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Back injuries can do more than make training and competition
painful. They can end an endurance athlete's participation in
the sport unless properly treated. Eight out of 10 adults will
seek medical attention for back problems at one time or another
in their lives. At least seven million Americans are disabled by
back pain at any given time. The challenge to Triathletes facing
back problems is to maintain conditioning while receiving proper
treatment for their injuries.
One of the most common causes of low-back dysfunction is stress
caused by improper lifting of heavy objects during everyday
life. Keep the load lifted to a manageable weight and bend the
knees to avoid straining your back. Also, avoid any twisting
motions that will stress the lower back.
Weight training, a central part of every serious athlete's
training program, should incorporate good posture to strengthen
the stabilizing musculature of the lower trunk.
Strength-training exercises should be done sub-maximally to
fatigue the primary muscles being exercised, while keeping the
trunk in good postural alignment. |
Muscular flexibility is an important factor for any athlete
because it helps absorb shock and disperse the load placed on
the lower back. Many Triathletes incorrectly place their entire
training emphasis on strength and endurance. As a result, they
suffer from leg stiffness after running or cycling. To promote
flexibility, add stretching routines to your training program.
Cycling requires long periods of sitting in a crunched position,
placing tremendous strain on various portions of the lower back.
Many amateur triathletes who have desk jobs also tend to bend
forward in their chair while working, which only compounds the
amount of stress placed on the lumbar region. Proper sitting
posture can alleviate back pressure during work
hours. Be sure to use a chair with proper lumbar support. The
amount of daily tension placed on your lower back will decrease
almost immediately.
After recovering from a lower-back injury and returning to a
more normal training program, it's important to be aware of
proper cycling form and training habits to avoid re-injury.
Postural analysis of cycling form is important to reveal poor
positioning that can strain the low back (see photo 1) . The
handlebar and stem setup should allow for a comfortable
flat-back positioning. We often see triathletes in an
excessively flexed or crunched position that can strain the
lower back. The position of the saddle and seat post must allow
the pelvis to roll forward during cycling (see photo 2). On long
training rides, it's a good
idea to change arm position frequently in order to avoid
becoming over-fatigued and strained in anyone position.
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The following three case studies illustrate the most common
types of back injuries. Treated successfully, these triathletes
resumed competition without further pain.
Poor-posture syndrome
Carl, a 20-year-old college student, experienced prolonged
tenderness in the lower back, particularly when seated. A
thorough examination revealed that his back pain resulted from
sitting for long periods in a crunched, forward-bent position
that strains the lower back. We placed Carl on a program of
stretching and strengthening exercises to overcome the stress on
his low-back musculature. We gave him a rolled pillow to support
his lower back in good postural alignment while seated, so he
would not bend forward.
When we analyzed Carl's cycling form on an indoor trainer, we
found a bent-forward posture again his handlebar stem was too
short, forcing him to overflex his back. His bike was also set
up with a soft seat at a neutral pitch, thus rolling his pelvis
and lower back backward, further rounding his back.
We lengthened his handlebar stem, gave him a firm saddle and
adjusted it to tip slightly downward all to flatten out his back
while riding. Carl was advised to continue cycling and maintain
his training program, as long as he stopped before he developed
pain. He was instructed to frequently stretch and change
position to relieve stress on his lower back. Within three weeks
of seeking treatment, Carl was back to his normal training
program, free of pain. We advised him to maintain strengthening
and flexibility exercises to prevent recurrence of his postural
syndrome.
Stiff-back syndrome
Tanya is a 29-year-old office manager and amateur triathlete.
Her job involves a great deal of desk work and she trains
several times a week. She began to feel severe stiffness and
pain in her legs and low back when bending, particularly during
cycling and swimming flip turns. After several days of
discomfort, she sought professional attention. Her examination
revealed that her pain resulted from long-term inflexibility and
repeated stress to the lower back and legs. We recommended that
she take an over-the-counter oral anti-inflammatory drug and use
ice on the tender areas to relieve pain. She was also told to
halt her cycling and to swim without flip turns, but she could
keep her running mileage constant during the recuperative
period.
We placed Tanya on a vigorous program of flexibility training,
emphasizing the leg and trunk areas. In-office physical therapy
of stretching and anti-inflammatory medication helped relieve
her symptoms during her self-management program.
