Lower Back Pain

Swallow Tail

Michael Peterson status
Oct 6, 2017
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Your Mom’s House
What did the PT do? I'm assuming targeted exercises. Did they prescribe a comprehensive preventative training regimen for after you regained ROM and some strength?
- ROM, which included breaking up a ton of scar tissue w the elbow. Felt like my arm was on fire. After that strength training

W the neck and shoulders, LB besides ROM it’s what I would call
“Activating” muscle groups that hadn’t been used in ages due to severe pain - ie no weight, super light weights or resistance bands and just firing those muscles, learning to continuously work to the edge of pain n that would eventually move/get better over time and then strength training w weights.

good form is critical w this stuff and a PT through observing helps correct/maintain proper form so you’re not “cheating” and you get maximum benefit from the work you’re doing.

I’ve gone to places where they looked at images, goals, then printed out a bunch of exercises then showed me how to do them - the McDonalds of PT. Next to useless. Always better to go to a small one or two man shop
 

One-Off

Tom Curren status
Jul 28, 2005
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- ROM, which included breaking up a ton of scar tissue w the elbow. Felt like my arm was on fire. After that strength training

W the neck and shoulders, LB besides ROM it’s what I would call
“Activating” muscle groups that hadn’t been used in ages due to severe pain - ie no weight, super light weights or resistance bands and just firing those muscles, learning to continuously work to the edge of pain n that would eventually move/get better over time and then strength training w weights.

good form is critical w this stuff and a PT through observing helps correct/maintain proper form so you’re not “cheating” and you get maximum benefit from the work you’re doing.

I’ve gone to places where they looked at images, goals, then printed out a bunch of exercises then showed me how to do them - the McDonalds of PT. Next to useless. Always better to go to a small one or two man shop
I just visited a PT. First thing was ROM. My ROM for neck and shoulder was normal. I gave her a list of all the stuff I was doing and said I get an A+ for my homework. She added a couple of things and said if my condition gets worse to call. So I’m basically self medicating.
 

Mr J

Michael Peterson status
Aug 18, 2003
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I just visited a PT. First thing was ROM. My ROM for neck and shoulder was normal. I gave her a list of all the stuff I was doing and said I get an A+ for my homework. She added a couple of things and said if my condition gets worse to call. So I’m basically self medicating.
nice to get a stamp of approval for your maintenance exercise, but apart from that seems like no help? No diagnosis or next step investigation for why shoulder hurts after surfing? How about shoulder strength/pain tests for various directions of resisted arm movement?
 

Mr J

Michael Peterson status
Aug 18, 2003
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- ROM, which included breaking up a ton of scar tissue w the elbow. Felt like my arm was on fire. After that strength training

W the neck and shoulders, LB besides ROM it’s what I would call
“Activating” muscle groups that hadn’t been used in ages due to severe pain - ie no weight, super light weights or resistance bands and just firing those muscles, learning to continuously work to the edge of pain n that would eventually move/get better over time and then strength training w weights.

good form is critical w this stuff and a PT through observing helps correct/maintain proper form so you’re not “cheating” and you get maximum benefit from the work you’re doing.

I’ve gone to places where they looked at images, goals, then printed out a bunch of exercises then showed me how to do them - the McDonalds of PT. Next to useless. Always better to go to a small one or two man shop
I've had good experiences with physios similar to you on knee and shoulder. Knee problem was vastus medialis muscle had gone to sleep and knee cap getting pulled out of alignment. Fixed by re-training that muscle and stretching ITB. Shoulder is all about getting those little rotator cuff muscles working back up to full strength. When certain muscles switch off or get weak, then there is uneven tension on the joints which can cause wear and pain.
 

One-Off

Tom Curren status
Jul 28, 2005
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nice to get a stamp of approval for your maintenance exercise, but apart from that seems like no help? No diagnosis or next step investigation for why shoulder hurts after surfing? How about shoulder strength/pain tests for various directions of resisted arm movement?
She did some resisted arm movement. That resulted in one of the stretches she added. But in general I do not feel pain with movement. It only comes on after an hour+- of surfing and then gets progressively worse. Surf sessions last only two hours now days. Then the neck/shoulder/trapezius is sore the rest of the afternoon/evening. I wake up the next day and it is generally fine.

This is the stretch she added, not one I've ever seen googling shoulder pain. It isnow part of my morning stretch routine-


She also gave me some "scapular stabilzation" stretches.I could not find a video of the exact one I do but this is similar. I don't quite get the holding the scapula because to me it doesn't seem to want to move that much.

