Cycling-Related Lower Back Pain

Is it ok to ride through low back pain or should you stop and seek medical help?
Mechanical low back pain (LBP) is the most most common physical complaint among cyclists.




The exact cause can be difficult to diagnose,and many cyclists,myself included,are given general "soft advice": take things easy,rest,lower your gear ratios,use a higher cadence,etc.However,treatment and pain management-and whether to rest or carry on cycling-should be determined by your GP,Osteopath or physio,based on the specific type of lower back pain you are experiencing.

What's Causing The Pain

Often cyclist presume that their lower back ache is caused by a simple muscle strain,brought on by over- training,or jarring the back.In fact,the problem is usually mechanical.When the spinal muscle-fibres strain,they pull on the wings of a spinal joint called facet joints.There's a pair of facet joints at each of the five lumbar vertebrae-almost like having two spines in parallel.These muscle attachments act like a puppet on a string and can manipulate the facet joints in any direction.

Therefore,if a deep spinal muscle is strained  by a sudden movement or micro-trauma (repetitive movements) then a taut thickened muscle band will develop.This taut band is liable to pull the facet joint out of its correct position and change the alignment of not just the lower five vertebrae but often your pelvis and mid-back too-resulting in pain,inflammation and restricted movement.

What Is The Lumbar Spine?

The lumbar spine is the lower section of your vertebral column.It is comprised of five large vertebral segments.Its primary function is to provide stability,strength and power for movement.Yet its well-engineered structure protects the spinal cord,existing nerves and abdominal contents.Large intervertebral discs act as shock-absorbers and are a very common source of back pain,since they dehydrate (thin) through degeneration or injury (disc bulge or prolapse).

Can I Carry On Cycling?

It's advisable to rest for the first four or five days after the initial onset of LBP and wait for the first inflammatory phase to subside.You should not attempt cycling if the pain is too severe (difficulty turning over in bed or unable to stand up straight); when you experience referred pain down your legs (sciatica) ; or a tingling/numbness in your feet.

 In some cases,back pain can be due to a serious problem or disease,so if severe pain persists,please consult you Gp,Physio or Osteopath.

Self Help Exercise

It's not all bad news: research has shown that cyclists who regularly work on their back flexibility can reduce their risk of experiencing low back pain (LBP).Complete these execises pre/post-ride and 24 hrs after each ride

Read More: Click Here.

Back Pain and Diagnosis

Did you know that many doctors miss areas of concern that could lead to cures? Did you know that back pain is common, yet many doctors fail to see the cause? The answer is simple. The reason is most medical doctors have little experience in the system of healing so to speak. Rather many doctors focus on prescribing medicines and searching for answers, which many times rest in front of them. Don’t get me wrong, good doctors reach everywhere, yet these people lack educational knowledge of the spinal column, central nervous system and so on. As well, these people fail to see that many causes of back pain rests in misaligned bones, or spine. Of course, diseases may cause back pain as well. Sitting too long, lack of stretch exercises, etc, all cause lower back pain.

If the back pain is, serious it will often show up in MRI or CT scans. X-rays will show back conditions, however since doctors review all areas, except the alignment of the bones and spine, thus most times the x-rays only reveal what the doctor wants to see. This happens to many people, including myself. A pro in analyzing the spine and bones is the man you want to see if you have chronic back conditions.

The types of back pain include sciatica. The back problem may be listed as slip disk in some instances, yet the pain often challenges doctors diagnose since a sharp, electrical shock-like and distressing ache starts at the back and then travels to the legs. Sometimes the pain is intermittent, while other times the pain may be chronic. The particular problem often requires surgery to correct. Sciatica according to few experts is one of the worst backaches endured, since even when the pain has mild pain it is difficult to bend forward and over to tie a shoe. The problem rests in the spine, joints, and connective elements of the spinal column that links to the entire body.

The spinal column makes up muscles, bones, central nerves, etc. What holds the spine together is disks, connective tissues, tendons, ligaments, etc? When a person stands erect, the spine’s elements will join to apply tension. You can visualize the tension by considering how a string will respond when you pull it down. The changes assist the body in mobility; as well, it determines how the body responds to movement.

