Aches and pain in lower back when sleeping or swimming on my front

[evosy1978]

Hello all

When I sleep on my front for more than a few minutes and then get up or roll over, my lower back muscles either side of the spine both throb and theres a dull ache that is only relieved when im stood up.. The muscles in question are about 2-3 inches above my waistline but about 1/2 inches away from the spine.

It takes an age to stand up straight as the longer I have lay on my front then the stiffer the back is? If I wake up after being on my front for a long time such as more than 30 mins,,,, OMG it feels like my lower back has seized and locked in position..

Its also exactly the same aches and problems in the same muscles when I do front stroke swimming. When I do one length of the pool and get to the end of the pool my back is just locked into the position of what can only be described as hyperlordodis or sway back....

Any advice on whats happened and which back muscles are the problem?
Thanks

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[MrPhysio+]

Hello Evosy1978,
At a quick guess from your symptoms I strongly suspect that you have sacro-iliac joint (SIJ) ligament irritation causing
erector spinae muscle tightening and probably piriformis shortening as well. The effect is the hyperlordosis you describe.
SIJ problems rarely show on scanning as they are ligament based and have a poor blood supply meaning slow healing.
If conventional treatments do not help you, a sacro-iliac joint non stretch 50mm belt worn over the gluteus medius muscles
would stabilise the pelvis and assist healing.
It is very important to put the belt on when laying down, not standing, to ensure the ligaments are not under strain, If you put the belt on in standing the pelvic joints are loaded and the belt will hold them in the wrong position.

Initially, use the belt 24 hours a day (except showering), then after around 4 weeks wear during the day fdrom when you get up to when you go to bed for a fortnight. After this time, if feeling better, you can reduce the time by one hour every few days.

It would be wise to use the belt whenever doing activities such as lifting, twisting or lunging.

Overall, avoid lunging movements as they will load the SIJ. Standing with your feet a little wider than normal and knees with a very slight bend (just unlocked) reduces strain as well.

To reduce pain / inflammation in the initial stages you can take slow release paracetamol and fish oil capsules (6 1000mg), provided you have no problems with such items - check with your Doctor if unsure.

Hope the above helps.
Cheers,
MrPhysio+

[nmarman]

Sounds like mechanical lower back pain, a central circle of pain about the size of two fists either side of the spine. The pain will be generating from the facets of the spine and will be become sharp from time to time (this will cause the muscles to spasm around the area). This makes the joints closer together which in turn causes more pain

The Sacro iliac joint will almost certainly be dysfunctional but that pain normally does radiate up as high as you mentioned.

you must stop lying on you front (for ever! if possible it is seriously bad for your back) and stop swimming as both of these activities push the small highly sensitive facet joints together- if you must swim only do freestyle (head in water) for the next few weeks. If that still aggravates stop.

You will need to open the joints to get relief. So bend forward and hang. If this causes discomfort you have left this condition for a long time and must now seek passive care. Manipulation and passive stretching will work the quickest but passive stretching + massage will work quite well as well.

The belt is a great idea as it will give the muscles a break/rest but you need to cut out the aggravating factors first.
Have an Epsom salt (magnesium sulphate – muscle relaxant) bath 1kg in bath for 20-30mins then lie on back with knees up and slowly and individually rise the knees to the chest.

my advise go and see either a chiro or osteopath for manipulation other wise find a physio that has done a post grad in the technique. Otherwise go through home management as mentioned above

[evosy1978]

Thanks for the information both very informative.

The aches and pains Ive described are the most recent type of aches and pains Ive had in a 8 year long history of back pains and other problems.

I have a Leg length discrepancy - right side is slightly longer. (this is corrected when my im lying down and my hips are shaken) The LLD returns as soon as I stand up. (Ive known about this for 2 years)

My right knee has very noisy crepitus which I hear when going up stairs or crouching down. This has a mild pain under the knee plate. (this has gradually got louder over the last 18 months - the mild pain under the plate for the last 4 months)

Im also conscious of locking my knees out when Im standing still.

