When to Return to Running after Experiencing Low Back Pain

mta_returntorunning

http://marathontrainingacademy.com/return-running-experiencing-low-back-pain

Marathon Training Academy

September 13, 2016

In this guest post for Marathon Training Academy, you will learn why initial activity and exercise are critical when treating low back pain (LBP) and how to determine if you are ready to return to running after experiencing an episode of LBP.

WomanWithLowBackPain

Low back pain (LBP) can be so severe and debilitating that it can completely derailing your training. It’s hard to run if your back, buttocks or leg hurts. You either won’t try to do it or you try to suffer through it only to be rewarded with worsening symptoms later on. However, initial activity and exercise are critical when treating LBP. Continue Reading

The Number One Reason Why You Won’t Reach Your Training Goals

MTA_NumberOneReason

http://marathontrainingacademy.com/number-one-reason

Marathon Training Academy

June 6, 2016

In this guest post for Marathon Training Academy, you will learn how to effectively exercise and work the core muscles in order to prevent or treat low back pain (LBP) as well as other common running injuries affected by weakness in the core and pelvic muscles.

The number one reason why runners won’t reach their goals is also one of the most preventable reasons: injury!  Nothing derails a perfectly developed training plan like an injury.

The most common injury to runners is also the most common injury for those in the western world: low back pain (LBP).  LBP is estimated to affect nearly 80% of the U.S. population at one time or another.  And worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence.  Continue Reading

The 3 Most Common Mistakes Runners make that can cause Low Back Pain

MTA_3Mistakes

http://marathontrainingacademy.com/low-back-pain-2

Marathon Training Academy

May 25, 2016

In this guest post for Marathon Training Academy, you will discover the three most common mistakes runners make that can lead to low back pain (LBP), and you will learn prevention tips in order to avoid injury.

Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and throughout the western world.  Avoiding the following most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services.  More importantly, avoiding injury and LBP insures that you can keep training and racing to your heart’s content!  Continue Reading

Take a Peek Inside of the Treating Low Back Pain during Exercise and Athletics Video Package

Did you know that an estimated $50 billion dollars is spent annually on back pain related issues?  It affects nearly 80% of the U.S. population at one time or another.  It’s one of the top reasons for physician and physical therapy visits and one of the most common reasons for missed work days.  The best training plan in the world won’t do us much good if we’re unable to implement that plan due to pain and/or injury.

WomanWithLowBackPain

When reviewing research or anecdotal evidence online, there is no shortage of articles, blogs, and opinions regarding low back pain (LBP).  But what about a specific resource for the athlete, the weightlifter, the CrossFitter or the runner who is experiencing low back pain during exercise?  How does an athletic population know how to handle episodes of LBP?  What specifically can an athlete or active person do to avoid low back pain to lessen the risk of injury and lost training days?  Is there a specific step-by-step plan that really works?

The prevention and rehabilitation strategies outlined in my rehabilitation guide, Treating Low Back Pain during Exercise and Athletics, answer those questions.  You will learn how to safely self-treat your low back pain and helpful methods for a speedy recovery.  (Not to mention, possibly saving you time and money by avoiding a physician visit!)

The good news is that participating in sports, running, CrossFit, and weightlifting doesn’t increase your risk of developing LBP.  On average, being in good health, physically fit, and active actually decreases your risk.

The Treating Low Back Pain (LBP) during Exercise and Athletics Video Package includes:

Treating Low Back Pain during Exercise and Athletics eBook

product-cover-lbp

In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain.  LBP has reoccurrence rates as high as 90%.  If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management.  Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level.  Topics include:

  • Specific strategies for LBP prevention.
  • How to address specific causes of LBP.
  • Best practices on how to prevent and self-treat when you experience an episode of LBP.
  • A step-by-step LBP rehabilitation guide complete with photos and detailed exercise descriptions.
  • How to implement prevention and rehabilitation strategies.

7-part Series of Instructional Videos

Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics.  An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:

  • Potential Risk Factors for Lower Back Pain
  • What are the Core Muscles?
  • Prevention during Exercise (Part 1 and 2)
  • Initial Treatment
  • Further Treatment and Taping
  • Long Term Management Strategies and Final Recap

Want to peek inside the video content? Watch now as I describe what really the “core” is and why it matters.

