My Aching Back - Belts - Remedies

[arothafel]

Here?s a new thread since some of us have the same basic issue with our lower backs. I am a walking, talking science experiment when it comes to this subject. And, I?ll apologize in advance for this lengthy post? but if it helps just one person?.

I also can assure you that hunched-over skiing is just asking for problems. And if you race hunched-over you?re REALLY asking for it! I?ll explain why further down. First, my lower back credentials:

I?m 53 and been fighting lower back spasms/pain, etc for more than 30 years. I've been given loads of advice, seen numerous chiropractors, doctors, massage therapists, acupuncturists, maybe even a gypsy.... I've taken everything from heat and ice to advil and cortisone sometimes all at once! I've had MRIs that simply revealed normal wear & tear on my disks and the most recent diagnosis discovered a hyper-mobile SI (sacro iliac) joint that may be the root cause of most my back issues.

Further, I've been told that I have the tightest hamstrings on earth. If we stripped back the skin we could probably play my hamstrings like a guitar! Tight hamstrings often manifest their complaints with the lower back. Aggravation is typically ?felt? at the weakest part of the kinetic chain even though that part may not be the root cause.

Through it all, the experts all said: ?Make sure your abs are strong.? Yup, that's the answer. "Strong abs will take all that pressure off the back." And, whenever I even mentioned things like doing some back extensions, I heard a resounding NO! That will just aggravate the disks and cause inflammation, etc. So, for years... it's been abs, abs, abs..... stretch, stretch, stretch the back.

I still got injured. Skiing, putting my pants on, an odd sideways movement, etc. It would take me out for 4-6 weeks at a time. And, would start up the whole cycle of experts, drugs, etc. to find the holy grail.

The truth is: (1) backs are very complex, (2) most problems are caused by a number of issues going on? and (3) each person is a bit unique.

Finally, during a race camp at Mammoth, I met Howard. Howard is a Physical Therapist and a ski junkie who, for a time, was head trainer for the LA Rams (remember them?) and before that several major league baseball and hockey teams. I relayed my ?agony-of-the-back? story to him. He offered to come and workout with me and to check out my back at the same time.

The first thing he did was put me on a Swiss ball (on my chest) and have me raise my legs -- one at a time. While doing this, he had his hand on my erector muscles (back). He just started laughing and said, "You have the erector muscles of a 4 year-old!"

What he told me next made a lot of sense. I had been working so hard on abs, that my back had become weak. My entire core was out-of-sync and out-of-balance. Great abs, no back. He immediately recommended all kinds of back strengthening exercises - especially those that incorporate my guitar-string-hammies. Plenty of work on the oblique muscles as well. HH?s exercises shown in his books and elsewhere are dead-on for skiing. The goal, of course, is to stabilize the entire core.

Well, it worked for me. My back still goes out, occasionally, especially if I?m in gates. But, nothing like before. And I recover almost immediately or in a few days. Even my Chiro/Massage professional can feel the difference and she should know since she?s been working my lower back for 10 years!

The point is, a belt will not take the place of really, really solid work on your core muscles. Period.

But, I still wear a belt.

For me, it?s a matter of applying constant pressure to my SI Joint. I wear an SI Joint belt with Velcro. Because an SI Belt is worn low, it inhibits the hip flexors a little, but I?ve learned to overpower it. If interested, you can Google ?SI Joint Support Belts? and a couple million will come up. Look for the ?sports belts? that allow for adjustment with Velcro straps.

Hunched-Over

Besides having a bad back, I am the ?poster child? of hunched-over skiing. This clip is on blue terrain. You can imagine how hunched I get in the steeps!

http://youtube.com/watch?v=Yab1VOCeGsw

And if you think your back hurts now, just keep skiing hunched over and I guarantee it will eventually go out ?big time? and you?ll be out of the game for a few months.

Here?s how it was explained to me (no doubt HH or someone can add some science to this).

