Sunday, January 31, 2010

the lower back pain issue

i've mentioned my lower back issue from time to time in this blog. not really directly, but more in relation to other discussions covering training and racing. those of you who've followed this blog consistently over the years can probably recall the posts i've made on the troubles i've had with my lower back and all my efforts to address it. i figured i'd devote a post to it and share what i've found in case other athletes were having similar problems that threatened their involvement in a sport.

my lower back, quite frankly, is a pain. a bad one. particularly through the sacroiliac, sacrum, lumbar, hips, and pelvic region. not bad enough to be permanently debilitating, and certainly not anywhere near the level that would impair normal living, but definitely bad enough that it is delimiting, in that it's served to inexplicably flare up at the times i've really needed it the most (races, mostly Ironmans) and prevented me from being able to really generate the kind of lower body power that i'm ordinarily (as in shorter distances) capable of exerting.

i've done my best to just gut it out when the pain has come on, but as any of you who have had a bad back know, it's not something you readily dismiss. especially when you're hunched over on a bike in the exact position most likely to induce it for mile after mile after mile after endless intensifying painful mile.

i've tried all manner of things over the years, from brute force weight training to increased stretching to sport-specific physical therapy. they've all helped to some degree, but never enough to address what happens over the course of a 140.6-mile Ironman race course. the lack of substantive success has driven me to be much more experimental relative to other people--athletes and non-athletes alike--in trying new solutions.

after some years of searching and trying various options in the wake of my last debacle (Ironman New Zealand 2008, where my back was so bad that i couldn't maintain the aero position on the bike and had to stop at every aid station for several minutes to stand and relieve the stress in the lower back), i think i can say i've found some success using a combination of various things. i'll comment on each of them below:
  • pilates: yes, pilates. i used to wonder about this. i wasn't so sure. but i gave it a try, and was stunned to find out that i couldn't do some of the basic moves. the physical therapists and dancers (yes, i learned this from dancers, who deal a lot with lower back issues, and so i figured they must know something about how to deal with it) taught a lot of the moves to me, particularly the ones that don't require special equipment. i found that this did wonders in developing my minor muscle groups and increasing my structural stability, especially through the core--including my lower spine through the abdomen, sacrum, and hips.
  • core-related physical therapy: a lot of these are related to pilates, but i broke them out because these involve some basic equipment. the exercises i'm referring to involve use of the swiss ball, medicine ball, balance ball, and dumb-bells, where you focus on proprioception and kinesthetic, which focus on structural strength involving muscles coordinated in static and dynamic movements, respectively. these look simple, but are brutal. these, in particular, really amplified the development of minor muscle groups through the ranges of motion typical of the chaotic, ballistic conditions common to athletics.
  • kung fu: yes. kung fu. i've documented my education in martial arts, predominately traditional chinese martial arts (reference: ). this worked (and i mean worked) my body through complex, multi-planar, multi-angle ranges of motion that built structural strength in a way that was not brittle or stiff, but instead pliable and responsive to physical stress--think a 3-D shock absorber (as opposed to, say, a pillar), which is what you want in the high-load environment of sports.
what i found through these strategies was as follows:
  • yoga made me sore, and didn't work. in fact, it made my back issues worse. but i believe the reason is that all of the above focus on dynamic structure, which is what is involved in sports. yoga, in contrast, focuses on static structure, which may help, but only to a degree.
  • weight training doesn't work. so much of weight training is aimed at developing large muscle groups. unfortunately, this leaves the small muscle groups undeveloped. your body, unfortunately, is only as capable as its weakest link. as a result, despite all the improvements in large muscle group strength, my body was still being limited by the weakness in small muscle groups--and the small muscle groups are the ones used to maintain structural stability (which involves the lower back).
  • all the years of training had only resulted in major physical imbalances in my body, with opposing muscles groups having severe imbalances in strength. my coaches, physical therapists, advisers, and instructors all noticed this, and they all asserted that it was causing structural imbalances in my body...and my lower back issues were a symptom of this.
  • all of the above methods (pilates, core-related physical therapy, and kung fu) served to 1) identify the location and nature of my structural imbalances (because they're so comprehensive, they pretty much expose all of your body's flaws), and 2) target those structural imbalances (because they're so comprehensive, they don't let you hide any of your body's flaws, but instead force you to work on them again and again and again and again...).
i can't say that i've completely solved my lower back pain problem. that's something that i'll only be able to definitely know for certain under the race conditions of the 140.6 miles of an Ironman.

but i can say that i have seen some substantial improvement. my sacroiliac and lumbar areas don't catastrophically give way while engaged in simple actions (like standing up out of bed). my lower abdomen and spinal regions don't ache while working through long swims or while hunched over during extended rides on the bike. my hips and buttocks don't get as sore while having to ascend hills.

it has been, to say the least, a relief to know that my delimiting factor in training has not been my lower back, but instead the muscles of my legs and upper back and lungs and heart. it's something more consistent with the training and racing experiences of other athletes. for me, it's a different feeling.

which gives me hope, since maybe it means that i can start to be more like them.

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