ITB on my right side snaps quite loud over my right hip when I flex and then extend my leg,. (I only notice this when lying on my back) (Ive known about it 18 months)

I have mild scoliosis - with mild rib hump on left side. (I noticed it about 18 months ago)

I have over pronated feet, with fallen arches,.(I noticed them about 18 months ago) (Ive recently had a podiatrist make me some orthotics)

I get very stiff back - In the middle of the night when I get up for the toilet or to see the babies it takes me a short while to stand up straight because of a sharp pain to the right of the spine above buttock. ( 18months)

ALSO theres the back muscle aches which I describe in my first post...

NOW
My most regular and consistent pain for the full 8 years is a sharp pain on the right side of my back 3 inches from the spine above the crest which also sometimes radiates some pain to the top of the right buttock especially when I KEEP passing through the initially sharp pain. E.G If I have to bend down quite alot in a short space of time EVEN with WHAT I THINK is good posture.

Just to say I had a GP who for 6 years just kept giiving me anti-inflammortory drugs. I now have a different GP who yesterday sent me for an x-ray on my right knee and on my lower back so ill see what they show next week.

18 months ago my new GP reffered to a specialist surgeon for an x-ray- unfotunately the surgeon felt I didnt need one and just commented on my poor standing posture, sway back, hyper lordosis. Since then Ive been very pro-active with my posture also since that meeting with the specialist Ive started to notice all the other problems Ive described above.

Unfortunately for 5 of the last 8 years I was a plasterer plaster boarding ceilings and carrying things on my shoulders etc. ADD these physical activities to the fact that Ive been doing them with a pelvic tilt posture and its understanderble why I have had the consistant sharp pain...
( I just want to say at this point that Ive had the sharp back pains before becoming a plasterer)

When I HANG down legs straight and reach for my toes I have a dull ache at the base of the spine.

My main concern now is the fact that the crepitus has gotten louder over 18 months and the knee has slight pain, the stiff back in the middle of the night, The aches I describe in my first post are also worrying. I seem to be getting a new ache or pain to deal with every 6 months.

I used to do swimming quite alot about 3 years ago. NEVER had a problem with the back when swimming - and now this, so to be fair Im really gutted... especially as everyone says this is the one thing that helps bad backs....

I saw a nhs physio last year who I didnt think was really helpful but he did say my bottom few vertabrea at the bottom of my spine were not moving when i Leaned over forward.

IF you have read this then thanks and good on you. I aggre with pelvic dysfunction of some sorts, this is something Ive been looking at recently... Possibly also some disc problems over the years. Im just now concerned with how things will progress from here.

What is passive stretching and manipulation?

Any more advice is welcome.
Thanks

[MrPhysio+]

Hello Evosy1978,
The last posts details are helpful assisting me to make further comment.
I will run through the points made in sequence as well as make general comment.
In general, a scoliosis will give an apparent leg length discrepancy. the difference between an apparent rather than real length discrepancy is that the apparent length difference is due to posture rather than an actual shortage of leg bones.
It is not possible to correct spinal bony scoliosis or real leg length discrepancy by shaking the hips - such treatment is a con used by some charlatan therapists to fool patients and increase revenue. Scoliosis can be caused by muscle imbalances due to reactive spasm, uneven exercise, or sustained bad posture. Muscle spasm is usually an acute problem eased by correct treatment. Improper treatment over years caused by poor assessment or bad therapists can result in tightened muscles and chronic biomechanically inefficient movement represented as pain and stiffness.

Most of your symptoms seem to be related to such a history - noting that you have not had in depth investigations. It is possible that a spinal x-ray (thoracic and lumbar - not fullbody x-rays favoured by some therapists) may show the real extent of bony change eg wedging or early fusion; to eliminate diseases such as Scheurmanns, spondylosis or anxylosing spondylosis. The generalised aches and pains need to be assessed to rule out various rheumatological diseases (OA, RA, etc) and fibromyalgia type syndromes.

A SIJ problem worse on one side than another can create a muscle imbalance that will create a lot of your symptoms. A sway back posture results in the knees being locked back in standing, give soreness when in prolonged standing, sit to stand problems after rest, irritation swinging your legs in / out of a car and may give a secondary effect of ITB/ TFL lateral leg ache due to postural change after the body compensates to reduce SIJ strain.