When you link a series of turns your CM is moving laterally from side to side? as such your whole pelvic area, hips, lower back, ect. becomes ?loaded? with some serious G?s primarily on one side ..and then releases and then reloads on the other side. This was explained to me as ?lateral shifts under load.? If you are skeletally stacked properly, you can handle the load. However, if you are hunched-over, you?re not stacked properly and, in fact, throw much of that G-force on to your lower back muscles and associated ligaments and tendons. It is the equivalent to bending over at the waist, twisting to one side and trying lift a 100 pound weight. Those of you who race know the G-forces are multiplied? so the lateral shifts under load are intense.


Two things that provided significant help.

1.) Javelin Turns: Whenever I do this exercise, I immediately notice my entire body is in different position than my normal skiing. I mean, I am in a whole different ?space.? Why? Because the Javelin turn absolutely demands my body be in balance and will not allow me to be hunched over. I asked HH and others at the Hood camp about this? and they, too, noticed that it put me in better balance and better posture. So, consider this drill to help correct the issue.

2.) Harb Carvers: These also will force you to maintain better, more balanced posture since you don?t have any fore/aft ski on which to rely. If you get too hunched over on these babies, you?ll be eating some serious tar.

So, that?s my story. I hope it?s helpful for anyone experiencing lower back issues. I?ve spent years trying to figure it out and the journey continues?

Art

[theskiwizard]

Art,
Great to hear you finally got advice that recommended BALANCE in your work outs! I think we have a tendency to get overly focused on the "abs". Core stability is a better term. We definitely need balance between all muscles of the core and they must work together in an organized fashion to provide stability and controlled mobility of the spine for high level dynamic activities such as skiing!

You mentioned you are using an SI Belt, I would recommend you do some extra work to strengthen your gluteus medius muscle as it may be inhibited by the belt. (outside of the hip muscle--> very important for skiing and stabilizing stance leg). Some suggested exercises are hip abduction machine at gym (push hips/legs outward), or lying hip abduction with weight (lie on R side with weight at ankle. L knee bent underneath you, suck in belly button toward spine to recruit core, lift leg 4-6 inches, hold 5 sec then lower. Work up to 3 set 10 reps. Repeat opposite leg) Another exercise I call Clam Shell works the gluteus medius and the hip external rotators (muscles which help control stance leg from inwardly rotating). Lie on R side with both knees bent. Can place a weight around your thigh, lift L leg off R keeping your feet together ie open leg like a clam opening its shell with your feet as part of hinge. Repeat on other side. Buid strength by adding weight and work endurance by working up to 30-45 in a row. Still another way to work gluteus medius and hip external rotators into a work out would be to get some theraband or sport cord that you can put around your thighs just above your knees (needs to relatively tight) then widen your stance to about hip width and perform 3 set 10 squats. Nice combo exercise which works quads, hams, gluts, glut medius and hip external rotators all at same time. Want to incorporate more core and balance.....perform the squats on to of a balance device such as a B.O.S.U.!

Time is now to get that base training in!

[arothafel]

Great stuff.... Maria

I'm all over the adductor and abductor machines. My adductors are about 30% stronger than abductors. Perhaps that shows the weakness, yes?

It would be great to ski with a PMTS instructor who also is familiar with some biomechanical issues. Do you ever ski Mammoth or do I need to make the trip to Tahoe? I'll PM you as the season nears for some info on your rates and avails.

Thanks again for the additional exercises. It all helps!

Art

[h.harb]

Art, Diana and I do leg raises as you described (bend over face down and lie balanced on a Swiss ball, lift the legs). We also do these to increase strength with a roman chair, bend forward over the leg cushions, face down, your chest on the front cushions. Hold you upper body stable with arms wrapped around the front of the roman chair and stabilize your core. Lift the legs from the floor to horizontal.

If you are new to this exercise, I suggest lifting one leg at a time and building up to two legs and then weights on the ankles. Diana and I do ankle weights of ten lbs. each. When you can do twenty lifts (reps) for three sets, your core won?t flake out on you when you are skiing. Of course you need to have the abs just as strong and balanced.

One of my favorite ab tests/exercises is done while hanging from a chin bar. Lift your feet with legs straight, raise them up until you can touch the bar with both shins. This puts you in an up-side-down pike position. Don?t swing to get your feet up, use your abs. Try to reach ninety degrees, (legs straight out) before going for the full bar touch. This requires tremendous core strength. I try to keep myself at ten reps through the season, but you have to stay with the program to keep that up.