When we examined Tanya's bike, we found that it was set up with
one-piece aero' bars that allowed only two cycling positions. On
long training rides, she could not vary her position much to
reduce the stiffness in her back. We installed drop-bars with
clip-on aero' bars to give her more cycling positions. We also
advised Tanya to purchase a second bike adjusted for an
uncompromised aerodynamic position to be used only for racing.
She should use the bike with the clip-ons for long training
sessions and group rides because it allows for more position
changes.
Tanya's pain was relieved within six weeks of her initial
treatment, and she then resumed her cycling and flip turns
without further discomfort. We added flexibility and strength
exercises to her normal training routine to minimize back
stress.
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Herniated disc-syndrome
Thomas, a 35 year-old computer industry executive, takes his
triathlon training seriously. After spending hours seated behind
a desk and in front of a computer, he runs, cycles and swims
several times a week to stay in shape for competition.After a
weekend of backyard gardening, he felt pain shooting down his
leg, accompanied by discomfort in the low back. After the pain
persisted for a day, Thomas visited his physician who ordered an
MRl scan. The test results revealed a herniated intervertebral
disc in the lumbar region of the back, which was contributing to
his back and leg pain. |
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This severe condition most often occurs after a series of
micro-traumas that create momentary strains on the lower back.
These can include long periods of uninterrupted sitting or
crouching, as well as repetitive twisting motions that can
progressively damage the lumbar region.
The lower back consists of five lumbar vertebrae bones with
intervertebral discs positioned between them along the spine.
Each disc is a hard cartilage ring with a soft watery center
known as the nucleus pulposus. Spinal nerves end in the middle
of the back and the lumbar region, and a series of free nerves
exits between the lumbar vertebrae and the discs (see
illustration).
When the body is bent forward, the back walls of the discs
stretch while the front walls compress. This causes the nucleus
pulposus to be forced to the back wall, further stretching it.
Twisting and sudden turning motions over prolonged periods can
tear the area that is over-stretched. When the discs tear or
herniate, the nucleus pulposes can escape, irritating or
pinching the space between the vertebrae where nerves emerge.
Unless diagnosed and properly treated, herniated discs can cause
entrapment of nerves in the lumbar region, as well as other
types of serious dysfunction that may require surgery.
After prescribing an anti-inflammatory drug and icing of tender
areas to ease the pain, Thomas's doctor referred him for
physical therapy. We reviewed his case history, and conducted an
exam to identify his areas of inflexibility and weakness. He
progressed through an individualized rehabilitation program that
stresses increased trunk and leg strength and flexibility to
speed recuperation and regain muscle function.
We also noticed that Thomas's lifestyle and training routine
included some of the most common tendencies leading to
lower-back dysfunction. Therefore, we recommended a number of
modifications to help speed recovery: Thomas needed to avoid any
exercise activity or position that increased his leg pain, which
was a sign of worsening symptoms. He was put on an exercise
program of water jogging, swimming drills and easy walking to
help maintain his cardiovascular condition during the period he
was experiencing acute symptoms.
Thomas's bike positioned him well in his clip-on aero' bars, but
he was crunched in his drop-bars. We lengthened the stem to give
him better drop-bar positioning, but that put him in an
excessively stretched aerodynamic position. So we replaced the
aero' bars with a set that had elbow pads behind the handlebars,
giving him a flat back in his drop- and aero' bar positioning.
As the pain subsided, we recommended a moderate routine of
running, cycling and swimming that maintained a comfortable
level of activity. Proper healing continued and after six months
Thomas was allowed to gradually increase his training program,
eventually returning to his original level of activity.
Preventing and treating back pain
If you recognize any of these symptoms of low-back problems,
consult your physician immediately to rule out all medical
causes other than those related to mechanical dysfunction. Take
aspirin or Ibuprofen, apply ice and avoid strain. A physical
therapist specializing in the treatment of endurance athletes
also can help your recuperation and Improve your overall
physical conditioning. A cycling coach can work on cycling
setup, proper posturing during riding and individualized
training pro- grams to help prevent injuries while cycling.
A triathlete can minimize the chances of suffering low-back
dysfunction by following these and other preventative
suggestions. Yet any number of other circumstances beyond your
control can also cause low-back injury.
Although you may have the urge to "tough out" a low-back
dysfunction, it's better to take the cautious route and seek
proper attention and individualized advice. –
by Bruce R. Wilk, P.T., D.C.S. and John Howard |
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