Preventing and Treating Overtraining Syndrome eBook

product-cover-ot

In this BONUS eBook, you’ll learn how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  Topics include:

  • How to recognize the warning signs.
  • Specific strategies for OTS prevention.
  • How to self-treat OTS.
  • How to safely overreach.
  • A complete guide to Foam Roller Stretches and Mobilizations with photos and detailed exercise descriptions.

Is your low back hurting? Are you ready to take your training to a new level?  What are you waiting for?  Let’s get started! 

Use discount code LBP to receive 15% off now!

Purchase Package

Still on the fence about the Treating Low Back Pain during Exercise and Athletics Video Package? I understand that the full package may not be the right choice for you. You still have the option to purchase only the Treating Low Back Pain during Exercise and Athletics eBook.

Use discount code LBP to receive 15% off now!

Purchase eBook (Download)

Why You Keep Hurting Your Back

Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and the western world.  In fact, an estimated $50 billion dollars or more is spent annually on back pain related issues.  Nearly 80% of the U.S. population is affected by LBP at one time or another.  So why are we all hurting our backs?  Why does the pain seem to always reoccur?

2 Reasons Why Low Back Pain tends to Reoccur:

  1. The original risk factor(s) or precipitating actions that caused the initial low back pain (LBP) were never addressed.
  2. The inner core stabilizing muscles were never properly rehabilitated.  This makes the spine vulnerable to re-injury.

Just imagine if you had a significant knee injury which required surgery.  The injured leg would be weak and require specific exercises to help it to rehabilitate.  In most cases, the muscles of the injured leg would be obviously smaller due to muscle atrophy.  This same atrophy happens deep within the muscles of the lumbar region (particularly, the muscles known as the multifidus shown below).MultifidusMuscles

These muscles are responsible for spinal stabilization and to prevent shearing between vertebrae to vertebrae.  Just like the muscles in the thigh (in the knee example above), these muscles will shrink and atrophy when injured.  The problem is that you cannot see or feel them easily, so most of us never know that the spine’s ability to stabilize during activity is compromised.  This is a critical factor as to why reoccurring LBP is so prevalent.

Low back pain is a serious and debilitating condition.  It will either most certainly affect you or someone close to you.  The good news is that you don’t have to be a statistic!  You don’t have to live in fear of your next episode of LBP.  First, you need to address the likely causes that lead to the initial episode of low back pain, and be mindful of your risk factors.  Please refer to 12 Risk Factors for Low Back Pain.

Next, by implementing the proper exercises for prevention and rehabilitation, you can live pain free, train pain free, and live the life you want without fear of reoccurring low back pain!  Treating Low Back Pain (LBP) during Exercise and Athletics is designed for individuals of all levels from weekend warriors to soccer moms to elite athletes.  These principles can help you live the pain free life that you desire!

Treating Low Back Pain during Exercise and Athletics

product-cover-lbp

In this complete self-treatment package, Treating Low Back Pain (LBP) during Exercise and Athletics, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

LEARN MORE

12 Risk Factors for Low Back Pain

We all work hard exercising and training for the next race, game, and/or competition.  We invest hundreds and thousands of dollars and hours upon hours training for our sport or activity.  We learn everything we can about our sport.  We buy the newest gear and fitness apps.  We invest in the newest and greatest training plans and programs.  Yet, we often fail to address the obvious. The best training plan in the world won’t do us much good if we’re unable to implement that plan due to pain and/or injury.  Many of us just accept occasional episodes of low back pain (LBP) as a normal part of life, but these episodes of LBP can have both devastating monetary and training consequences.

Young woman out jogging suffers a muscle injury

What if you could prevent injury and the loss of training days?  What if you could prevent costly physician visits?  What if you could spend your money on the best fitness and training programs and gear instead of on pain relief gels, oils, and scams?

The following list of potential risk factors for LBP addresses how you can be proactive in maintaining a healthy back.  How many of the following 12 risk factors can you relate to?

