TRAINING DOCTOR’S ORDERS

the office. There are three its sufferers are those peo- When to Worry main categories of back ple you see walking around pain that befall the triath- bent over, resembling a about Back Pain lete and runner: muscular, human comma. bone-related and disco- The good news about genic back pain. muscular back pain is that it Jordan D. Metzl, MD Muscular back pain is is almost always quickly the most common type of reversible, and if someone back pain, and involves the has had it once, good pre- ave, a triathlete, walks into the office acute onset of pain along vention can keep it from saying, “Doc, here’s the deal. I have the sides of the spine. The coming back. Treating mus- Dbeen out riding this spring and my train- paraspinous muscles, also cular back pain initially ing was going well. In the past few weeks, known as the erector involves ice to control the however, my back has been killing me. I’m spinae muscle group, are muscle pain, as well as the really having trouble doing anything; the past strong muscles on either side of the spine that use of an anti-inflammatory medicine and a couple of weeks have been terrible. You real- are responsible for moving, twisting and bend- quick visit to a good massage or physical ther- ly need to fix me!” he implores. ing the spine. These muscles run from the apist to try and stop the spasm in the muscles. Wow, I really need to help this guy, I think. back of the hip, along the spine, all the way Some patients swear by acupuncture, which But before I can do that I need a little more to the bottom of the skull, and are among the can also be helpful in the setting of an acute information. “How did it start?” I ask. “And strongest muscles in the body. muscle spasm. can you describe the pain in more detail?” So what happens with muscular back pain? Once the initial pain has been reduced, the He tells me, “Doc, the pain came on all of In general, the muscles are either too tight, real work begins: fixing the cause of the mus- a sudden. One day I was training, no prob- not strong enough, or both. Muscular back cle pain. This can include low back and ham- lem. The next day, I had this terrible pain in pain is characterized by an almost immediate string stretching and core muscle strength- my back. In the past few days, it has also start- onset, often when the athlete twists sudden- ening. The most effective core strength ed to shoot down my leg. Did I slip a disc?” ly and feels a tear along the side of the spine. program is through the Pilates method, a sys- Back pain is a very common complaint in Acute muscular back pain is quite severe; often tem of exercises that emphasize core muscle

128 MAY 2005 WWW.TRIATHLETEMAG.COM TRAINING DOCTOR’S ORDERS

strength. It’s best to pursue your Pilates pro- pain, good core muscle support can fix most have symptoms from them. A study of 100 gram under the guidance of an instructor, as of the symptoms of bone-related back pain. people without back pain in their 40s and 50s proper technique is important, but some of Discogenic back pain, otherwise known as found that roughly 30 percent had evidence of the videos that present Pilates workouts are a slipped disc, is the third cause of back pain. disc herniation on MRI. The key to recog- helpful as well. The intervertebral discs, made of cartilage, nizing a symptomatic disc, therefore, is usu- Poor bike setup is also a common cause of are built like marshmallows that sit between ally the presence of nerve symptoms includ- muscular back pain. When triathletes don’t the vertebrae. When a patient “slips” a disc, it ing pain shooting down the leg. fit properly on their bikes, they may find them- means that part of the lining of the disc is torn, So what about Dave? He had a small lum- selves in a position that puts excessive stress and the disc material inside bulges out, pinch- bar disc herniation, which, I learned, had giv- on the low back. If muscular back pain is ing the nerves from the spinal cord that sit en him trouble a couple of times previously. the diagnosis, a bike fit can sometimes fix the just behind. Different than muscular back He was started on an anti-inflammatory med- problem. pain, which hurts on the side, and bone-relat- icine, sent to physical therapy and an MRI What about bone-related back pain? Not ed back pain, which hurts in the middle, disco- was obtained, which showed a small disc her- nearly as common as muscular back pain, this genic back most often shoots pain down the niation in his lumbar spine. He kept his fit- type of back pain results from a problem inside leg, since it is pinching on the nerve. ness through swimming and weightlifting and the bone structure of the spine called the Discogenic back pain often takes several he strengthened his muscles with Pilates and vertebrae. Most commonly the problem is weeks to cure, and usually involves medica- physical therapy. After one month he was 75- arthritis in the spine. It is characterized by tion, an MRI to evaluate the size of the disc percent recovered, and by six weeks he was a gradual onset beginning with a dull ache, herniation and sometimes an injection of cor- moving full speed ahead. If he continues to which becomes progressively worse over tisone. Surgery is rarely necessary. Physical do his preventive strengthening and stretch- many months. therapy is a must for patients with discogenic ing exercises, chances are I’ll only to see him Other forms of bone-related back pain back pain, both to reduce the acute muscular on the road, not in my office. s include a stress fracture called spondylolysis, pain that often accompanies this problem and as well as a slip in the spine called a spondy- also to try and provide more muscular stabil- Jordan D. Metzl, MD, is a nationally recog- lolithesis. With all causes of bone-related back ity in the spine. nized sports medicine specialist at Hospital for Spe- pain, an X-ray and proper diagnosis is the first Of note there are many more people walk- cial Surgery in New York City. In addition to his step towards understanding and fixing the ing around with asymptomatic bulging and medical practice, Dr. Metzl is a 25-time marathon problem. As is the case with muscular back herniated discs than there are people who runner and three-time Ironman finisher.

130 JUNE 2005 WWW.TRIATHLETEMAG.COM