Low Back Pain - Pars Defect / Fracture

[webbdawg99]

Towards the end of last season, low back pain during skiing became almost unbearable so I ended the season early and skipped Nationals. I was hoping that some time off would allow some healing. However, after 9 months of nagging, sometimes debilitating back pain, I finally went to a sports med./spine doctor.

 

The diagnosis is an L5 pars defect (stress fracture), L5/S1 disc disease, and a bruised L5 vertebrae. By the nature of these injuries, it is my suspicion that my normal activities of weight lifting and water skiing have contributed to my current state.

 

The options presented to me were fusion or physical therapy. I was told a fusion would be a short term solution but that I may find myself right back where I am a few years down the road. So, I'll be taking the physical therapy route. Ive been told no more squats or dead lifts. However, he says I should be able to continue skiing. But at this moment, its hard to envision that happening without significant pain.

 

Has anyone else dealt with this? What was your course of action? Were you able to get back to skiing? Any and all advice and insight is greatly appreciated

 

[Wish]

Do NOT do surgery. I've have the exact same problem. Find a private PT (not a meet market of PT assistance working with 5 patients at a time). Find a good sports related PT and bring in film of what you do as far as skiing. Be vigilant with advice. I'll hedge my bets and say squats and dead lifts is not the way to go just yet. Life style changes are a must. And the PROPER use of an inversion table does wonders and has been a life saver for me. PM me if you would like to know what I do. My Orthopediic surgeon is a big proponent of surgery as a LAST resort and that skiing will actually be beneficial. He is a course skier. 15 yrs of his and my PTs advice and have not gone under the knife. I am not an overly physically fit guy and do little to no cross training. I also do not hang onto stupid shit when the line comes tight..not worth it and I stay rather competitive.

[Guppy73]

Surgery as last option unless you get bad sciatica that results in leg muscle loss. Lots of p/t - get that core rock solid. Use steroid injections to mange pain - either direct or Caudill into multiple discs at once. Good luck. Keep skiing. Also - stretch those hamstrings as when tight those pull on lower back.

[6balls]

I second the fact that @wish is not an overly physically fit guy and does little to no cross training :smiley:

I agree dodge surgery if you can. I had no choice and had both neck and back surgery in the last 3 years but there was no way out for me. Having said that I'm ready to rip come spring--just don't know how long it will last and I'm also a good shot older than you, my friend.

Good PT, core stuff, try an inversion table if traction at PT is helpful. Consider steroid injections before thinking about surgery/fusion.

Agree with tapping CP's neurosurgery group in a sense that they understand what we do.

If all else fails...you may need to decide if skiing is fun cuz it's water and skiing and rounding balls...or if it's only fun if you are pushing the hard limits which subjects you to much more bodily stress.

Good luck, man. Hoping to hit skiwatch this fall...if you body is holding up any chance of running into you there?

[WaterSkier12]

Agree, do not see a surgeon, unless you have debilitating leg pain, numbness, weakness and intractable pain.

Find a good PT who uses Stuart McGill's rehab and core strengthening program.

I have the same problem as you...

[Wish]

@6balls at least someone agrees with me!

[WaterSkier12]

Wish and I= genius!

[I5boi]

Has anyone used a float tank for therapy? Supposed to reduce spine compaction??

[Deep11]

Goode power vest

[webbdawg99]

@Wish What is proper and improper use of an inversion table?

[JAG]

2nd vote for Goode Power Vest.

First season ever with no lower back issues.

[ToddA]

@webbdawg99 I would also agree with getting with a sport specific Physical Therapist who has a very good understanding of tri-plane function and functional strength, conditioning and flexibility (I am a PT, so I have an obvious bias!). :). I would specially ask the PT to address your Psoas and Iliacus tension/flexibility, as well as Glute Medius/Minimus weaknesses and flexibility issues. Now, as to the Psoas and Iliacus, be certain not to be mislead to thinking "I stretch my hip flexors and I don't have a problem with them.". I see people all the time having been told to stretch hip flexors and they have such poor mechanics, that all they are doing is to shift into lumbar hyperextension, this shifting all load onto your lower back, not targeting or addressing the hip flexor group...This the specific need for a PT with great skill at coaching and correcting mechanics.

 

As you progress through static stability, dynamic tri plane stability will be crucial. It is a long road, but one that you will crush with commitment, dedication and hard work/time. You will come out better for it! Best wishes, and shoot me any message or questions you may have. Todd

[The_MS]

@webbdawg99 Dont hang with any big pain. Dont extend it to hang completely free from the back board, just lay back and go as far as the board lets you go.

 

[jjackkrash]

I am generally skeptical of doctors who say "don't squat and deadlift" ever again if you ever get a back injury. And most seem to knee-jerk say that. Sometimes that advice is warranted, but many times it is not. It is just safe for doctors to say that because they don't have any control over how you squat and deadlift. Better advice sometimes is heal up first, do your PT, then "don't squat and deadlift incorrectly or to failure."

 

I had severe back pain and back issues in my 30s--and still have to be careful with what I do or minor injuries occasionally make the pain flair up--but the flair ups generally occur when I get lazy and fat, sit in a chair a lot for work, and when I am not regularly squatting or deadlifting.