The lower back is made up of large-scale structures, including the backbone and the hip joints. The hip joints connect to the pelvis and each element joins with the spinal column at the triangle bone in the lower back and at the baseline of the spine that joins the hipbones on either side and forms part of the pelvis. (Sacrum)

The large bones attach to the legs, which provide us strength and support to the vertical spinal column. We have thick bones that start at the opposite side of the thick cord of nerve tissues (Spinal Cord) that is near the neck. Along this area, the joints are thick and the bones start to thin and shrink. The spinal cord is a “thick whitish” nerve cord surrounded by tissues and extends from the base of the brain and continues to the spinal column, giving mount to a pair of spinal nerves that contribute the body.

Combined these elements give us the ability to move and provides flexibility. In addition, the organs are directed by these elements.

The spine is held up by the larger group of bones at the lower region, smaller base, and the top architectures. Stress occurs at the area, since below this region larger muscles work by directing and sparking movement. This is how the legs are able to move, which brute stress is applied to the vertebrae. At the back, we also have a lumbar spinal disk. The disk is affected by the brute stress, since each time we bend and sit, we are applying more than 500 pounds to this area, yet it stretches to a “square inch” around the disks and per count along the area.

Treating ankylosing spondylitis Part 2

Tumour necrosis factor (TNF) blocker

If your symptoms cannot be controlled using painkillers or exercising and stretching, a tumour necrosis factor (TNF) blocker may be recommended. TNF is a chemical produced by cells when tissue is inflamed.

TNF blockers are given by injection and work by preventing the effects of TNF. This helps reduce inflammation in your joints caused by ankylosing spondylitis. Examples of TNF blockers include:

• Adalimumab
• Etanercept
• Golimumab

TNF alpha blockers are a relatively new form of treatment for ankylosing spondylitis, and their long-term effects are unknown. However, research into the use of TNF blockers for treating rheumatoid arthritis is providing clearer information about their long-term safety.

If your rheumatologist recommends using TNF blockers, the decision about whether they are right for you must be discussed carefully and your progress will be closely monitored. This is because TNF blockers interfere with the immune system (the body’s natural defence system).

NICE guidelines

The National Institute for Health and Clinical Excellence (NICE) has produced guidance about the use of these TNF blockers. NICE states that adalimumab, etanercept and golimumab may only be used if:

• Your diagnosis of ankylosing spondylitis has been confirmed
• Your level of pain is assessed twice (using a simple scale that you fill in) 12 weeks apart and confirms your condition is still active (has not improved)
• Your Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is tested twice, 12 weeks apart, and confirms your condition is still active (BASDAI is a set of measures devised by experts to evaluate your condition by asking a number of questions about your symptoms)
• Treatment with two or more NSAIDs for four weeks at the highest possible dose has not controlled your symptoms

After 12 weeks of treatment with TNF blockers, your pain score and BASDAI will be tested again to see whether they have improved sufficiently to make continued treatment worthwhile for you. If they have, treatment will continue and you will be tested every 12 weeks.

If there is not enough improvement after 12 weeks, you will be tested again at a later date or the treatment will be stopped.

Infliximab is an alternative TNF blocker that may be used to treat ankylosing spondylitis. However, it is not recommended by NICE. If you are currently taking infliximab, you should continue to do so until you and your rheumatologist decide it is appropriate for you to stop.

Other new TNF blockers and similar medications are being developed and may be approved by NICE.

Bisphosphonates

Bisphosphonates are usually used to treat osteoporosis (weak and brittle bones), which can sometimes develop as a complication of ankylosing spondylitis. Bisphosphonates may also be effective in treating ankylosing spondylitis, although the evidence is not entirely clear. They may also be used if you have osteoporosis.

Bisphosphonates can be taken by mouth (orally) as tablets or given by injection.

Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) are an alternative type of medication often used to treat other types of arthritis. DMARDs may be prescribed for ankylosing spondylitis, although they are only beneficial if peripheral joints are involved rather than the spine.

Two DMARDs found helpful for inflammation of joints other than the spine include:

• Sulfasalazine
• Methotrexate

Corticosteroids

Corticosteroid medicines (steroids) have a powerful anti-inflammatory effect and can be taken in various ways, for example as:

• Tablets (oral)
• Injections (parenteral)

If a particular joint is inflamed, corticosteroids can be injected directly into the joint. After the injection you will need to rest the joint for up to 48 hours (two days). It is usually considered wise to have a corticosteroid injection up to three times in one year, with at least three months between injections in the same joint. This is because corticosteroids injections can cause a number of side effects, such as:

• Infection in response to the injection
• The skin around the injection may change colour (depigmentation)
• The surrounding tissue may waste away
• A tendon (cord of tissue that connects muscles to bones) near the joint may rupture (burst)

Corticosteroids may also help to calm down painful swollen joints when taken as tablets. Occasionally, when pain and stiffness are severe, corticosteroids can be very helpful when given as an injection into your muscle (intramuscular injection).

