Wednesday, December 30, 2009

Back Pain

Time to 'fess up: I've been having low-back pain since mid-August.  It is worst when getting up in the morning, and flares whenever I try to lift anything, including myself.  Even picking up a penny on the ground requires that I squat way down.  I can't even put on my pants standing up!

I can walk and sit without pain, but that's about it.  If I'm careful, I can exercise without pain.  But even the slightest mistake guarantees the pain will increase, if not immediately, then soon after the workout ends.

At first, I thought the back pain was due simply to all the additional time I'd been spending cycling in the aero position.  But cutting back on my bike time, then zeroing it, did not affect the pain at all.

I talked to a personal trainer, who recommended things not to do, activities and motions to avoid, to help prevent making it worse.  It hasn't gotten worse overall, but there are certainly good days and bad days.

I got several massages, and while they felt great and gave me temporary pain relief, they had no lasting effect.  But a massage therapist did recommend some changes to my body position when I sleep.  That did help reduce, but did not eliminate, the morning discomfort.

I met with a physical therapist, who recommended some simple stretches, mainly for the hamstring, to try to remove stress from the back.  No immediate change in the first couple weeks, but I'm sticking with them.

I saw my primary physician to get a referral to my sports medicine doctor, but he said that since I was pain-free for my day-to-day activities, my condition did not rise to the level of clinical significance, so there was no need for immediate treatment.  But he did give me a thorough physical to ensure my back pain wasn't a precursor to another condition.

The personal trainer did some research, and uncovered a surprise: Everyone experiences back pain sooner or later in life, and for many people, their back pain lacks a direct cause (such as injury, mis-use or over-use).  There isn't all that much known about back pain that lacks a clear and direct cause.  One fairly common factor is emotional/life stress, and I do have tons of stress in my life right now.

I should mention that when I was in college I had developed severe back spasms that sometimes kept me from walking upright, and that required medication to relieve.  I was scheduled for physical therapy after the spasms subsided, but it turned out not to be necessary.  Evidently, just turning off the spasms for a while was all that was needed for me to heal on my own.  For the next 25 years I had no significant back pain.

So I know what back spasms are, and I'm certain I don't have them now.  The current pain really feels like my back was over-fatigued, but my back hasn't responded to my efforts to eliminate all forms of back fatigue from my daily life.

Could stress be the main issue?  The timing is interesting, since the back pain arrived about 2 months after a major increase in the stress present in my life (about 7 months ago).

During this entire year, I had been carefully and steadily increasing my training load (mainly distance and time, not peak effort) in all 3 triathlon sports.  The only constant has been my strength training, which I have been doing for about 8 years now.

I have lost about 20 pounds during the past year, which I attribute not only to the higher training load, but also to significant improvements to my eating patterns (I'm not on a "diet").  Thanks to the Holidays, and my currently reduced training levels, 8 pounds of that loss has returned.  Not enough to be a strain on my back!

Most importantly, aside from my mystery back pain, I have otherwise been injury-free since starting triathlon: I have tailored my training with the long-view in mind, and have no desire to push myself hard enough to risk injury.  But I do want to see steady improvement in all areas, since I know I have lots of room to improve both my speed and endurance.

Fortunately, short runs and long swims still feel good (well, they don't make my back worse), so I do them both in moderation, being careful not to start a run or swim if I'm too fatigued or in pain, and I stop the moment I feel any new pain in my back.  And I'm still doing my strength training, modified to avoid loading up my back.

Cycling on the road is out, since I can't hold my back up, and my arms don't handle the extra load very well (hands go numb).  Worse is that I can't pedal anywhere near full power, since I need to use my back to get power to the pedals when I'm in the saddle.  I'd be more comfortable on the bike if I could sit vertically, but neither my road bike nor my hybrid bike supports that position.  All that leaves me with is cycling out of the saddle, which I can't do long enough to last a whole ride.  So, I haven't been cycling at all.

That's what I've been telling myself, at least.  But the simple truth is there is a way to get lots of biking in, sitting vertically, with plenty of time out of the seat: Spin classes.  For some unknown reason, I've been resisting going to class: I think I became spoiled by all the road riding I was doing.

Time for that to change!

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