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Low back/SI Joint/Hip reoccurring issues (aka typical low back injury)

edited April 2014 in General
My story with my low back injury is long, frustrating, and boring so I'll try to keep it brief.

Originally hurt myself about 2 years ago doing heavy deadlifts, early in the morning, with poor warm-up.... yeah stupid....

Since then it's been a never ending battle of re-injury and constantly having to think about my back with everything I do. I've seen traditional Chiropractors, a Chiro that uses the Koren and NUCCA techniques, PT's, an Acupuncturist, a Sports Massage therapist, and a Sports Medicine doc who works with a Pro Football team and uses the Active Release Technique (ART).

The Chiro who does the Koren and NUCCA is my "normal" guy, I go see him about once a month, unless I hurt myself. normally my second stop is my Acupuncturist, and finally the Sports Medicine doc who uses ART. The ART is probably what I see the biggest immediate difference with and I would love to go more but he's somewhat far away and isn't cheep to go see.

With all that being said, my main question for this discussion is "How can I fix my back? Like REALLY fix my back? Permanently."

So many people have low back/SI joint issues, I know of at least 3 others at my gym with something similar. It's such a huge problem in our society now-a-days and no one seems to have a start to finish "here's the plan" or even "here are the possible plans."

I roll out, stretch, mobilize multiple times a day. I get made fun of at my gym because I'm the guy who always mobilizing before and after the wod. I have a desk job but have a standing/sitting desk, and I try to move around as much as possible during the day (even got caught a few times rolling around on a lacrosse ball in my office). I'm not saying I'm doing everything right and I'm probably getting a lot wrong. I try to look at it like an experiment, like I'm trying to figure out what works and what doesn't but can never seem to find the right answer.

Any help or idea's are appreciated. I'd love to be able to pass my knowledge to others with this issue and help people to find their way back to a healthy back.

Comments

  • I have a similar issue I've been working on.  Mine started 2 years ago.  I pulled my groin surfing, then tweaked my back a few weeks later doing a heavy clean.  Ever since, pelvic obliquity, SI, low back, QL, occasional baby toe tingling/numbness.  Looking for reasons why the pain wouldn't go away, I found an inguinal hernia. I'm not sure if they are related.  Long story short, I've developed some gnarly compensation patterns to protect the groin/hernia/SI all on the right side.  I think the key here was that I've continued to work around the injury, so my movement patterns have really changed.  
    I saw a chiro for the first year, then another chiro, 2 PT's, X-rays and I make a pretty solid effort at the MWODs. Unfortunately those didn't work. Well, chiro maybe to keep my hip in alignment, but it doesn't last long at all.  
    My current plan is, stop Crossfit, 10 session Rolfing series and Pilates Personal instruction.  Both practitioners are seeing the same thing, which is a first.  Twisting and rotation, tight sides and weak sides.  I can keep you updated on progress, but I think I found a good combo.  
  • I had a problem with my back also. In the past I had partially herniated discs in the last 3 vertebrae of my lumbar spine. it knocked me out for about 9 months from doing anything athletic. but through some PT it healed up so that it was pain-free, although i would get a flare up about 1-2x a year.  

    But that was before I fixed my posture, began working on KBs and FMS, and discovered MWOD.

    My posture sucked but I didn't know it.  My first discoveries came from taking the Gokhale Method class with my mother. I had been over extended and didn't even know it. But it only gave me part of the solution. They have some good guides on how to figure out your best spinal alignment, working on torso bracing, and some good elements on hinging.

    KBs gave me another part of the answer as did taking the FMS cert.  You cannot do KB movements safely without knowing something about moving while in a good posture. I had poor mechanics when i started but slowly but surely they improved as i worked with a good coach and integrated MWOD.  Taking FMS helped me also understand proper movement mechanics, although it was not focused on posture there were many elements to work in, apporaching more from a functional and rehab standpoint.

    MWOD gave me the last important bits of the answer.  The missing parts for me were, how to assess mobility for posture and how to get mobile enough to achieve a proper posture, and the need for bracing 20% in the glutes.  Also, the concept that posture was a 24/7 training endeavor - you cannot just train for posture in the gym for an hour and then stop. you must reinforce it all day and even all night when you sleep (sleeping curled up in bad posture is not a good thing).

    The other thing to think about is breathing. It is not obvious but proper abdominal breathing (vs. breathing through the upper body) is crucial first, and THEN you need to train to be able to breathe while bracing the torso.  Our first inclination is to tighten up everything when we brace. But actually, you can brace with one set of muscles while taking in breaths with another set. This can be trained and is actually the right way to breathe. It will also be very useful when you're doing continuous sets at high load so you don't gas and get winded for air.

    But back to the SI joint problem - it is inherently tied to proper posture and bracing during movements and workouts. You fix posture, maintain it 24/7, and i guarantee your back problems will go away - that and knowing when you should stop and put the bar down (no matter how many people around you are yelling at you to continue) because you can feel your ability to brace is slipping. To work through that slipping of concentration on maintaining bracing increases the risk dramatically that something bad will happen. I for one do not intend on being out of training for 9 months again....


  • edited April 2014

    I could have posted this myself, my situation is so similar.  I have been battling SI/Hip pain for about 6 months with little or no improvment.  Been through, Chiro, rolling, lacross ball, acupuncture, Deep tisue massage, MWod/Supple Leopard,  rest, but it always comes back after a few days of lower body movements that involve squatting position.  It is very prevelant in any sitting position.  I almost feel like giving up its so frustrating.  I crossfit roughly 4-5 times a week.  Almost all of the pain is in the muscle between the SI Joint area and my side/hip.  Not sure if I am explaining this correctly but the pain travels along an area from the SI Joint along the top of the Gluteus Maximus then down into the side/hip area.  It does not go deep down into my leg and the pain is like a constant deep burn, never a very sharp debilitating pain.  I am open to any additional ideas and would love to know more about how to self evaluate posture such as David is refering too. So if I hijacked this post but it seems like many people are in similar situations and I'm just looking for any help I can find.

