Treating low back pain (in spite of modern imaging techniques) is like repairing a car without opening the hood.

In spite of no supporting evidence I intuitively believe that building strength and endurance in the core spinal stabilizing musculature is important. To properly do 3 sets of 15-20 reps of 5 or 6 key exercises takes how long?

But the exercises alone are rarely enough. It's like adopting good dental hygiene instead of getting a filling. It might work for a very minor pathology.

What is most neglected in North America is the breaking of compensatory movement patterns that almost always develop long before symptoms appear.

Here's a simple example: the nervous system responds to tight hip flexors by altering and compromising normal spinal mechanics during the gait cycle. Sit-ups, and the compressive load they subject the discs to, will not do a thing for this. Examining for it and making the patient aware of it, then having the patient do the appropriate exercises properly will work better.

Ie. if the software is faulty then increasing the strength/endurance of the abs and low back muscles won't do much.


Sufferers of severe debilitating back pain have as much muscle strength as healthy people but they have significantly less muscle endurance. The key is not to build muscle strength but endurance. Hikers should understand this.

One last little thought: when you work out at a gym do most of your exercises with free weights and in a standing position. Spend time on wobble boards, balance boards, gym balls etc. Focus on increasing muscle endurance, not strength. Work the core after the extremities and plan on 6 exercises requiring at least an hour to do properly.

 

[Karst]

This seems to be a relevant thread from a few years ago:

http://vftt.org/forums/showthread.php?t=10900&highlight=

And after 30 years of being a spinal patient, I agree completely with Neil. Every time I get lazy or think my other exercise activity is enough, I get caught and pay the consequences.

 

[Jasper]

Mac the Knife.

Doctors like to keep busy. Alway be circumspect about their intentions as their is an inherent conflict of interest. If at all possible, stay away from the knife. I know over 5 people who have had operations on their spine and none are much better for it. I know this is unscientific, but that is how it is.

My personal routine over the last 5 years is to do sit-up a 3 times per week followed by some yoga (sun-dog and something else my wife taught me). Absolutely, no back problems over that time period. It works for me.

 

[prino]

One last little thought: when you work out at a gym do most of your exercises with free weights and in a standing position. Spend time on wobble boards, balance boards, gym balls etc. Focus on increasing muscle endurance, not strength. Work the core after the extremities and plan on 6 exercises requiring at least an hour to do properly.

Thanks for those pointers Neil! Excellent recommendations.
I'm back to the Gym this week.

 

[Dr. Dasypodidae]

All back pain is different. I would be leery about soliciting opinions on a message board. One suggestion from someone may cause a much bigger problem for you. That being said, I "cured" my back problems by becoming a stretching zealot and dropping a few pounds. I still stiffen up on occasion, and have missed a trip or two. However, stretching (back, neck, arms, chest, butt, hamstrings, thighs) is a good place to start.

I think that dug is right on the mark. Hans Krause, M.D., the great Gunks climber, was founder of a pain clinic in N.Y.C., where, with another famous Gunks climber Bonnie Prudden, he treated both Eisenhower (see first link below) and Kennedy (see second link below; JKF was under his care when he was shot in November 1963). Hans also treated me after my neck surgery in 1993, was a strong advocate for stretching, and felt that back surgery was almost never warranted (in studying my MRI's, after my surgery, he agreed that I was an exception). Bonnie Prudden (see third link below) moved her center for myotherapy from Massachusetts to Arizona many years ago, although I am not sure she is still in practice (she is 94 now, I think). However, some of her proteges are still at work (see fourth link below). Finally, if you want a wonderful book to read, I recommend one by Susan B. Schwartz about Hans Krause (fifth link below).


http://www.fitness.gov/50thanniversary/toolkit-firstfiftyyears.htm

http://www.jfklibrary.org/Historical+Resources/Archives/Archives+and+Manuscripts/fa_kraus.htm

http://www.bonnieprudden.com/

http://www.sbwellnessdirectory.com/MyotherapyofSB.htm

http://www.amazon.com/s/ref=nb_ss_g...ks&field-keywords=susan+b.+schwartz&x=15&y=20

 

[hikingfish]

Hi Guys,
I read all your posts (quickly though, I'm at work). I'm going to re-read everything again a bit later. All good posts! To make one thing clear, which has been repeated a couple of times, I DO WANT TO KEEP ACTIVE! lol And to touch a bit of what Neil was talking about, I think I'm starting to put barriers for myself, which is scaring me a bit to be honest. I've been feeling so 'down' lately because I can't go out and do what I want that I'm losing interest in training and hiking.

I'm meeting my doctor on Wednesday. Hopefully, he'll be able to tell me what the MRI saw 'under my hood' and how we're going to go about treating it.

I'll post a longer reply soon!

Fish

 

[jime]

Pt

That's interesting...I just got back from my first ever visit to a Physical Therapist. I've suffered from back pain off and on since I was 17 and after all of the shoveling this winter I just couldn't shake it any more. So, I paid a visit to my doc who prescribed lots of drugs (I'm not a fan and haven't used them very much) but, and most importantly, scheduled me with a PT. Best thing I've ever done! I've been going to a chiropractor for a few years and normally he can help but not this time for some reason.

So my suggestions mirror those who've gone before. See the docs, both PCP and Chiro, skip the drugs if you can (they do have their place), see a PT and do light stretching and exercise.

 

[bikehikeskifish]

FWIW, my knees were MRI'd and the left one showed absolutely no problems while the right showed a small pocket of fluid "consistent with a small meniscus tear". Oddly enough the left on hurt way more than the right.

The point here is that the MRI may or may not show anything. I was rather saddened to not know any more after the fact.

Tim