Lower back issues

[Susan]

I have been having issues with my lower back for years. First, it was only noticable when I had "overdone" it - heavy garden work, extra long hikes or something like that. Over time it became a chronic issue. My back bothers me, no matter if I am standing, sitting or even lying in bed. It's in the lumbar region and doesn't go down into my legs. I have a very stiff back (the lower part won't bend at all) and very tight hamstrings (can't reach my toes bending down).

Knowing that back pain is mostly cured by training the muscles around the problem area, I tried to work on it by myself, but mostly because I didn't know what exacly I should do without making it worse, I asked my doctor about it and she prescribed 14 PT sessions and massage.

I really hoped that this would at least result in some pain management, but 2 month after starting the PT sessions I have to say, I don't notice any change to the better. If anything it got a little worse. Because it was so bad for some days in the beginning (which was, according to the PT, normal) that I could hardly move, I tried some exercies from a book called "Foundation training", that DH brought home. It has some routines for strengthening the back muscles. If I do the routines, I really notice some pain relief.

Here is what bothers me: the exercises in the Foundation book seem to contradict the exercises I got from the PT.
My PT told me to "tuck my tail" (sorry but I just can't figure out what tilting the pelvis "backwards" or "forwards" means - I always confuse them) for most exercises - there where some for the lower abs, some lying on my stomach, some sitting on a Pezzi ball and stretching exercises while standing. To come back from a bend down position for example, she told me to bend my knees, tuck my tail, and come up in a "rolling" movement.
This movement with tilted pelvis hurts my back, but I though maybe this was necessary to get improvements.
The Foundation book basically tells me to do the opposite - extending my back and bending my knees when I bend down. Very similar to what you do when you do squats in weight lifting (if you don't know what I mean, there are some videos on their website: http://foundationtraining.com/video/...n_how_to_move/). Coming back up from a bend over position you try to keep your back extended.

Since the Foundation exercises feel good and seem to help, I went on doing them, but still, I'm confused about the two different approches. From my understanding, I must do something wrong in my everyday movement patterns, else my back wouldn't hurt so much (so I'm not convinced that I know what is best for me, I can't go just by feel). But am I supposed to "tuck my tail" to protect my back, or do the opposite? The natural curve of the spine goes inward in the lumbar region, doesn't tucking your tail bend this part in the wrong direction (or is this wrong direction on purpose, some kind of stretching move?).
If I have to lift heavy things (like garden soil or kids )- what is the right movement pattern? Can I safely assume that I do it the same way as squatting, with extended back?

I'm only 33 (and on some days my back makes me feel a hundred years old), and really fear to not be able to move at all some day, if I don't get this sorted out.

[OakLeaf]

There are McKenzie therapists in Austria. Don't know if any of them are near you. I would definitely see if you can connect with one of them.

[e3rdpower]

I am a PT, but I do not diagnose via the internet

Having said that, everyone is built and moves a bit differently. "Tucking your tail" may be your PT's way of getting you to engage your transverse abdominus. There are many ways to skin that cat, and the Foundation program is very solid and gets you to engage very well. Essentially Foundation teaches you to stabilize your spine in a neutral (for you, which varies from person to person) position while you complete tasks. Very safe, and an excellent way to move.
Pain is by no means necessary to see improvement. Talk to your PT, let them know your concerns, and tell them about the benefit you feel with Foundation. It's an very well thought out and good program.
Good luck!

[Kathi]

I too have had lower back pain coupled with SI joint issues. For various reasons I've seen 4 pt's for this issue. The last PT, a woman, identified my low back as flat, no natural curve, and very stiff. Much like you're describing.
All my therapy involved gaining mobility in my spine. While I still have some pain at times I can definitely see an improvement. Because I had so much pain from the SI joint and also have the stiffness in the morning, I sleep with a small pillow under my knees while on my back or between my knees if I'm on my side. This has really reduced the morning stiffness. I also use a lumbar support pillow when riding in the car. Mine are inflatable and I can adjust them to fit my comfort needs.

Your video seems to follow what my PT told me. I also found this website. http://hab-it.com/blog/?p=55 There's lots of valuable information here on how to strengthen the important muscles of the low back. Read through the entire blog, including the answers. Sometimes, there are exercises included in the answers that are helpful. I found that keeping the tailbone "up" really has helped my pain and my posture. The other exercise I found is laying on your stomach for a few minutes with your head on a pillow. At first I had to put a pillow under my hips as it hurts my SI joint but it really calmed my muscles.

Hope this helps, I know how frustrating it is to have low back pain.

[OakLeaf]

I should add that my McKenzie therapist who treated me for related troubles last year prescribed glute strengthening exercises along with (initially twice, then once) daily press-ups, knee to chest and supine twists to improve my lumbar mobility. I've had bad experiences with PTs too in the past, but my sole experience with a McKenzie therapist plus the excellent advice here on TE has me a believer.

[Kathi]

My PT said that changing the position of the low back is difficult, some people never get it and it can take up to a year for things to settle down. I have to constantly think about the position of my tailbone and hips.

[Kathi]

One PT had me doing knee to chest stretches too, which didn't make sense because that's the way I could bend. It's the other direction, tailbone up, I couldn't bend. I also read, not sure if it's true but makes sense, that a flat back, or tucked tail, opens the SI joint which can get one in the situation I'm in. I do notice that when I tuck my tail my SI joint starts "talking to me".

My SI gets out of whack about every 6 mos and has to be adjusted so we'll see if this "new" position works.