  • "My current plan is, stop Crossfit, 10 session Rolfing series and Pilates
    Personal instruction.  Both practitioners are seeing the same thing,
    which is a first.  Twisting and rotation, tight sides and weak sides.  I
    can keep you updated on progress, but I think I found a good combo."

    Erik, I'd be very interested to hear about your progress with this. I've often thought about the fact that CrossFit doesn't have much, if any, side-to-side movements. Since a lot of stabilizer muscles would also be involved in side-to-side movements I can see where an imbalance could be caused. What sorts of things/movements are you doing to deal with having tight sides? And, what to strengthen them?
  • This is right up my alley. I have been battling low back and SI since Oct of last year. started out with sciatica. Went to chiro and made adjustments but never would got better much. Went to my normal doc who thought it was more SI than a lumbar problem. Tenderness over the glute and SI joint but no tenderness around the lumbar spine. Sent me for PT. Got a little better but the pain never went away. PT had me doing press ups and some stretching but again never really went away.

    My pain is sharp in my glute and sometimes goes around to my lateral hip ( right where my belt will sit.) Sometimes it will shoot down my quad and hamstrings. sometimes flank pain as well. Now I notice that it is radiating into my lower left abdominal area. I really think it is tight muscles but as much as I use the supernova, lacross ball and other mwod tools it eases but comes back. Training acutally makes it better.

    Once I get warm I'm good. still feel a little pull but no where near as bad as later in the day and when I wake up. Same when I getg up from a chair. first few mins suck but once I get to going its not as bad.

  • David, I couldn't agree more.. It has to be a 24/7 thing. At work I mostly stand when on my computer and I always try to think about my body, how I'm standing and what positions I'm defaulting to when I let things slip.

    As far as breathing goes, that's something I've always felt somewhat uneducated about. I've always been told I'm a belly breather and that's a good thing but as far as techniques go I don't know to much.

    I think one of the most frustrating things for me is that my back used to be a strong point for me. Having to constantly (24/7) keep it in my mind is frustrating at times, especially when I think I have been and I still flare up. But, I guess it's all good until it's not anymore.
  • BKIllini, no worries, hijack away. The more people the better.
  • I think one of the big problems with talking about low back injuries is that it doesn't always seem like the same thing for everyone, there's no one thing that fixes it for everyone. But, I wonder if it would be possible to come up with some sort of template or process for people to go through and determine their own recovery plan.

    For example, assuming strength discrepancy and tightness is present I would think attempt to resolve the tightness and strengthen the weak area would get people back up and going. My questions are: What is actually tight? What's weak? How to we permanently resolve the tightness? What do we need put in place to get/keep "it" strong?
  • I'll keep you updated. I am 4/10 sessions through the rolfing. As far as exercises right now, glute activation, pelvic stability and awareness and core to extremity movement. I chose this route because both of these people saw the same thing and have dealt with it before. So far I have corrected some midline bracing flaws. I'm still waiting for the si, glute, leg issues to subside, but we haven't gotten there yet in the rolfing series.
    My PT is having me wear and SI belt. I'm not sure how effective it is, but what the heck, it's worth a shot. 24/7 for 3 months.
    Strength training is on hold until I am pain free. Then I'll probably start the mwod style rehab. Category 1 movements only.
  • Dominik,

    That is good that you are already a belly breather. That is the first step. The next step is to learn how to brace and breathe at the same time.

    Most of the time when people brace, they have to flex their entire muscle set in the abdomen including muscles they would breathe with. So they end up holding their breath in order to brace.  In actuality you only need to brace with (i think - my anatomy is not really up to par) the transverse abdominals and not with the rest of the muscles there.  This is how you brace 20% all day long and not feel like you can't breathe.  Of course in times of stress, like when you're under heavy load, you'll need more of your abdominal muscles to hold your spine steady - then its more like breathing with a lot of shallow puffs.

    Then when people start to breathe, they end up letting go all their abdominals and then their lumbar spine gets overextended as a result.

    I have found a good chapter on abdominal breathing in Rehabilitation of the Spine by Craig Liebensen, but am still looking for texts on the other elements like breathing pattern and rate and breathing while bracing. I'm about to take a class that has some good rehab techniques in doing breathing while bracing.


  • This is an article that resonated with me about SI joint issues.  Use your judgement if it is right for you, maybe have a PT confirm your diagnosis.  This one is talking about an unstable joint.  

    The big takeaways for me are
    1. normal strength and conditioning programs assume a strong pelvis.
    2. Injured SI Joints don't respond well to Bilateral loading and saggital plane movements
    3. There are a lot of issues up and down stream that occur as a result of the laxity
    4. Have a personal trainer ensure you are doing corrective exercises that are right for you and are doing said exercises correctly.  My Pilates trainer coincidentally started me at the same starting point Dean Somerset talks about.  
  • Great advice here. I think the only thing I can add is just to constantly keep yourself in motion, don't let your muscles get rigid. A trainer friend of mine who has helped several of her clients rehabilitate their range of motion after serious injuries swears by using the Vertical Vortex, which is kind of like a hybrid between a giant slinky and a flow toy. Promotes range of motion exercises using kinetic energy. Best part is it's compact and easy to transport anywhere so her clients can use it whenever and wherever they may be.
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