.
 
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Mr J

Michael Peterson status
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@One-Off I can't relate to the post surf pain you are experiencing. I have shoulder problems completely different from you. The last thing I need is more internal rotation range of motion.

I've been doing scapular stabilization exercises completely different to the one you show. I do them standing with dumbells in my hand and flatten my scapular against my back by tensing certain muscles - took me a while to get this degree of control. I started off just squeezing my shoulder blades together, but later developed the ability to move only the muscles needed to flatten the scapula.
 

Mr Doof

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Jan 23, 2002
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Just heard an oddball "back pain" adjacent story this weekend.

Was helping out Friend #3 with his cabin in the woods down in Boulder Creek (near Santa Cruz).

As we were driving down, he told me how he got his new-to-him Tundra.

"So my neighbor died a month ago, and the wife comes over and asks if we would want her dead husband's truck. I say yes, and then ask how he died. She says, 'He went for his usual jog, but when he came back says he threw his back out. He takes it easy for the rest of the weekend, goes into the doctor on Monday because the pain never subsided and he was in a lot of pain, like maybe a freak break of a vertebrae or something...he's has some back trouble for the last few years. After some poking they get an X-ray, and the docs want to send him for an MRI right away and more exams. Turns out he had stage 4 lung cancer and it was everywhere, especially in the vertebrae and this weakened the bones to the point where they just collapsed. He died a little more than a weak later.'"

Anyway, no trees on his property had come down, and the rains have washed some more of his property down the hillside onto a different part of his property, and all I got was some wet feet and pants from walking around. And we pulled off a dozen or so ticks from his dog before we drove home (after seeing that number of ticks, I undressed and did a check for ticks on me and my clothes...and found none).
 

Mr J

Michael Peterson status
Aug 18, 2003
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Turns out he had stage 4 lung cancer and it was everywhere, especially in the vertebrae and this weakened the bones to the point where they just collapsed. He died a little more than a weak later.'"
... .
that's a clear case when there was something physically wrong rather than some psychosomatic or pain oversensitivity problem. Personally I reckon all the pain that I have experienced is for a real physical reason with some real injury or physical condition that needs to be fixed. In other words my nerves are telling me something useful and ignoring the pain will quite likely make the problem worse. Fix the physical problem and pain goes away.
 

One-Off

Tom Curren status
Jul 28, 2005
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Just heard an oddball "back pain" adjacent story this weekend.

Was helping out Friend #3 with his cabin in the woods down in Boulder Creek (near Santa Cruz).

As we were driving down, he told me how he got his new-to-him Tundra.

"So my neighbor died a month ago, and the wife comes over and asks if we would want her dead husband's truck. I say yes, and then ask how he died. She says, 'He went for his usual jog, but when he came back says he threw his back out. He takes it easy for the rest of the weekend, goes into the doctor on Monday because the pain never subsided and he was in a lot of pain, like maybe a freak break of a vertebrae or something...he's has some back trouble for the last few years. After some poking they get an X-ray, and the docs want to send him for an MRI right away and more exams. Turns out he had stage 4 lung cancer and it was everywhere, especially in the vertebrae and this weakened the bones to the point where they just collapsed. He died a little more than a weak later.'"

Anyway, no trees on his property had come down, and the rains have washed some more of his property down the hillside onto a different part of his property, and all I got was some wet feet and pants from walking around. And we pulled off a dozen or so ticks from his dog before we drove home (after seeing that number of ticks, I undressed and did a check for ticks on me and my clothes...and found none).
I'm surprised he could have advanced lung cancer and not have noticed something amiss during his jogs?

ps googled it and found it is very possible to have stage 4 lung cancer with no symptoms.

that's a clear case when there was something physically wrong rather than some psychosomatic or pain oversensitivity problem. Personally I reckon all the pain that I have experienced is for a real physical reason with some real injury or physical condition that needs to be fixed. In other words my nerves are telling me something useful and ignoring the pain will quite likely make the problem worse. Fix the physical problem and pain goes away.
The diagnosis given to me by a pain specialist MD (and was seconded by Von Meister) is that I had some kind of pathology (VM called it a "soft tissure event", MD called it "non specific lower back injury") but that in the majority of cases the pain is a kind of over reaction to the novel input and can be attentuated by a process of "acclimitization" (my term)- a gradual exposure to movement which resets the response. With a case of "Disc bulges" or "degenerative disc desease" fixing the physical problem is not always necessary and the attempt to fix the pathology (surgery) doesn't always fix the pain.