12 Risk Factors for Low Back Pain:

  1. Smoking – Smoking is a major risk factor for low back pain (LBP).  The chemicals in cigarette smoke affect both the lung’s ability to exchange oxygen and the body’s normal healing response.  These chemicals alter the blood supply to the discs and other spinal structures which affects nutrient exchange and increases the risk of pain.  Healing time for all medical conditions worsen with smoking.  Although research is forthcoming, it’s likely that vaping also has a negative impact on healing and LBP.  Anything that negatively affects optimal health will increase your risk of LBP and recovery from injury.
  2. Gender – This is an interesting one.  It may relate to certain behaviors more than anatomical differences, but males have a higher risk of LBP.  Females tend to experience more cervical or neck pain.
  3. Pregnancy – Pregnancy increases your risk for LBP due to structural changes as the baby develops and hormones change.  The expectant mother releases relaxin, a hormone which loosens the whole body, to prepare for the baby’s delivery.  Again, a risk worth taking!  Most women can manage the pain by modifying posture and movements while learning techniques for self-management.
  4. Heredity – A family history of low back pain increases your risk.  In some cases, this may be due to actual structural deformities which may be genetically linked.  More commonly, it’s a learned behavior, such as chronic sitting and slouching (poor posture), that can lead to a higher risk of LBP.
  5. Prior Episodes of LBP – Once you have experienced LBP, you are more likely to have re-current episodes.  This is typically due to not addressing the precipitating factors that led to the first episode of LBP.  It’s also likely due to weakness in the deep multifidus muscles that help to support the spine and prevent shearing forces.  This weakness can be addressed with proper physical therapy intervention.  (Please refer to Why You Keep Hurting Your Back.)
  6. Lack of Exercise/Activity – A sedentary lifestyle will increase your risk for LBP.  The spine is designed to work and move.  In order for the spine to remain healthy, it requires exercise and movement.
  7. Too Much Sitting – Sitting for even a moderate amount of time not only affects your general health status in a negative way, but it also increases your risk for LBP.  Sitting for more than 30 minutes at a time can increase your risk.  Worse yet is sitting with poor posture or unsupported.  Sitting on vibrating surfaces such as a heavy equipment operator will increase your risk further.  Please refer to The #1 Way to Extend Your Life Span for the reasons why sitting has such a negative effect on your body.
  8. Poor Posture – In western culture, we spend most of our day sitting slouched or standing hunched over.  This is an excellent way to increase your risk for LBP.  It’s one of the major risk factors for disc herniation and development of spinal stenosis.  Please refer to How to Improve Posture & Eliminate Pain for exercises that can help you to develop better posture and strength to eliminate back pain.
  9. Lack of Warm Up Before Exercise – This is a common mistake which can lead to injury.  A proper warm up prior to an event or exercise session is critical for injury prevention and in order to achieve peak performance.  A poor warm up affects your ability to get the most out of each training session.  A warm up should consist of a cardiovascular component, a spine specific component, and a dynamic stretching routine of the actual exercises you will be performing to insure you’re ready for the movement.  This is pertinent for any training session regardless of sport including weightlifting and running.
  10. Training when Exhausted – Allowing yourself to become over fatigued will increase your risk of all types of injury including LBP.  This is a common problem among CrossFitters and anyone who trains at a very high intense level.  Typically, this results in poor technique which further increases your risk.  Combine poor technique with muscles which can no longer perform the proper movement pattern, and you’re likely to become injured.
  11. Poor Technique – Poor technique often occurs when performing exercises that are too advanced, with too much resistance, and/or when feeling exhausted.  Performing unfamiliar lifting techniques or lifting too much weight will likely result in poor technique.
  12. Training Volume – Overtraining syndrome (OTS) can occur when you train too hard for too long.  Your training plan should include scheduled rest and recovery cycles to allow your body the time to recover between competitions and high volume or intense training cycles. OTS definitely increases your risk of injury.

The key component to preventing reoccurring episodes of LBP is to address your risk factors.  Determine what initially caused your LBP.  If you are looking to finally prevent those reoccurring episodes of LBP that derail your training and/or are currently suffering from LBP, then Treating Low Back Pain (LBP) during Exercise and Athletics is the solution.  This complete guide and system will help you to prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.

Treating Low Back Pain during Exercise and Athletics

product-cover-lbp

In this complete self-treatment package, Treating Low Back Pain (LBP) during Exercise and Athletics, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

BUY NOW

Why Low Back Pain almost always Reoccurs

I had waited all year for the City of Trees half marathon.  My goal (as always) was to post a PR (personal record) for the event.  Since it was a fairly flat course, I figured it would be a good opportunity to run fast (at least, fast for me).  As part of my training protocol, I was squatting two days per week and working on general leg strength and cross training (practicing yoga) one day per week.