Increasing lateralis abdominus muscles, stretching erector spinae muscles whilst improving core stability (possibly utilising an SIJ belt across gluteus medius muscles to hold the sij area if put in place when lying down) will address the sway back and reduce alot of the symptoms.

The dull ache in your back when bending forward is inflammation and strain of the SIJ as well as fatigue of piriformis and erector spinae muscles.
Compensatory changes in posture over years may also increase the knee crepitus, however this can also be due to genetic variation susceptibility or simple incorrect or over zealous exercise creating premature wear of the patello-femoral cartilage.

Be very careful re orthotics, especially the rigid types, as these can cause more problems than they ease. Flat feet are not as bad as people first thought. The latest running shoes deconstruct support to provide a more barefoot running style which allows the foot structures to work more naturally, build muscle and have natural shock absorption without loading the heel like traditional athletic shoes.

The mid overnight or early morning musculature tightness and pain occurs due to the inflammatory fluid effect once you stop moving around.The daily movement in a poor mechanical position creates the inflammation which sets at rest and at the same time the nerve irritant becomes more concentrated increasing discomfort.
Swimming is not bad for you once your posture, core stability etc is addressed. I disagree with some of the advice given to you, but understand why this was stated. Anything you do whilst you have muscle imbalances, a sway back etc will be aggravated by increased forces or repetition through your body.
It will be interesting to know the result of your recent x-ray, which is only the beginning of your proper assessment.

One thing I have not asked: do you tend to have hypermobile joints, red or blonde hair, blue eyes or gastrointestinal irritations over a long period of time? Some yes answers may mean you have a gene that predisposes you to joint injury.

Passive stretching is where you just stretch a muscle gently without bouncing the muscle, holding the stretch for 15 seconds and repeating 3 times three or four times daily.
Manipulation is generally considered to be defined as a high velocity thrust movement given by a therapist to a patient at the end of available range of movement of a joint in a way the patient cannot resist. Such a movement has risks associated with it, including discal damage and in the neck torn vertebralm arteries. Huge numbers of joint manipulationsc are performed daily throughout the world by therapists - some therapists believe that allm the bodies ills are caused by the spine if 'malaligned' and manipulations or adjustments are done to correct the problem. The literature has examples of serious injuries being caused including death and paralysis, even when conducted by trained therapists. There are no conclusive foolproof screening tests to avoid problems. Some therapists claim that joints are out of place - but it is to be noted that the American Chiropractors are themselves at odds with each other about the validity of this claim.

I have not examined you, however from the post so far I would not agree that manipulation is suitable for you. There are three components that provide joint stability: joint interlocking shape, supporting ligaments (neither of which you can voluntarily change at will) and third the overlying muscle. Ongoing joint manipulation may cause joint ligament laxity that eventually has the effect of the surrounding muscle becoming excessively tight to stabilise the joints to stop the nerve roots or spinal cord becoming damaged. This causes back ache as the muscles cannot hold tension for a long time without irritation.
Some therapists make a career out of having patients return more and more frequently for treatment as the muscles become tight requiring more and more manipulation. That is, the therapist can make a patient dependent upon them for treatment! Patients attend with painful stiff backs, get crunched quickly (which stretches the muscles releasing the pain quickly), the patient feels great initially in the ever shortening cycle anmd the therapist increases income anmd takes the praise.

Epsom salts are are short term coverupm whilst you have symptoms. Be very careful if you use the salts in your bath as the bath will be very slippery and increase the risk of a slip. not good with a sore back.

Yes, I am critical of such activities by any therapists.

Plenty to think about. I hope my comments assist your thoughts regarding your diagnosis proceeding to treatment.
Cheers,
MrPhysio+

[evosy1978]

Thanks for taking the time to reply.
I have a couple of questions regarding the information you have wrote.

Where would I get a sacro-iliac joint non stretch 50mm belt from? What if the problem wasnt SIJD related, would it do any harm wearing one?

Whats the purpose of the fish oil capsules? Is it for their lubricant properties or the omega 3 benefits?