[theskiwizard]

Just be careful when you perform the exercises Harald describes that you do not arch your back to lift your leg. Your back should remain in a neutral position (ie not arched or bent) suck your belly button to your spine to pre- recruit core to stabilize your back, then lift you leg. Back should remain in same neutral position and not arch. IF it arches then you will be over utilizing your back extensors and possibly stressing your lumbar joints and discs. Don't progress to more advanced levels of this exercise until you can perform all reps without leveraging off your back (ie back arching).

Maria

[h.harb]

Yes, the legs should hang and drop from the hips and your pelvis should be supported by the chair. Pull up with your buttocks, glutes, not your lower back. This does not arch the back in a bad way.

[stikki987]

Have they ruled out anterior pelvic tilt? Tight hamstrings are usually the result of this. If the quads, hip flexors, and adductors are overactive the pelvis is pulled down in the front and raises in the back thus yanking hard on the hamstrings. In addition to this the femur is internally rotated (overactive/tight adductors) and the glutes are most likely inhibited.

If this is your case you need to: strengthen/activate the glutes and abs (but not the psoas!), and lengthen the quads (r. femoris)/psoas/adductors.

Also, do not stretch the lower back. The lower back is supposed to be stable and excessive mobility is the cause of a lot of problems and a stems from a substitution for poor mobility through the hips, which are supposed to be mobile.

[h.harb]

Very good post, totally agree, glutes are often the neglected group and the tight short psaos is a big problem. I know this first hand form my bike training experience of a few years ago when I had my seat too far dropped forward. The leg lift exercise addresses this problem as it engages the glutes while stretching the psoais.

Anterior pelvic tilt and internal rotation of the femurs, active adductors, are a deadly combination and often knocked kneed stance skiers demonstrate this problem. Over time this can cause overuse injuries.

Note: the highly espoused and defended technique of ?Leg Steering?, by the PSIA, Epic group, is a strong contributor and a highly detrimental way of skiing, as it aggravates what we are discussing here. In direct contrast, (remember the little piggy between the knees) notice how PMTS?s kinetic chain approach, with little toe edge tipping first, results in external rotation of the femurs, rather than the opposite produced by leg steering approaches to skiing. Not only keeping you more muscularly balanced, but much more efficient as a skier.

[arothafel]

Yikes....! stikki987 you've described my body to a T! My psoas are part of the issue. What's more is I have a long femur which must add to the issue.

I am curious about not stretching the back. I get the logic, but could you clarify... Don't stretch the back at all or just less focus? What about strengthening type exercises for the lower back (erectors, obliques, etc.) Those should be part of the program... right?

Here's what I know for sure. When I raced I got injured. I think it's because I was "muscling" my way down through the courses. But ultimately I paid the price for poor technical skills (blown out back) and I'd be out for 4-6 weeks.

Since starting with PMTS I don't have near the aggravation / inflammation -- and for the first season in five years I didn't totally blow out my back. I attribute this to better, more efficient technique. And, as I continue the process and get better at the fundamentals of PMTS, I'm sure it will add many more uninjured seasons.

Hell, just the javelin turns, alone, have helped significantly as I continue to learn more about balance and body position.

All of the exercises and drills on this thread are excellent and I've cautiously attempted them all. Thanks to everybody for the help (Maria, Harald, stikki987).

Funny, I started this thread just to warn against thinking a belt would help back issues - or hunched over skiing .... and it's turned into my own personal exercise/training consultation.

(where do I send the consulting fees)?!!

Art

[theskiwizard]

I too agree with the whole cascade of issues that occur with an anterior pelvic tilt! The body is an amazing compensator and typically a lot of patients I see in the clinic have been moving with compensatory patterns/habits for a long time. It takes time and diligence to stretch the tight muscles, strengthen the inhibited muscles to restore appropriate length tension relationships and balance between muscle groups.

