Before surgery is considered in these patients, these less invasive treatments with good to excellent evidence can be considered:. Intervertebral discs have poor blood flow and thus are not good at repairing themselves once injured. While a bulge can retreat, tears are often painful and resistant to healing. Due to this, the use of intradiscal PRP is being used increasingly to promote disc healing.
A randomized clinical controlled trial 22 has shown PRP injection intradiscally to be superior to sham injection for discogenic low-back pain. Please see my previous article on regenerative medicine for more details on this form of treatment. For those interested, PRP is very low risk and can be done without sedation In our practice, patients and discs have been treated with intradiscal PRP.
However, at this time intradiscal PRP is not covered by most insurances and may cost a few thousand dollars. JJ had a five-year history of severe low-back pain at its worst with sitting. Prior to this, she would run for hours at a time, but as the back pain worsened she could not run more than 20 minutes before excruciating back pain caused her to stop. She had no radiating symptoms down her legs. There was no particular injury that preceded the pain.
This is the disc between the fourth and fifth lumbar vertebrae near the bottom of the spine. Physical therapy, manual manipulation, activity modifications, time, and over-the-counter medications had failed to resolve her pain. The L4-L5 disc is darker than the others, is herniating posteriorly, and has a high-intensity zone a white spot in the herniation indicating a tear.
Image: Bodor, 3. Six months following the injection she had experienced significant improvement and was running plus miles daily. Two years after the procedure, she gave me full permission to share her story. In , Nate Bender had his first episode of severe back pain. The symptoms resolved temporarily with chiropractic and self-care in four to six weeks or so.
Image: Forrest Boughner. Fast forward six years of physical therapy, chiropractic, and steroid injections later, Nate continues to run but finds himself in an increasingly worse situation with his back. Thankfully, it seems he now has the correct diagnosis.
But how did he get there and what sort of treatment will work for him? This interview explores these questions. Nate Bender : Throughout the winter of to and the spring of , the low-level discomfort started becoming increasingly frequent. I decided to seek out more advanced medical help, starting with physical therapy. This made slow progress and I wanted to understand what was causing the pain once and for all, so I committed to the expense of seeing spine specialists.
They ordered a bone scan which pinpointed some inflammation and degradation in my lumbar facet joints, specifically at the L3-L4, L4-L5, and L5-S1 levels. They followed this up with three facet corticosteroid injections at these levels in May, June, and July of , respectively. Certainly the facets could appear inflamed due to taking on load from damaged discs.
Also, facet pain is uncommon in younger people and typically occurs with back bending or prolonged standing. Disc pain tends to come on with sitting or bending over and, the worse it is, it can occur with standing and walking as well. Did the injections help? Did you ever get an MRI? Then, a day of backcountry skiing sent me into a major relapse where I was incapacitated again for several days, requiring another [steroid] injection. From there I was nearly symptom-free until a month ago, when another big day in the mountains sent me into a relapse.
This time I scheduled another injection as soon as possible.
Back pain | Causes, exercises, treatments | Versus Arthritis
However, this [steroid] injection brought zero relief, and we decided to get an MRI to better understand what was going on. The MRI showed a bulging disc at the L4-L5 level and this disc is pressing on some nerves going to the legs as well as a torn disc at the L5-S1 level. Of note, bulging discs are very common and usually not painful, but disc tears can certainly be painful.
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At this point, I would want to know your pain triggers and whether or not you are tender on the disc or facets to palpation. If pain comes with sitting and bending over, the disc is the likely pain cause. If the pain comes with twisting and bending back, the facets are the likely cause. Once I arrive at a diagnosis, I would either treat the disc with PRP or the facets with a nerve ablation or PRP to avoid the negative effects of repeat steroid injections or treat the stenosis or radicular pain with a targeted steroid injection or continued physical therapy.
Bender : The plan is to get an interlaminar epidural injection into the spinal canal at the L4-L5 level, and cut out all of my upcoming projects and races through the rest of the summer and fall so I can double down on physical therapy. This seems to be the most promising option for getting out of this cycle of feeling good followed by a painful relapse.
Are you having pain down your legs? Bender : No radiating pain, thankfully. Some of the triggers have been moving a medium-weight piece of furniture up a flight of stairs, picking up a light laundry basket, rock climbing and scrambling, and trail running. I would recommend looking into intradiscal PRP as a more long-term solution than epidural injections.
An epidural may provide temporary relief, but would not be expected to treat the actual disc problem. I do have a tear at the L5-S1 disc and I believe this tear was part of the first, acute injury five years ago that likely started this whole process. Thank you so much for sharing your experience. One detail not included in that article, to stay focused on his bone injury, was that he was also found at the same time on MRI to have a pinched L4 nerve root from the low back in the same leg as the fracture.