Group of people running.

My back had been sore off and on for almost five years.  Medical professionals didn’t offer me any specific reasons as to why.  Neither chiropractic nor physical therapy seemed to help much, so I just ignored it.  But not this day!

I had just completed my second work set of squatting at the gym.  At the time, I wasn’t experiencing any notable back pain.  I was on my second repetition and on my third set when my low back gave way.  The weight came down and hit the rack safety rails!  My back hurt, but worse, it felt unstable.  I decided to leave the gym in shame.  I picked up the weights I was using, but the pain began to worsen.

By the time I drove home, I could barely get out of my truck.  I decided I was tough, so I took some ibuprofen and still went to work.  By the time I made it to the office (about 10 minutes), I was in real trouble.  I walked around for a while, and I took some Tylenol before I decided to go home.  I got in my truck, but by then the pain was so bad that I couldn’t push in the clutch or hardly use the brakes.  I really don’t know how I make it home that morning, but I needed help from my wife to get out of my truck.

LowBackPainIt only got worse from there.  I went to lie on my bed.  Again, another bad plan!  An hour later when I needed to urinate, I realized I couldn’t even get out of bed!  The pain was worse than anything I had ever experienced.  After much struggle and help from my dad (who was called in to help), I was able to get upright, only to break out in a cold sweat, start shaking, and nearly pass out from the pain.  Still having to urinate, I experienced one of the more humbling things I have ever done.  I had to ask for help from my wife to urinate into a plastic bottle because I couldn’t get out of bed.

Long story short, I went to a doctor who diagnosed me with low back pain (LBP) from a lumbar strain and prescribed pain medication and a steroid pack.  After many more days of pain, I was finally upright again.

A month later, I was ready to start back into my training, but frankly, I was nervous!  My back felt weak, and I had no idea how much was too much.  The worst part of it all:  I’m a physical therapist!  Shouldn’t I known what to do?  It sure didn’t feel like it at the time.

The medication did mostly relieve the pain, but I had a chronically sore back that felt weak and unstable.  I was performing physical therapy exercises and stretches.  I was even using heat and electrical muscle stimulation (EMS).

My treatment wasn’t helping me that much.  At least, not to the point that I felt I could get resume my training for my upcoming half marathon.  All I wanted to do was to get back to training, but I was too scared to!

This experience started me down a path of study that changed my life.  I realized how incompetent I had been as a physical therapist who treated others experiencing severe low back pain.  I had new appreciation for those patients who wanted to get back to their sport and activity.  I also realized that my prior physical therapy interventions were not preparing people to get back to sport nor most high level activities.

What do you do when you’re past the worst of the pain and want to resume training, but you don’t feel physically, mentally or emotionally ready?  Your insurance money may be used up.  The pain may have dissipated, but you’re still not sure how to progress through the next steps.  What if it happens again?  Can I train as hard as before?  Am I really better?  I have lost so many days of training, should I even compete in my event?

Often after a severe case of low back pain, you may be too scared to train like you did prior to the injury, and it turns out you should be!  At least until you understand why low back pain almost always reoccurs and what you can do to prevent it. 

The most common treatment strategies for low back pain are too general for most active individuals, weekend warriors, sport enthusiasts, CrossFitters, weightlifters, and runners.  I have spent the past 11 years researching, studying, and refining best practices for treating LBP.  I have combined research with known anatomical and physiological principles in order to develop very specific strategies for LBP prevention among active individuals.  I have designed a complete guide and system to help you to prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.

Treating Low Back Pain during Exercise and Athletics

product-cover-lbp

In this complete self-treatment package, Treating Low Back Pain (LBP) during Exercise and Athletics, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

BUY NOW

Treating Low Back Pain during Exercise and Athletics Video Package (2016)

product-cover-lbp

In this complete self-treatment package, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

5 Tips to Prevent Low Back Pain during DIY Projects

Many of us will be planning our yearly DIY (Do It Yourself) projects now that it’s nearly summer time (in the U.S.).  I have a few minor landscaping projects that will be addressed this summer, too.  Whether it is an outside landscaping project, an indoor painting project, moving furniture around, and spring cleaning (don’t forget the garage!), you are likely to be exercising different muscles and performing activities that you aren’t used to.  It’s easy to imagine the new paint color or a beautiful landscape design.  Now imagine crawling around on the floor because you can’t stand up as your best laid plans are derailed by a bad episode of low back pain (LBP).  Not exactly the picture you were hoping for!