 

When you heal up, look into sumo deadlifts, trap-bar deadlifts, goblet squats, and other variations that will make your back strong without hurting your spine. You can combine these with planks and other posture exercises to help make you more balanced. And never go to failure on a big lift.

 

Working with a load the right way generally makes you stronger; sitting in a chair is mostly what f's your posture and back. The lack of working with a load makes you atrophy, weak and susceptible to injury, IMO.

 

[Wish]

This is directly from my PT. Inversion tables are a decompression tool. Decompression is a SLOOOW process. Your back has a protective mode. Do the inversion to fast and to far and your back will get sent into this mode meaning muscles tighten up and it tries to stop the over stretch..and will lock things in place. Exact opposite of what you want. I start laying flat. Then move to 10ish degrees and hold and wait. You must be 100% relaxed. Any sharp or increase in pain and your are done. After back gets used to 10 degrees, move to 20. Then hold and wait. As you relax at each angle, you should feel like your sliding down the table..slightly. You're not. You're actually lengthening. This takes time and relaxation. Then move to 30 degrees. Repeat relaxation and wait for that elongation feel (sliding down table). Then slowly to 40 degrees. Again, wait for it. This literally can take 3-10mn per angle depending on how relaxed you can get and how tight it all is. I have a stop at 40 degrees where table can go no further. NEVER go past 45. That will put your back in over stretch and protection mode. I have spent up to 40mn getting to 40 degrees. All the while concentrating on relaxing every muscle and feeling the elongation. Have fallen asleep at 40 degrees. Now that's relaxed but not recommended.

 

This is important. Once done, you can go back to your feet..slow for blood rush purposes. You must lay down flat on a bed or a flat couch immediately. Place a few pillow under the knees. Stay like this for 20mn or so. If you walk around directly after the elongation, it will "snap back" do to gravity. All progress made will be lost rather quickly as what has been stretch will want to return to where it was and then some. Laying flat for a while will slow that process and over time of doing all this you will make gains. You'll need to block out some time. I do this right before bed. Off inversion table and right to bed for the night.

[Wish]

This may have been said but.. no chiropractor.

[Milford]

I have been managing lower back issues for years. Tried pretty much everything from chiropractic, accupuncture, decompression, PT, surgery, supplements, cross training and a Goode powervest.

 

It took me awhile to realize that this is something that you don't simply fix. You need to come up with a strategy to manage it the best you can. If you can successfully manage the disfunction and ski while making good decisions it should improve with time.

 

One of the best things that I have found to help manage my lower back issues is called a Nubax Trio. You can find it on Amazon and look it up on YouTube. It allows lower spinal decompression without muscles protecting and locking up. I use it every night before I go to bed and think it keeps things functioning properly. Certainly not a fix, but as I have said earlier, it's all about management. Nubax before bed and Powervest while skiing = powerful combination.

[MrJones]

FWIW. I'm a skier, a PT, and back manager for 25 years including surgery.

 

I agree with several of the things mentioned here. Mainly that you buy Stuart McGill's "Low Back DIsorders" book to educate yourself first.

 

My quick take from what you have said is that you will very likely be able to ski. Getting rid of the extra (and unneeded) wear and tear of heavy squats and dead lifts is going to be a must. Extremity flexibility and core strength/stability are also a must. Certain skis load you back in different way's (which seems odd, but is very true) so you may need to experiment there.

 

It is management rather than cure, but it is doable. Good luck on the journey.

[Wish]

Agree, no need. Just post how you can help. Would be interested in hearing what you have to offer. Apologies if offended you. Not my intent. It was suggested by my PT and Orthopedic surgeon to not seek the help of a chiropractor. No data. Just experience.

[Wish]

So how can you help?? I'd rather be informed.

[ktm300]

The body's capacity to heal is amazing. You can definitely heal up and ski again. Forgive me if this is too elemental but, if you have not, pursue the best imaging option to determine specifically the degree of damage to the bone. Is it bi-lateral? A copy/paste about the limitations of various imaging techniques is below. IMHO, without the best imaging, one has to guess at the correct treatment protocol.

 

Unfortunately, since a misdiagnosis of spondylolysis is often made, an early recognition of this entity is essential. A complicating factor in the early stages of the disease that leads to a misdiagnosis is the fact that plain radiographs, even with oblique films, may not be helpful at the stress fracture stage. Other imaging techniques, such as bone scan possibly with single photon emission computed tomography (SPECT) or magnetic resonance image (MRI) should be used early in the diagnostic process. In the primary care setting, an early diagnosis of posterior element involvement related to low back pain either at the stage of pars stress fracture or early spondylolysis can prevent progression of the disease and obviate the need for an aggressive intervention of a more significant defect.

 

 

[ktm300]

I've posted the below several times. Might be something you already know but, I didn't until I had to learn to heal my back.

 

* Crunches shorten the rectus abdominus.

* The lumbar spine has only 3 degrees max rotation per segment while the thoracic spine has up to 7 degrees rotation per segment.

* Shoulders that round forward or have some C shape to them, greatly limit thoracic rotation.