Then, as Autoprax can attest to, and like you say, sometimes the neural danger signal is appropriate. I am sure there are lots of people whose patholgy is bad enough to warrant drastic intervention.

Even though my problem was not that serious, I still recognize that there is a pathology. My back still hurts while and after surfing, but I have not had a serious, incapacitating spasm in a couple years, despite the activity. However, I know there is a root physiological cause because when my back gets sore it's in a specific location (lower lumbar, right side). It's only "non specific" because no imaging was done to specify what it is.
 
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One-Off

Tom Curren status
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Are you sure you read the book?
Yeah. It’s all stress/tension is it? I don’t buy that. The only thing I took from the book is what I also got from the pain MD and VM- that disc pathologies do not always equate to symptoms, therefore you have to manage the neurologic/psychological response. His recommendation not to do physical therapy (which for me means stretching and resistance) I heartily disagree with.

You got to chapter 3 and got better, but then got worse. How are you doing now? Do you believe it’s unresolved emotional issues causing the pain?
 
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Mr J

Michael Peterson status
Aug 18, 2003
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The diagnosis given to me by a pain specialist MD (and was seconded by Von Meister) is that I had some kind of pathology (VM called it a "soft tissure event", MD called it "non specific lower back injury") but that in the majority of cases the pain is a kind of over reaction to the novel input and can be attentuated by a process of "acclimitization" (my term)- a gradual exposure to movement which resets the response. With a case of "Disc bulges" or "degenerative disc desease" fixing the physical problem is not always necessary and the attempt to fix the pathology (surgery) doesn't always fix the pain.

Then, as Autoprax can attest to, and like you say, sometimes the neural danger signal is appropriate. I am sure there are lots of people whose patholgy is bad enough to warrant drastic intervention.

Even though my problem was not that serious, I still recognize that there is a pathology. My back still hurts while and after surfing, but I have not had a serious, incapacitating spasm in a couple years, despite the activity. However, I know there is a root physiological cause because when my back gets sore it's in a specific location (lower lumbar, right side). It's only "non specific" because no imaging was done to specify what it is.
I don't doubt that the condition where someone gets their system into an overactive response to pain exists. I listened to an AM radio broadcast episode about this and the case they described was a cyclist who hurt his knee, healed and rested the knee, but every time he tried to cycle no matter how long the rest his knee hurt. After determining that there was no longer an injury that warranted such a pain response he was put on some sort of acclimatisation program - if I remember correctly prescribed some stationary bike cycling sessions to convince his body that nothing terrible was happening. I tried to find the name for this condition, AI thought it is " hyperalgesia ". @PRCD I think you have had this with your hip, is that right?

I also don't doubt that psychosomatic pain in the back or wherever is very real for those who experience it, nor do I mean to belittle those who suffer from that. I don't think I handle stress very well and can feel a general deterioration in well being, disrupted sleep etc and the two bouts of shingles I have suffered coincided with some very stressful periods in my life.

Whenever something hurts in my body its usually for an obvious reason - I've dislocated my shoulder etc. My back is like yours, a bit more mysterious "probably a disc bulge" was the answer from the chiro when an x-ray showed a good amount of disc thickness in the region of my lower back that hurt - although some thinning in the neck discs which didn't/doesn't hurt.

The reason why I don't think that my back was some overactive response is because, it didn't get cured by a gradual re-exposure to the offending activity - which would have been difficult as it wasn't any particular activity or movement - it had happened skateboarding, but it also happened spontaneously. When I decided to get some professional treatment for this recurring problem it involved giving away surfing for 3 months and a huge list of lifestyle posture adjustments, exercises, stretches, massage which I have detailed a number of times in the other back pain thread. I wasn't required to stop skateboarding (although no rotational tricks) and when I returned back to surfing, there was no gradual re-exposure - just got back into it full on up to my fatigue levels. I still maintain these posture control and other exercises. From a symptom point of view I consider myself fixed. What actually got "fixed" I have no idea, I suppose it doesn't matter :shrug: I'm feeling other benefits from the maintenance regimen I'm on, so regardless of how important it is to maintain I don't mind carrying on - although my strong gut feeling is that its good for me in the long run. We got to believe in something!

Right now I am just over 3 weeks into recovering from rotator cuff surgery. My arm is still in a sling and twinges of pain are giving me warnings that its not ready to do much! Apparently this 6 week period is very risky for re-injuring surgical repairs.
 

