By Rick Rosa, D.C.,D.A.A.P.M.
What’s going on inside my back?
If we go back over the items that we mentioned in the first article in our series on back pain, we had spinal disease listed first. The obvious thing here is that you get the problem treated. If that’s some type of organic disease like metastasis, SLE, gout, etc. you need to get that disease treated first by your physician and then explore when and if you may return to the bike.
Now, if the cause is a herniated lumbar disc you should progress through conservative treatments first like chiropractic, physical therapy, nutrition, and medications (we combine these in my office). The earlier you get treatment the better the chances are for the inflammation and tissue to shrink so to speak and stop putting pressure or chemical irritation on the nerve root. I advise cyclists to get treated ASAP and to combine some of the conservative treatment options because this condition can be very difficult to treat for a cyclist.
Why you ask? Well, when you ride your bike you are in a flexed position and this tractions or pulls the nerve root over the herniation or disc material. Once you have been treated successfully for this condition, you can move into a rehabilitative phase where you can incorporate some of the methods I will present in the other treatment sections.
Not Good Reading…
If you don’t respond to conservative treatments, then what? In my clinic we then combine epidural blocks (injections of medication into the spine near the nerve) in a series of up to 3 total blocks for 3-4 weeks combined with various forms of traction and rehab. If all of this fun stuff still doesn’t provide you with the relief you’ve been searching for, surgery may be in your future. If this becomes the only option, you would want to go with a neurosurgeon that can perform a minimally invasive technique if they can and will be followed up with rehab.
Another spinal disease that may affect the more mature cyclist is Degenerative Joint Disease (aka Osteoarthritis). This is where a build up of bone can cause spinal stenosis (a decrease in the size of the hole where the spinal cord and spinal nerve roots travel through. It is a build up of bone due to various stressors being placed on the joints over time. In fact, most of us will develop at least a small amount of DJD over time but it is only when the spine or nerve roots become compromised where we get a serious problem. The symptoms are similar to a disc herniation but your doctor will obviously be the one that will determine your condition. The treatments are similar to the ones previously mentioned but the chances are smaller that you will respond to care.
Of course we can’t forget to mention trauma. Oh the glorious pain of falling of your bike and if you haven’t yet taken a tumble, you will at some point. If you happen to fracture one of the vertebrae, you may have a medical emergency so don’t move your body. In a serious fall, let the EMT handle the situation. You don’t want a fractured spinal segment cutting into the cauda equina (bottom of spinal cord.) If your broken back does not require major spinal reconstruction and you don’t have a compression fracture of the vertebrae, then rest or a new procedure called vertebroplasy may be recommended. This is where they inject a cement like material into the bone to butteress the vertebrae from within.
In the best case scenario, you sprain your lumbar spine and this can be very painful. The amount of fluid that develops from the inflammation is a lot less then say your knee but the joints are much smaller and tighter. The result is pain. Typically, you strain the muscles of the spine which means you tear some of the fibers and strain the joint tissue which means over stretching of the ligaments. The worst part is the muscle spasms that are an inherent reflex mechanism that will be present the following morning when you wake up in pain and as stiff as titanium.
So what do you do? Well see your doctor (I know you are sick of me saying that) and you should begin a combination of acute care treatment, physical therapy, spinal manipulation, and proper nutrition and or medication. The idea is to decrease the amount of scar tissue formation, restoration of proper spinal biomechanics, decrease of inflammation and pain. Most cases responded very well to this combination of treatment and you will soon be in the final or rehabilitative phase.
In Part III I will discuss the final two areas, namely bike fit and the problems that occur from the act of cycling. You will be able to pick up there when you have recovered enough from the previous mentioned injuries.
1. White III,AA and Panjabi, MM:Clinical Biomechanics of the Spine. Lippincott Williams & Wilkins Baltimore ed. 2, 1990
2. Cilliet, R: Low Back Pain Syndrome. F.A. Davis Company Philadelphia ed 4, 1992
3. Cox, J: Low Back Pain. Williams & Wilkins Baltimore ed 5, 1990
4. Reilly: Practical Strategies in Outpatient medicine. Sounders ed 2 1984
Rick Rosa, DC, DAAPM, is a practising chiropractor based in Maryland. He is the owner of Rosa Rehab in the Washington, DC area, and has worked as a team doctor for a wide variety of champion boxers and cycling teams. He can be reached for comments at firstname.lastname@example.org
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