Read Part 1 HERE

Ankylosing spondylitis (AS)

Ankylosing spondylitis (AS) is a type of chronic (long-term) arthritis that affects parts of the spine, including bones, muscles and ligaments.
Arthritis is a common condition that causes pain and inflammation of the joints and tissues around them.
The symptoms of ankylosing spondylitis can vary, but most people experience back pain and stiffness. The condition can be severe, with around one in 10 people at risk of long-term disability.

What causes ankylosing spondylitis?

In ankylosing spondylitis, the spinal joints, ligaments and the sacroiliac joints (the joints at the base of the spine) become inflamed. This inflammation causes pain and stiffness in the neck and back. Sacroiliitis (inflammation of the sacroiliac joints) leads to pain in the lower back and buttocks.
It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27.

Treating ankylosing spondylitis

There is no cure for ankylosing spondylitis. The aim of treatment is to ease the pain and stiffness and to keep the spine flexible. Treatment includes:

• Physiotherapy – where physical methods, such as massage and manipulation, are used to improve comfort and spinal flexibility (only the muscles and soft tissue should be manipulated and never the bones of the spine – manipulating bones in people with ankylosing spondylitis can cause injury)
• Medication – helps relieve pain and control symptoms
• Lifestyle changes – to minimise the risk of other health conditions and improve symptoms

Complications

Inflammation of part of the eye (uveitis) is sometimes associated with ankylosing spondylitis. If you have ankylosing spondylitis and develop pain or redness in one of your eyes, you should urgently see your GP as it can lead to loss of vision.  

In advanced cases of ankylosing spondylitis, the pain and stiffness can lead to your posture becoming fixed in one position.

Who is affected?

Ankylosing spondylitis can develop at any time from teenage years onwards, although it usually occurs between 15 and 35 years of age and rarely starts in old age. It is around three times more common in men than in women.

Further info on the treatment of AS can be found HERE

Treating ankylosing spondylitis Part 1

There is no cure for ankylosing spondylitis (AS). Treatment aims to relieve symptoms and slow the process of the spine stiffening.

Physiotherapy

Keeping active can improve your posture and your range of spinal movement, as well as preventing your spine from becoming stiff and painful.

As well as keeping active, physiotherapy is a key part of treating ankylosing spondylitis. A physiotherapist (a healthcare professional  trained in using physical methods of treatment) can advise about the most effective exercises and draw up an exercise programme suitable for you.

Types of physiotherapy recommended for ankylosing spondylitis include:

• Group exercise programme, where you exercise with others
• An individual exercise programme – you are given exercises to do by yourself
• Massage – your muscles and other soft tissues are manipulated to relieve pain and improve movement (the bones of the spine should never be manipulated as this can cause injury in people with ankylosing spondylitis)
• Hydrotherapy – exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath); the weight of the water helps improve your circulation (blood flow), relieve pain and relax your muscles
• Electrotherapy – electric currents or impulses (small electric shocks) make your muscles contract (tighten), which can help ease pain and promote healing

Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important (see below).

Exercise

The National Ankylosing Spondylitis Society (NASS) provides detailed information about different types of exercise to help you manage your condition.

However, if you are in doubt, speak to your physiotherapist or rheumatologist before taking up a new form of exercise or sport.

Alongside physiotherapy, you will also probably be prescribed medication, such as:

• Painkillers
• Tumour necrosis factor (TNF) blockers
• Bisphosphonates
• Disease-modifying anti-rheumatic drugs (DMARDs)
• Corticosteroids

These are described below.

Painkillers

You may need painkillers to manage your condition while you are being referred to a rheumatologist. The rheumatologist may continue prescribing painkillers, although not everyone needs them, at least not all the time. The first type of painkiller usually prescribed is a non-steroidal anti-inflammatory drug (NSAID).