With reference to the orthotics, Ive been wearing my orthotics for 3 weeks now gradually introducing them to my daily activities and I have an appointment with podiatrist next week to see how Im adapting to them. What I will say is the left arch FEELS higher than the right foot. What i mean is when Im standing or walking I can feel it in my left foot more than I can feel the right orthotic?? Ive looked at them closely and they are identical in height and shape. When wearing the orthotics for about 4 hours the left arch then will start to ache slightly and its nice to take it off.... What do you think? ALSO The podiatrist has put a heel lift on the RIGHT orthotic. 3mm I think.

The reason I went to see a podiatrist was because when I do some running on the treadmill I was getting a sharp nerve trapped pain in the right foot after about 10 mins and if I tried to run through it then it would stop me running put it that way.... (not a pain, - a nerve trapped.) This has happened 3 times over the last 6 months, and I only ran the 3 times... YET I used to run every night on the treadmill about 2 years ago without a problem.. It is also quite apparent I have fallen arches as I managed to get my hands on several old pairs of footwear and they were all worn out where the ball of the foot is. She also said I have no range of movement with my big toes,. (I also get severe shin splints after doing alot of walking)

What type of exercises would Increase the lateralis abdominus muscles. I was thinking peliv tilts and planks?
Im also struggling to find stretching excersises for piriformis you mention,. Do you have a link?

I was also reminded today of a sharp spasm I sometimes get in and around my right hip joint. Its a quick spasm that makes that leg feel momentarily weak. e.g (if I was to miss the last couple of steps when walking downstairs and land on the right leg it could possibly SLIGHTLY giveway from the hip outwards)

I have light brown hair - I presume you mean ginger when you say red?

Glad to here swimming shouldnt be a problem if I strengthen my core and abs and stretch the Erector spinae.

Cycling is another issue I have... Its that arched posistion - when I get off the bike its like the middle of the night when it takes me a short while to stand up.

SO if you manage to answer any of the above that would be great. Especially about the belt and orthotics. For now Ill wait and see what the x-rays show, Ive no doubt they will show something and then Ill get reffered to either a Hospital Doctor or a physiotherapist (NHS) see what happens...

So Il think plenty of stretching the Erector |Spinae is in order for the night?

Thanks again....

[MrPhysio+]

Hello again,
Hopefully the following will answer your questions.
Check the following link for SIJ 50mm belts Serola Belt - Rationale and Research There are probably other suppiers, just search for SIJ belts (not the late stage pregnancy types). Ensure the belt is fitted when laying down otherwise the ligaments have already had stress applied to them and the effect is not as beneficial.

Fish oill capsules act as an anti inflammatory in higher doses as well as including the Omega three effects for cardiovascular health. Fish oil has been shown to reduce depression as well, which can help for people in chronic pain.

Regarding orthotics. If you do not have a real bone shortening on one side and can have your scoliosis corrected by stretching your back muscles through a leg flick, you should not have need for built up shoes. A build up will hold you into a shortened position on one side causing you new problems. I have not examined you, but judging from the descriptions given I would stay clear of orthotics.
The nerve entrapment pain may be due to poor positioning of the bones in your foot - which could be mobilised by using a frozen plastic bottle of water as a rolling pin under the arch of your foot.
Plantar frozen 1.jpgPlantar frozen 2.jpg

You could also mobilise your big toes and those next to them by stretching the toes in a lengthening fashion (traction) then whilst stretched moving the toes side to side and up and down. You may hear a small cracking noise in some joints which should be pain free, then the foot may feel better afterwards.Takes some practise.

You may be better off purchasing Nike Free run shoes that are designed to mimick bare foot running. Very comfortable once you get used to them and they actually help your feet function better by building muscle and alowing the foot to work the way it was designed. Adding orthotics will shorten your arches possibly increasing the risk of hammer toes. You sound like the usual athlete with over protective shoes that cause you to land on the heel when running and this stops you absorbing shock in the way the foot was designed. All the add on bits will eventually worsen the problem.