Exhausting work in garden

Whether you are an avid exercise enthusiast, runner, CrossFitter, weekend warrior or couch potato, you are likely to experience an episode of LBP despite being young or old.  LBP is estimated to affect nearly 80% of the U.S. population at one time or another, and it’s one of the top reasons for physician visits.  Fortunately, most LBP is mechanical–meaning it’s from a physical or structural cause not related to conditions such as cancer or infections.  The problem with this type of LBP is that it usually comes back.  People who have had an episode of mechanical LBP are 90% more likely to experience it again.

If you are going to be tackling those DIY projects and desire to still be standing upright at the end of the day, it’s best to minimize your risk factors for experiencing LBP by being proactive!

5 Tips to Prevent Low Back Pain during DIY Projects:

1. Warm up.

Just like any other exercise and/or event, you should warm up first.  A good place to start is to perform standing back extensions and press-ups.

StandingBackExtensions_PressUps

2. Loosen up.

So many of us sit too much!  This causes tightness in the hip flexors and hamstrings.  Try stretching your hip flexors and hamstrings.

HipFlexors_Hamstrings

3. Limit the amount of time spent in one position (including sitting).

Don’t sit or bend over for a prolonged period of time without at least standing up straight (and preferably, performing additional standing back extensions and press-ups as well as stretching your hip flexors and hamstrings).

If you are sitting, maintain proper posture.  Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve.  A great tool to help you with this is a lumbar roll.

4. Use common sense.

If you don’t think you can comfortably lift something, be sure to ask someone for help.  Stay within your limits, and don’t over estimate those limits!  Just because you could lift 100 lbs. in high school, it doesn’t mean that you still can.  Use common sense and proper technique when lifting a heavy object or when performing repetitive lifting.

After taking a prolonged rest, be sure to spend a few minutes warming up and loosening up again.  Don’t make the mistake of sitting down and resting during your lunch break, only to launch back into the project without making sure that your back is ready.  Take the extra time to be certain that your back is ready to start working again.

5. Preventing LBP is always best.

Once you have experienced an episode of LBP, you have a 90% chance of it reoccurring.  Be proactive!  Reoccurrence rates can be impacted and reduced!

Developing adequate strength in the lumbar extensor muscles and core musculature is the primary way to prevent initial episodes and to prevent reoccurring episodes of LBP.  Research clearly indicates that the right targeted exercises are the most effective way to manage LBP.

Stay tuned in during this upcoming month as I introduce you to my new complete self-treatment package, Treating Low Back Pain during Exercise and Athletics.  I have designed a complete guide and system to help runners, CrossFitters, exercise enthusiasts, and weekend warriors just like you (and me) prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.  In the meantime, be sure to check out my FREE resource, 10 Minutes per Day Low Back Pain Prevention Guide.  Download the .pdf file, which is full of photos and exercise instructions, to get started!

For additional information on LBP, please refer to the following:

Which DIY (Do It Yourself) project do you hope to accomplish this upcoming summer?  Please share below.

Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!  If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

Q & A: How to Manage Spondylolisthesis Pain

Q What are some tips on how to decrease pain caused by spondylolisthesis? -Lisa

A.  Excellent question, Lisa! A spondylolisthesis (spondy) is a certain kind of back injury that is associated with a pars interarticularis defect which is part of the vertebrae. It’s often called the “scotty dog” fracture because of its shape. This condition can be congenital (from birth) or happen from trauma. It’s diagnosed slightly more in males (5% of the male population versus 3% in the female population).

It is important to note if the fracture is stable or not. If the spondylolisthesis is unstable during active motion, such as bending forward or backward, the vertebrae can actually slip and move forward or backward.

Spondylolisthesis injuries are graded I, II, III, IV, and V.