 

The shortening of rectus abdominus can lead to the C shaped shoulders to some extent. When RA shortens, it flattens the lordotic curve in the low back which greatly weakens it as so much strength derives from the structure of the curve. If the shoulders are rounded and greatly limiting thoracic rotation, then the rotational limits are exceeded in the low back. The low back is now flatter, weaker and subjected to rotational forces that exceed natural limits. If we add to this a lack of hip mobility and short hamstrings the low back is doomed. The rotation is to be derived from the hips and thoracic spine not lumbar.

The lumbar spine needs to be trained for stability not movement. Planks, side planks, walking while carrying one kettlebell overhead etc. can provide superior core training.

 

@EFW I did write it. However, there is not an original thought in it. When I hurt my back, I researched a lot. Read two of the McGill books and lots of other info. The above is my distillation of the information into something hopefully useful and actionable by skiers. The absolute best at putting the info into an actionable format is Mike Robertson. Has a masters degree in biomechanics. Ignore the hokey marketing, the guy is really knowledgeable. Not promoting it; just citing it as my main source of what I believe to be great information.

http://robertsontrainingsystems.com

 

[scoke]

Adam,

 

Sorry to hear that you had some serious issues but have some potential solutions.

 

My last year in Mens2, the Mens3 guys all talked about their lower backs/hips/abs having issues etc. Always scratched my head "what are they talking about? I feel great down there"

 

Skiing 36mph at the time, I I personally felt none of those issues but felt all whiplash, upper back and neck type of issues.

 

After 6 months at 34 in Mens 3, my neck and all those issues went away but guess where it hit me and lock me up hard? Completely had to change the workouts and stretching routine for hamstrings, hips, lower core, lower back and the likes. Also, I had to add the chiropractor in for making sure the hips weren't out of alignment for too long. A modern sports based chiro does wonders and keeps 34mph skiers going that's for sure.

 

Amazing what 2mph can do to our bodies and where it affects them.

 

[webbdawg99]

@ktm300 Thanks for the insight. My first visit they did an x-ray and suspected the pars fracture. An MRI was then suggested. I had an MRI done last week which confirmed the pars fracture and also revealed the issue with the disc and the L5 bruising. Fortunately for me, Emory Ortho and Spine has a great reputation and is right in my back yard. I have my first PT session on Wednesday.

 

@scoke I agree 100%. The difference between 36 and 34 and how it impacts the body is enormous. I remember my FIRST set at 34 was on the way home from my last M2 nationals. I ran 38 that day and also went home with a very sore back. I'm going to be trying multiple things to try and expedite healing and prevent future injury. Physical therapy, joint supplements, inversion table, modified activity, etc. Hope to see you on the water this summer!

[jjackkrash]

When you have healed a bit (and maybe before) I'd recommend picking up Steve Maxwell's Encyclopedia of Joint Mobility DVD (you can get it on Amazon). Its a video of him demonstrating several hours of rehab/stability exercises to help every joint in your body. It has exercises that start easy and move to progressively more challenging drills. And the drills work if you are willing to put in the time.

 

 

[Wish]

@Bruce55 If you're going to hold your profession and experience in such high regard as to prove a point by "putting a baller..me..in his place", then I would think you would not want that post to be the last thing people read from you. Rather 31 successful years has got to translate into some kind of sound advice for @webbdawg. From your post, it sounds like you can be a big help to him and others including myself that suffer with back issues. Maybe some suggestions of what to do or not to do. What to try or avoid. A referenced web link or two...something?.

 

[Nautibynature]

@ktm300 someone with lower back issues(L4/L5, L5/S1 degenerated disc disease) should not do crunches? I have been doing the planks, side planks, overhead kettle walk, and crunches along with a lot of stretching. All that is in addition to weight training.

[jjackkrash]

I'm with KTM300. Planks and side planks are awesome; endless crunches, not so much. I am convinced crunches do more harm than good and there are plenty of other, more effective options.

 

Strap your feet in a power wheel and walk 100 yards with your hands, for example.

 

http://www.strongestcore.com

 

[ktm300]

@Nautibynature Some crunches are probably okay so long as you aren't doing so many that it begins to shorten rectus abdominus. However, there is really no need for them. The planks and other exercises you are doing are all your core needs. Push yourself on the planks to see how long you can hold them. Another good core exercise for skiers is the Palloff press. I have just found that the nerves firing to hold a plank for a long time is good stuff. Your whole body shaking trying to find efficiency and hold on a little longer.

Everybody is different and has to find what works for them. I'm just sharing what I was led to after researching and experimenting with my L5 herniated disk.

 

[Horton]

@webbdawg99

As a skier who has had a number of injuries and a couple that required surgery I have two pieces of advice.

 

1) Not all doctors or medical professionals are the same. Just like mechanics or cooks or coaches or skiers some are way better than others. I suggest dealing with doctors who deal with high level athletes. Your local back Dr. may (or may not) be the best for you.

 

For my sake and yours do not take medical advice from a web forum. I would personally trust the advise of @bruce55 and or @MrJones but this forum is not a medical exam room.

 

I am closing this thread before someone gets bad advise and then sues me over it.