Kinda reminds of me of coaching skiing......replacing compensatory movements and patterns with balance and efficient movements ie the Essentials!

Art, your question about stretching the back.......On one level I agree with stikki987 that the lower back needs to be stable and excess mobility can cause problems as this is exactly how most of my patients present. However having never evaluated you I don't know if you have any mobility issues. I would suggest stretching to maintain balance in your mobility but not stretching to excess. Continue to work to strengthen core progressively challenging yourself in less stable environments (ie: adding balance devices to your workouts such as ball, foam rollers etc.)

I also agree with stikki987 and Harald that hip tightness, loss of mobility, and strength imbalances may also be contributing. You actually mentioned that you can lift ~30% more with your hip adductors. This immediately tells me you have an imbalance between the muscle groups. Some difference may be inherently normal (example the hamstrings are typically ~25% weaker than the quads). Might help if you work for more balance by pushing the abductors strength. I would also focus on stretching your hips (see my posted article in coaches section) and Harald's book Ski Flex for suggestions. Focus on gaining external rotation mobility (think of sitting in chair with R foot resting on top of L knee, how far down does your right knee drop? That's hip external rotation) Improved hip external rotation will help your skiing by creating more flexibility for tipping. As you tip beginning with your feet the movement is translated up the chain, if you have tight hips (or you don't flex enough) your tipping may be inhibited.

Good Luck!

[h.harb]

This is excellent advice you are getting here:

Skiwizard presents:

On one level I agree with stikki987 that the lower back needs to be stable and excess mobility can cause problems as this is exactly how most of my patients present.

This is a key to keeping lower back and core heath. Diana had some rib trauma (due to severe coughing attack) a few years ago. The rib was broken and caused painful upper back problems. As a result her upper back became stiff, muscles rigid and spasms were frequent. Orthopedists tired to correct the problem with manipulation and correction for the rib, but they managed to loosen the sacrum.

This just made everything worst, as it made the lower back hyper mobile and as a result it flared up . Lower back mobility is dangerous. Diana to this day is trying to keep her lower back in place.


Keep the muscles around the lower back toned, not by excessive stretching, but by strengthening as stikki987 suggests.

[MonsterMan]

I was thinking about getting a roman chair, (refer page #125 Essentials), to work on impressing Diana next year at Hintertux by working on the "keg" I so fondly remember her admiring and was talking to my wife about what they do at the Gym and she suggested the following using a Swiss Ball.

Lie with say your left hip on the ball, right, (stance), foot on the floor and against a wall. I tried bending the free ski leg to various positions to aid balance. Then do the roman chair style side crunches.

Would someone mind trying this to see if it's working the right muscles ? I've never tried a Roman chair and they cost about $400 here and I'd rather put that towards my next camp.

Thanks

Geoff

[stikki987]

Monster- you mean like this:
http://www.youtube.com/watch?v=ODSOEXem56Q
If so, yes, just another variation. Easier than on a roman chair because your body angle is at 45* versus 90*, but the ball adds an element of unstability.

I posted a thread lower down with a link to site that had a progression for side bends/crunches. Here's the link again:
http://www.elitefts.com/documents/training_the_obliques.htm

[fisherskionsnow]

Great discussion on the back and what imbalance can do to the back and the rest of body. Hypermobility or hypomobility in one part of the body will also effect other parts of the body. So when we stretch the hamstrings we need to be aware of what else are we stretching like the low back or upper back musculature. I see many people doing hamstring stretching exercises, but in reality they are stretching the upper or lower back musculature and the hamstring continue to be tight.

Hip flexor muscles like the Psoas are inserted in the lumbar area, thus when we do situps or do straight legs raises we need to be aware what that particular exercise does to our lower back. It is highly recommend that we stabilize our low back and maintain a neutral position when doing some of these exercises.

I highly recommend Yoga or pilates. Great for flexibility and core strengthening. Plus a great work out.

[arothafel]

I went to the gym today and tried the side crunches on the ball. After I fell off the ball a couple of times, I finally got the hang of it. It really points out weaknesses. Fantastic drill.... but I'm really going to regret it. I'm already sore and it's only been a few hours....

Art