Mr J

Michael Peterson status
Aug 18, 2003
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Are you sure you read the book?
My now fixed condition sounded rather similar to yours. Back just "goes", crippling pain, can barely walk, driving a car would be impossible, then within days rapid improvement and after about 1 week back on my skateboard/surfboard. Back might still have been achey and a bit sore, but feeling good enough for those activities. That your situation? The difference is that during the week of recovery I wasn't reading a book.

Then the last time it happened (roughly 15 yrs ago) that was the third such "event" in a year, I decided things were bad enough to feel desperate to see a specialist from a medical profession with a dodgy reputation - general practitioners had been no help - take some paracetomol, its just a back sprain and other useless advice/info. That's when I got put on that massive program of therapy, exercises and lifestyle adjustments.
 

Random Guy

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Jan 16, 2002
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Yeah. It’s all stress/tension is it? I don’t buy that. The only thing I took from the book is what I also got from the pain MD and VM- that disc pathologies do not always equate to symptoms, therefore you have to manage the neurologic/psychological response. His recommendation not to do physical therapy (which for me means stretching and resistance) I heartily disagree with.

You got to chapter 3 and got better, but then got worse. How are you doing now? Do you believe it’s unresolved emotional issues causing the pain?
This week I’ve been snowboarding at Stowe in Vermont on typical east coast conditions
Which means ice

And I’ve fallen on my ass, I’ve landed on my back
I’ve twisted all sorts of ways that i probably shouldn’t
And my back feels a little muscle achey if I dont move for a while, but nothing similar to back spasms

After try he last 3 days at Stowe, today and tomorrow I’ll be at mount snow.
I don’t think I can describe how amused I am that 1 week after not being able to walk 5 feet , I’m beating my body up, unit slowed down at all by back pain, and feeling great

I listened to the whole book while driving the 6 hour drive to Vermont The book only works if you believe
Obviously I believe
 

Random Guy

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My now fixed condition sounded rather similar to yours. Back just "goes", crippling pain, can barely walk, driving a car would be impossible, then within days rapid improvement and after about 1 week back on my skateboard/surfboard. Back might still have been achey and a bit sore, but feeling good enough for those activities. That your situation? The difference is that during the week of recovery I wasn't reading a book.

Then the last time it happened (roughly 15 yrs ago) that was the third such "event" in a year, I decided things were bad enough to feel desperate to see a specialist from a medical profession with a dodgy reputation - general practitioners had been no help - take some paracetomol, its just a back sprain and other useless advice/info. That's when I got put on that massive program of therapy, exercises and lifestyle adjustments.
Yes, very similar
 

PRCD

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Feb 25, 2020
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Even though my problem was not that serious, I still recognize that there is a pathology. My back still hurts while and after surfing, but I have not had a serious, incapacitating spasm in a couple years, despite the activity. However, I know there is a root physiological cause because when my back gets sore it's in a specific location (lower lumbar, right side). It's only "non specific" because no imaging was done to specify what it is.
The fact that you get sore in the same place every time is more a matter of hysteresis than an underlying physiological problem - your brain has simply learned how to produce that response possibly due to an acute injury earlier which might've come from a gradually-learned movement pattern from the past. The pain is a learned response your brain is good at. You have to approach chronic pain like this:

Stiff muscles are sore muscles. Chronically-tight muscles hurt. The key is to mobilize them in a way that doesn't threaten your nervous system. Somatics are best for this, or its predecessor Feldenkrais, Somatics being the more-formalized, easily-accessible version. So far, no one on here has tried this.

I tried to find the name for this condition, AI thought it is " hyperalgesia ". @PRCD I think you have had this with your hip, is that right?
Yeah, I just had a bout of hip pain for about six hours. I had gone to some training that required a lot of breakfalling, I was worried about layoffs, my wife brought me some other bad news, and I had to travel the next day.

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One-Off

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The fact that you get sore in the same place every time is more a matter of hysteresis than an underlying physiological problem - your brain has simply learned how to produce that response possibly due to an acute injury earlier which might've come from a gradually-learned movement pattern from the past. The pain is a learned response your brain is good at.
Ok. I'll try to bank that. It's hard to consciously counteract a subconscious response. The RX as I've come to understand it is a physical response- movement.
 

PRCD

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Ok. I'll try to bank that. It's hard to consciously counteract a subconscious response. The RX as I've come to understand it is a physical response- movement.
See my update. I fleshed this out further.