Pelvic tilts and plank exercises are good for the core by building lateralis abdominus, provided you do them by controlling against a sway back during the exercise. An abdominal roller exercise wheel will work the abdomen very quickly, but only after you do the preliminary exercises first (Try Dino Direct for the roller)

The piriformis exercise is simple. Just pull your knee onto your chest diagonally eg Right knee toward the Left shoulder. Hold for 15 seconds no bouncing, repeat 5 times twice to four times a day initially then once a day. The exercise can be done laying on your back, sitting or standing.

Blonde or ginger hair is what I am speaking of, however people withother hair colours can have the gene as well, but less likely.

Any activity that causes a sustained anterior pelvic tilt will aggravate your symptoms, including cycling if you allow it.

Yes, address all the above as well as stretching the erector spinae. By the way, do not get convinced by anyone to buy curved sole shoes to improve your fitness or posture. They do not work in my opinion and the opinion of a biomechanics lab that tested various versions.
Cheers,
MrPhysio+

[evosy1978]

Hello again, sorry its been a while as I ve been waiting on the results of my xrays...

The right knee xray shows that there has been some movement of the plate moving closer to the joint but nothing serious and is the early signs of arthritis of the knee. (these are the words of the GP from the notes sent by xray person)

The lumbar spine xray shows -- vertabrae L3/L4 stress marks and degeneration ---- L4/L5 degeneration of the discs --- and facet joint wear and damage....

There was no mention of a hip dysfunction or any mild scoliosis? Would this have shown on a lumbar xray?

So what do think of the results with ref to information and advice in previous posts..

I looked into sacroiliac belts, I would like to get one but from all info and reviews they seem un-wearable when bending down? Something I do alot during the day.

Ive taken the heel lift off the orthotic which has relieved the dull ache I was getting in the arch of the opposite foot.. I like to wear the orthotics especially in my empty steel toe capped boots as they give me a feeling of stability. P.S you asked what type of orthotics they are, well if I want to re shape them (not that I would) then all I have to do is use a hot hair dryer aimed at the arch and then it will become pliable....

Ive been doing erector spinae stretching which I think is helping a bit, - not gone swimming yet - been cycling and it wasnt to bad.

So with ref to the questions above, would a lumbar xray show a hip imbalance, or scoliosis? Also what do you think of the xray results to my progrssion forward,.

Thanks all

[nmarman]

Ok being trained in musculoskeletal radiology I can confirm that ur diagnosis is one of spInal degenerative arthritis this is consequence of years of impactation of the facet joints and discs that separate them (which are currently thinning). As i predicted in previous post. To recover as best possible you will need to increase the movement around these sections. Go and seek manipulation from a chiropractor who can understand and explain the xray findings and give you passive mobility around degenerative areas.Shin splints is caused by medial tibial stress syndrome seek shock wave therapy for this from any body doing it in area 3 sessions and most cases are gone within one months.although given the signs of degeneration in back (high Impact or pounding running like exercises will only make this worse.

[evosy1978]

Thanks for the quick reply.

I just want to say since my first post I have consistently been stretching the Erector Spinae, and I can say I do not get the intense muscle pain either side of the spine 3 inches up from the waistline as stated in my first post in the middle of the night from lying on my front... Ive only just thought about it, and im really pleased with that.... Another technique Ive started doing to help me is - when I really feel the urge to lie on my front I place a thin flat pillow under my hips and pelvis to stop it sinking and this also helps. So my next step is to try a swim out which is something I havnt done for a long time prior to me starting this thread.

Moving on.
my back is still very delicate at the waistline centre by the spine in the night if get up for the loo and I still get the sharp knife like pain on the right side when I wake in the morning and i have to be very carefull when picking my baby out of the cot... I can CONFIRM this pain and delicateness is GONE within half an hour of mobility around the house... Which suggests to me its definately to do with Lumbar disc/facets.... as I understand they close together when you lie down at night and then open back up when you are mobile in the day,... So if there are signs of degeneration of the facets and disc then this will be exacerbated when I first wake up..

Theres also the sharp pain I talk about far right side at the waistline which comes after a physical days graft. (mainly when my hips are flexing and extending continuously throughout the day especially if im carrying heavy weights.) - could this possibly be from the hip dysfunction.?

Can I ask would the above x-rays show a hip or sacroiliac dysfunction?

Would jogging on a treadmill also aggravate the discs and facets?

Thanks