Non-steroidal anti-inflammatory drugs (NSAIDs)

As well as helping to ease pain, non-steroidal anti-inflammatory drugs (NSAIDs) help relieve inflammation (swelling) in your joints. Examples of NSAIDs include:

• ibuprofen
• naproxen
• diclofenac

When prescribing NSAIDs, your GP or rheumatologist will try to find the one that suits you best and the lowest possible dose that relieves your symptoms. Your dose will be monitored and reviewed as necessary.

Paracetamol

If NSAIDs are unsuitable for you, an alternative painkiller, such as paracetamol, may be recommended.

Paracetamol rarely causes side effects and can be used in women who are pregnant or breastfeeding. However, paracetamol may not be suitable for people with liver problems or those dependent on alcohol (have an alcohol addiction).

Codeine

If necessary, as well as paracetamol, you may also be prescribed a stronger type of painkiller called codeine. Codeine can cause side effects including:

• Nausea (feeling sick)
• Vomiting (being sick)
• Constipation (an inability to empty your bowels)
• Drowsiness, which could affect your ability to drive

Treating ankylosing spondylitis Part 2- click HERE

Back Pain Treatment

How to relieve back pain

Doctors often prescribe a variety of exercises, diets, stretch exercises, etc to relieve back pain. According to statistics, more than 200 million Americans alone suffer back pain. Some patients endure surgery, while others find ways to minimize the pain. Unfortunately, some people turn to alcohol and drugs to relieve such pain.

When pain is chronic, it makes it difficult to cope with daily duties. Most pain in the back starts at the lower region. With so much suffering, many people make a hobby out of finding relief.

Back pain mild or chronic can slow activities, mobility, and so on. While there are, many medical causes and sometimes-mysterious causes the fact is the majority of people in the world fail to maintain ROM of the joints by stretching and exercising regularly.

For this reason, back pain is the number one cause of time loss and money spent. The fact is back pain alone is one of the prime reasons that people must call in to work sick. According to statistics, the increase in back pains the total estimate of loss and medical costs soars up to $60 billion dollars annually.

Some people are lucky. That is some people mysterious experience back pain and in a few months, the pain vanishes, never returning. Lucky dogs!

While the large percentage of people soon recover naturally from back pain, another percentage makes up 100 and these people find relief by modifying their weight, adjusting sitting arrangements, and stretching.

Still, others suffer enduring back pain. Some of these people will sit inappropriately in chairs, or on couches until they lower back finally dents, forming the shape of the chair position they had sit. These people often spend a lifetime indulging in over-the-counter meds, such as analgesics. If they would get off the couch, align the back with stretch exercises and support of Chiropractors, thus the pain may disappear.

Still, other people suffer life-long back pain due to injuries, trauma, disease, and so on. The downside is these people rarely get the treatment they deserve, since it is rarely recommended by doctors. In short, doctors will often recommend over-the-counter medications, i.e. painkillers to resolve the problem. Doctors rarely tell patients to exercise, diet, etc. Sometimes you may hear, “Loose some weight,” yet the doctor will rarely tell the patient how it is done.

Painkillers work to eliminate inflammation and sometimes pain, yet what doctors fail to tell the patients is that some of these painkillers are in fact killers. In addition, painkillers do not have the same affect on all persons. For sure, some painkillers will reduce pain for some, while others may continue hurting.

This leads us to drug addictions and alcoholism, since these people need help coping with the pain, and if doctors are not offering that help, thus drugs and alcohol is the answer. We have another problem.

In view of the facts, back pain recoveries lay behind information. When a patient has an idea as to what is causing his/her pain, thus he/she can move to treatments that help them to find relief.

Fact: When a person is aware of cause, effect, only then can he take action to eliminate the cause. When a person is aware of cause, he moves to acceptance, in turn acceptance moves him to act.

How do I find the cause?

You find the cause by researching your condition. Once you begin research your eyes will open, which leads you to discuss with your doctor, treatments to eliminate your pain. Doctors prescribe medicines, recommend tests, and encourage surgeries in some instances, thus these people rarely focus on REAL HEALTH, which includes exercise.

Exercise has proven to reduce even the worst back pain. Exercise has gone as far as proven to prevent death from internal injuries. Most people would ordinary die after six months from internal injuries; however, one person stood against doctors and should them that exercise is the gatekeeper to good health.