  • A Grade I defect occurs when 25% of the vertebral body has slipped forward.
  • Grade II occurs when 50% of the vertebral body slips forward.
  • Grade III occurs when 75% of the vertebral body slips forward.
  • Grade IV occurs when 100% of the vertebral body slips forward.
  • Grade V occurs when the vertebral body completely falls off which causes a spondyloptosis.

In many cases, you will never know if you have this particular condition unless an X-ray is taken. For most people, this condition is completely benign and painless (particularly, in Grade I defects).

Spondylolisthesis_XRay

If you have a Grade I or II spondylolisthesis and are experiencing pain, conservative treatment (including formal physical therapy) is usually the first form of treatment. Surgical intervention may be performed as needed in the case of a Grade II spondylolisthesis. Surgical intervention is almost always necessary in cases of Grade III or higher.

Exercise and Treatment Considerations

In case of a stable Grade I and some Grade II spondylolisthesis, exercise is an important part of the treatment strategy. There are a few items of consideration. First, obtain clearance from your medical physician. Often, a series of X-rays will be taken while you are standing and standing bending either forward or backward. This can determine if the area is stable. If so, then conservative treatment can be initiated.

When determining which motions to guide your treatment, always let pain and directional preference guide your movements. A directional preference is simply a method to identifying a pattern to the pain.  Does the pain get worse when you bend over or does it improve?  What happens when you repeat this movement?  Determine how your pain responds.  If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction.  Stop that particular movement.  If the pain improves then continue with exercises in that direction.  Never do anything that worsens your pain or symptoms.

On average, I tend to have my clients be less aggressive with lumbar range of motion, especially press-ups and backward bending. Although it’s not prohibited completely in the case of a stable injury, it’s merely a precaution as some research indicates that it may have the potential to cause more pain and worsen the pars defect.

It’s also entirely possible that the cause of pain has nothing to do with the spondylolisthesis. A thorough physical therapy evaluation should help to determine the actual cause of the pain (although, sometimes it is never truly known). The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

The focus of the treatment and exercise is on the strengthening of the inner and outer core muscles and lumbar extensors. With the only caveat being that you may need to avoid excessive loading with the spine extended. In this instance, I recommend that you work with a highly qualified trainer or sports medicine professional to insure that you are performing your particular exercise and sport in a manner that will keep you safe and the fracture stable.

It is also important to insure proper hip and pelvic mobility so that the spine is not over worked. In cases of spondylolisthesis, insuring a normal amount of hip extension in addition to proper hamstring length and hip rotation is important. If the hip cannot fully extend during walking and running, it will cause excessive lumbar extension. You may even want to focus on having less of a lumbar curve (a posterior pelvic tilt) if your tendency is to hyper extend with an anterior pelvic tilt. Be sure to work on thoracic mobility to insure the entire vertebral chain can move freely.

Exercise is the critical component to the management of this condition. I would highly advise that you consult with a local physical therapist that has a Lumbar MedX exercise machine.  This particular machine can isolate the lumbar multifidus during exercise better than any other exercise that I am aware of.

Other exercises can be utilized to activate the multifidus. These Lumbar Extensor Exercises are designed to progressively activate the multifidus muscles (with the final exercise being the most challenging). Generally improving your core strength is a critical component to the overall treatment. My only caution is to once again avoid excessive loading in hyper extension and to take your strength progression more slowly while monitoring your symptoms.  If you perform an activity that causes worsening pain, then you will need to modify or eliminate that particular activity until it can be performed pain free.

In some cases, more flexion biased stretches would be indicated. This would be determined by the directional preference.  If extension biased exercises worsened the pain and flexion biased exercises improved the pain, then initially you would proceed with flexion biased exercises to help control pain while you progress into your core and lumbar stabilization program.  Examples of flexion biased stretches would be a single knee to chest (below left) or a double knee to chest exercise (below right).  Hold these for 20-30 seconds at a time and perform 4-5 repetitions each.

Spondylolisthesis_Collage_1200pxx450px

Good luck, Lisa! I hope you find this information to be helpful and provide some relief from the pain you’re experiencing.  For more information on treatment strategies for low back pain, please refer to How to Safely Self-Treat Low Back Pain.

Do you suffer from spondylolisthesis? Please share your best tips for pain management.

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