L4 nerve root pinching can cause weakness in knee extension. Paul was fortunately able to return to full weight bearing and pain-free running without any interventions beyond use of the Alter G a decreased-gravity treadmill and running-gait modification following a gait analysis. The L4 column shows the distribution of pain and weakness that Paul Terranova may have been experiencing.
Also, the pain and weakness distributions are shown for L3, L5, and S1 nerve-root compressions coming from the back, which can cause pain, weakness, and a loss of sensation and reflexes. Image: Lin, Core stability and strength is not just a fad but is required to protect the spine. Stuart McGill, PhD in spine biomechanics and Professor Emeritus at Waterloo University in Canada has measured the most effective exercises, now called the McGill Big Three, for creating core stability without increasing risk of injury.
The three exercises are:. This video demonstrates how to perform the McGill Big Three back exercises. The McGill Big Three back exercises. Image: McGill, For specifics on back-injury prevention in runners, I interviewed Dr. Stuart McGill, author of several books on reducing back pain including Back Mechanic.
How To Stretch Your Lower Back With These Exercises
Stuart McGill : Yes. First, there is a big difference between an Olympic weight lifter and the typical person who lifts weights. Gymnasts usually fall into categories from excessive motion, for example spondylolistheses[, or the slipping of vertebrae from their natural position].
Recreational runners usually do not have specific pain pathways for low-back pain from running itself. Some distance runners tend to become thoracic kyphotic[, where the thoracic spine rounds forward,] as they age, which may be problematic for some. But most recreational runners who come to me either have asymmetric hips leading to chronic spine stress or they have gotten too heavy with loading in the weight room.
I could go on, but really we need to discuss each individual case and in summary I am not concerned about running itself. Beyond these, is there any sort of strength or mobility training you would recommend for runners to avoid back problems? McGill : Nothing for runners as a group, only for each individual runner. If they present with back pain, we perform a thorough assessment to root out the cause and address it. Not only does this anterior pelvic tilt and hyperlordosis make it difficult for you to engage your glutes, but it also places more demand on the muscles of your lower back.
Over time these muscles, such as quadratus lumborum can become tight and painful. Nate and the team at The Run Experience have produced this great video to demonstrate what you can do about this common problem…. For us to move properly as we run, we need to achieve and maintain a balance between the actions of the various different muscle groups in this area. As an example, weakness or inhibition of the gluteal muscles often results in runners overusing their lower back muscles, as well as potentially their hamstrings and calf muscles.
Gluteal Inhibition or Relative Weakness? I find that these runners frequently lack the ability to comfortably extend and rotate properly through their thoracic spine. This video analysis of elite marathon runner Shalane Flanagan demonstrates the importance of extension and rotation of the torso in running gait. Picture the spine as a segmental unit, achieving motion in all planes as a net result of all the individual segmental motions.
If a number of segments are restricted in the desired motion the thoracic spine in this example , then the overall spinal extension and rotation needed in running will come predominantly from the lumbar spine. This type of compensation results in undue demand on the region by placing the lower back in the hyperlordotic position described in the first point above.
Running with proper technique will help you reduce the undue impact on your body, which is always a great thing! However, and potentially more importantly in this context, running with a focus on your technique will help you maintain good running posture and control of the lumbro-pelvic region.
Consider the fact that the bony and ligamentous architecture of the lumbar spinal segments gives them a good level of inherent stability…. If your back pain stems from having truly unstable spinal vertebrae, being able to run is probably the least of your problems. The ability to maintain good pelvic and therefore lumbar spine posture throughout the functional movements for our sport…. For specific diagnosis and identification of root causes for your back pain symptoms, I strongly suggest a visit to a sports physio or doctor with a solid knowledge of running biomechanics in particular.
An appropriate rehab and strengthening plan, alongside your running, will help you run pain-free. I previously stated that there are many different types and causes of back pain in runners.
Runners: How to Treat & Prevent Back Pain
Not all of the exercises above will be appropriate in every case. Having trained as a sports rehabilitation therapist, James now works exclusively with distance runners, helping athletes from beginner to pro to run stronger and pain free. Check out James' marathon training plan for beginners [PDF]. His transition into distance running has taught him what his body is capable of, a process which is ongoing!
Read more As a pilates trainer and a triathlete, pilates is more than the floor. It is a system of principles applied to any movement made whether that is supine, prone, side lying, standing, on the bike, swimming — pilates is in them all. Although these do provide a great start-point for many. The sooner we can get an athlete up off the floor into a more run-specific exercise the better.
I run up to 60km a week without any back pain. The cure — go for a good run. Works every time. You know what… I experience exactly the same thing. It was two bulging lumbar discs which eventually put an end to my rugby career.
If I spend too long seated in a poor position, I really struggle with sciatic symptoms. The two things that help me above all else:. The latter I only found to be beneficial for me through trial and error. My simply conclusion… my body likes movement. If symptoms get worse from being inactive with poor posture, then my remedy is to get moving!