Chronic Back Pain - Triathlon Training - Help

[SigMik]

Yes, Nick, I do think in your case that it is "fixable" and there is a lot of things you can do to help yourself. I often find it is a question of doing more of the good, and less of the bad, and a skilled therapist can help you with identifying relevant factors that can contribute to your recovery. I often say that it's not about what you see (osteo, physio, chiro, etc), but WHO you see. Personally, I'd recommend you to get a referral to a musculoskeletal ESP (extended scope practitioner) clinic or look for MACP-members (manipulation association of chartered physiotherapists). I'm maybe contradicting myself a bit here, but at least I know the criteria they've been trough to get to where they are. My point being, a skilled person practicing chiro, osteo, physio, would probably be skilled no matter what profession that person would become - it's more about personal traits (I believe) than what is being taught in the different schools........

I've become quite careful with advising anti-inflammatory drugs, as resent research suggests NSAIDs to delay healing processes. Another important aspect is that your pain being of 6 months, the chances of any inflammatory mediators being active is less than likely and that the pain now has a bigger component of inadequate pain-processing issues. Anyhow, it's all about overall net-gain or net-loss, and for your part, I'd say IF you can manage without, let it wait so you can monitor the effect of the interventions this communication might trigger.

Damien do bring up a technical point to the McKenzie approach, but taking it into a functional light rather than structural (derangement), my impression is that forward bending makes it worse - intuitively one would try to see what happens if you do the opposite - backwards bending. As long as you reassess the before and after effect, you'd be the one to tell if its meaningful for you.

The slump test as an exercise could potentially help the condition, but as Damien commented, "neural" issues can tend to be a bit irritable, a bit easy to flare up with a tendency of latent pain, so take it easy. It's purely hypothetical, but moving the nerves is thought to make its "fluid" flow better as it has thixotrophic factors, potentially improving nutritional conditions within the nerve, making it less sensitive to mechanical movement...

A few points that I forgot to mention in my previous post, was how a disc issue could produce symptoms in the situations you describe. The MAIN thing you mentioned, was the difference when swimming. Swimming is a non-weightbearing exercise, potentially causing less pressure to your disc and therefore potentially less tethering to the dura mater. It does also involve a lot of repetitive movements which could irritate minor "mechanical dysfunctions" in your upper back. This together with the transition to weight bearing out of the pool could explain why you feel sore after swimming in contrast to the other exercises you do.

Also, you mentioned that its worse while cycling. First of all, cycling is a forward-bending positioned activity, also not extremely far from a sloppy slump . Second, it could also potentially challenge this pivoting point as I spoke of earlier, as your upper body will absorb much of the torque (rotational forces) when you work with your legs and hold on to the handlebars. Personally, I'd use components of this exercise in tailoring a rehab-programme for you.

As you suggested, bring some of this info to your existing therapist or even better, ask them to read this post . I'm sure your therapist might also appreciate some input and will be able to use some of this constructively.

Best of luck,
Sigurd Mikkelsen