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Old 06-13-2007, 07:19 PM   #1
Howard Wilcox
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Hello folks,

As you may or may not know, I've been having pretty localized pain in my low back since last August (injury during a company kickball game). It's been suggested that it is an SI problem, or a disc problem, and a massage therapist even got the psoas to "pop"...so I think there was definitely a trigger point there. I've been avoiding back squats and deads since those seem to cause the most trouble. That and slouching in a chair (particularly after workout out). So, I've mostly been doing KB swings/snatches, presses, pullups, bodyweight squats occasionally, c2 rower, etc...

I went to the chiro today since I was having quite a bit of pain. I exercised last night and then did some yoga-like postures. I felt pretty good after exercising (just some light kettlebell work…35lber). I think the forward bending stuff is what is causing the pain and/or sleeping on my side for part of the night. So, he wanted to do x-rays and I agreed. He said it looks like I may have a pars fracture. He also said I have some scoliosis. I could see the areas he is talking about. The scoliosis seems obvious but the possible pars fracture is somewhat unclear (and he said as much). It also looked like the L5 was somewhat forward of where it should be. This is all very disturbing to me. I don’t even know what to make of it. I’m leaning towards booking an appt with a sports doctor again (last time I just saw his PA for the turf toe). I’m not sure if that is the best way to go but at least he should be able to book x-rays and/or MRI stuff and should be familiar with treatments and stuff...and if not refer me to the right person.

Anyone have any experience with this?

howard
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Old 06-14-2007, 11:35 AM   #2
William Hunter
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Howard, you need a bone scan. If you have a pars fracture, you will be put in a back brace. You can, however, have forward displacement(spondylolisthesis) w/o a fracture, so hope for that.

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Old 06-14-2007, 12:25 PM   #3
Howard Wilcox
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I went to the doc today. He ordered an MRI next week. He seemed skeptical of the pars fracture since I didn't seem to have pain with his diagnostic tests. This is somewhat weird as I haven't had pain most of my life it is indeed congenital. If it was caused by kickball (which, the more I read, the more odd that seems...most seem to be from gymnastics or football tackles), then why can't it heal (he indicated that it wouldn't/couldn't).

Also if it is a fracture, you think I would need to lay off...he didn't indicate that I need to rest or even stop working out.

It's all very weird.

I also got the obligatory "take up swimming and do leg presses" speech.

howard
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Old 06-20-2007, 07:35 AM   #4
Joe Celso
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Howard - I don't know your history or experience, but I gotta ask- why KB swing, snatch or row, but not deadlift? The preceeding are significantly more ballistic that the latter. I'm by no means a doctor, but IMHO if you can't DL or OHS (slow lifts), then you have no business doing the other stuff. Not every DL or squat w/o needs to be heavy. Do you have good/proper DL form? (most people that say they do really don't)

Based on what I've read in this post, you may want to spend some time slowly progressing with slow lifts and static holds. In addition to DL's, back extensions (they should be called "hip" extensions), knee/leg raises (hanging and supported), planks, push ups, body rows and lots of stretching all seem like a good idea when you need to work on re-stabilizing your spine.
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Old 06-20-2007, 07:41 AM   #5
Joe Celso
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I should add that if this has been going on for a while, I would think you should probably start really light and very slowly work your way back to normal loads over a significant time (like 4 weeks or something). It's really hard to be patient, but somethimes you just have to. Even if you feel ok... you may not be healed (I've come back too fast way too many times).
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Old 06-20-2007, 09:08 AM   #6
Howard Wilcox
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Thanks Joe,

Well, because the KB work doesn't normally cause discomfort...but squats and deads do (not air squats and as such, I do those). They are ballistic but not heavy (glute-activation??).

I'm really starting to think this is trigger-point related (but still went to the MRI). The more I read of Clair Davies book, the more it makes sense (and given the psoas release I had). Weighted squats and deads must activate the glutes more and it is possible there are some trigger points there (just debugging it with his referred pain diagrams). This had gone away in February and by March I was back up to PRs on those two lifts...but somehow it came back, not exactly sure what triggered it...pardon the pun.

I'm going to see a massage therapist next week for a full hip/flexor/leg work over.

I'll still meet with the doc next month for a sanity check, but those are my current thoughts.

howard
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Old 06-20-2007, 03:02 PM   #7
Wayne Nelson
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A spondylolisthesis may, or may not have an interruption of the pars (spondylolysis) associated with it. A fracture of the pars often occurs at an earlier age and is an incidental finding later. By that time the fracture has somewhat stabilized even if there is nonunion of the fracture. A bone scan will determine if it is of a recent origin.

The way I was taught was if the pain has been recurrent from early teen-aged years the spondy is often the source of the pain. If the pain is of recent onset, say after an incident, the spondy is likely not the origin, and the pain may be caused by another source. Often a functional aberration. Back extension exercises are often recommended for spondylos of non-recent origin.

Another fly in the ointment here could be that maybe the glutes are not firing at the appropriate time, this overloads the low back.
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Old 06-20-2007, 06:28 PM   #8
Howard Wilcox
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Thank you Wayne.

The glute-firing is an interesting angle. I started squatting seriously last year after a kickball game seemed to cause the injury (which would make pars seem improbable). As such I suspect they (and deads) aggravate the situation. At this point, I'm learnings towards there being little if any left-over injury...and towards trigger points, which may have gotten started trying to protect the injury and got worse over time with crossfit-heavy use of glutes/low-back.

My second guess is a disc-issue, like a herniation. The main problem with this is that there seems to be little if any centralizing (from McKenzie extensions). Similarly, flexing doesn't seem to make it worse, which according to him, it would.

My third guess is the SI issue from reading all of Dontigney's (sp?) stuff. But doing the adjustments didn't seem to matter too much...but the injury would seem the most likely from kicking a ball.

Not sure.

The massage therapist is also a yoga person, so hopefully she can help with some postures to decrease the likelihood of the muscles locking up again.

howard

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Old 06-22-2007, 12:40 AM   #9
Wayne Nelson
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Howard, at this point the injury, if it occurred is probably healed. What might have remained is the altered motor patterns the result of pain avoidance posturing from the injury and could have altered the firing order of the extension motor pattern.

You might try consciously activating the G mx every time before you perform a dead lift. Start at a low weight and over a couple two, three, or four weeks gradually add weight. If it works with low weight do a bunch of reps and groove the pattern of initiating with the glute firing. Keep immaculate form. Be very consistent for quite a while and see how it works. . It may, it may not. The proof is in the pudding.

Don't get cocky about it if it works!


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