[snapdragen]

I wonder if you should also try working on the tight hamstrings? I'm not a PT, but I know that when mine are really tight, my lower back hurts too. I feel your pain, I'm currently going through some pillow biting pain PT for a hip issue. Not fun.

[Kathi]

Yes, I have a hamstring stretch which is quite different from the traditional stretch. My PT said the "laying on the floor" type stretch flattens my low back which makes the stretch less effective. Instead, I do a standing stretch which is actually a version of a "hip hinge" and keeping the natural curve in my back. After doing it faithfully for 4 months I still can't touch my toes, but that's not my goal so I don't worry about it. Not sure if it helps to relieve the pain but I think it's the combination of exercises and stretches that are working.

[Susan]

Thank you for all your answers.
The McKenzie Therapy - concept sounds promising, I will look into this.

Kathi your back really sounds a lot like mine, and I too experience pain relief with a pillow between my knees (which I found out by accident not long ago). Thank you for the link, really helpful information!

And yes, I think the tightness of the hamstrings could be related to the back issues. Stretching is my weak point in general... I just hate it to be honest but will have to get back to doing it regularly.

I think I will give things some time to settle while working on my own and then give it a try with another PT.

[Wahine]

I would also encourage you to look into someone who does the McKenzie approach.

McKenzie doesn't work for everyone, but it does sound like it would be a good one for you.

Ultimately, everyone moves differently and we all have movement/muscle imbalances because of our habits. But treating them comes down to figuring out what movements ease your signs and symptoms and what movements make them worse and working with those to increase strength and function. Honestly, I never want my patients to be in more pain after their treatments, tired and fatigued sure, but not more pain. If the exercises are aggravating your back pain, you will move incorrectly to try to protect your back or compensate and that won't help you recover. So even if your PT is on the right track, it would be highly recommended that they find exercises for you that achieve the goals in terms of strengthening and regaining motion, without causing you pain.

[nscrbug]

I can sympathize with anyone suffering with lower back pain. I have spondylolisthesis of my L5/S1 (grade 2). There isn't a day that goes by in the last, oh say...15-20 years, that I haven't experienced low back pain to some degree. I wake up each and every morning with a very stiff, tight lower back. I do stretches while still in my bed (knee to chest, hamstring, child's pose) just so that I can stand up straight. Then I head straight to my inversion table and hang for 6-8 minutes to decompress my spine, before finally making my way downstairs (stairs are very tough on me first thing in the morning) to start my day. After my gym workouts, I literally spend about 30-40 minutes just on stretching alone...otherwise, my back and hamstrings will get all tight and spastic for the rest of the day. During longer rides, I have to take frequent rest breaks to get off the bike and stretch my back and legs. It sucks to live with back pain everyday.

Linda

[tulip]

I just wanted to chime in and say that I have (had) very similar conditions to what you describe. There were times 6-7 years ago at its worst that I could not sit down, hobbled down the street, and nearly cried in bed because I was so uncomfortable. In fact, the only time I was pain-free was when I was on my bike.

I was going through a very stressful time in my life during that period. My work also had horrible office furniture, to the point that I threatened a workers' comp claim, and lo and behold, everyone in the office got ergo chairs and computer trays.

The thing that really helped me, however, was going to a chiropractor (who is also a PT) and beginning classical Pilates at a reputable and serious studio. The chiro work addressed immediate problems and my Pilates instructor provided me with modifications to accommodate my back issues while I gained strength. This was extremely important; I would never go to a "pilates"-type class at a regular gym. Only classical Pilates studios have properly and extensively trained staff in my experience.

The combination of directly addressing the stressors in my life and making huge changes accordingly (in my case), working with my chiro/PT, and dedicating myself to strengthening my entire core and body (not just "back muscles") has gotten back to pain-free, strong, and flexible. I'm in my mid-40s now and feel much younger than I did 7 or 8 years ago.

I no longer go to the chiro/PT, but i have continued with Pilates. If I stop doing Pilates for a time, I will experience twinges of pain after a while. That is my reminder that i need to refocus on my core strength. I am careful in the garden, and I always need to make sure that I sit properly at work and get up and move every 30 minutes (I use a timer).

I am now investigating the Alexander technique so that I can continue improving my posture. I will continue with Pilates; it has helped significantly in so many ways.

Best wishes to you. I would encourage you to seek out treatment (McKenzie is recommended by others with more knowledge than me) as opposed to doing things on your own. My PT is the one who recommended Pilates to me.

[OakLeaf]

I've talked a good bit about my latest in the running thread, but wanted to add it in here ...

I fell hard, square on my side, in March, and sent my whole spine sideways. I've had little to no pain, but a lot of radiating numbness and some slight weakness from discs in my neck, middle and low back - side of my face and neck, portions of my arm and fingers, ribcage area, buttock, down into my leg.

Moving and having to find a new chiropractor delayed everything, but I'm back now working with the same PT I worked with last year, and I've had huge improvements since we started really targeting the upper back/thoracic area. Turns out three hard falls on my right shoulder (40 years since the first one!) created a whole lot of muscle imbalances there, and it's actually the thoracic area - the one place I wasn't having any symptoms - that's pulling the upper and lower spine out and squeezing the discs sideways. Just in the last week and a half or so, we've made huge progress on the arm and leg numbness, by adding in rotator cuff, rear delt and serratus work, plus doing upper spine mobilization on the foam roller.

Something to think about anyway.

[BodhiTree]

I am now investigating the Alexander technique so that I can continue improving my posture. I will continue with Pilates; it has helped significantly in so many ways.

I've found the Alexander technique to be very helpful for posture.