Member Case Study: Lumbar Herniated Discs and Training

author : AMSSM

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A few years ago, I was diagnosed with two lumbar herniated discs (L1-L2). I have started a very slow build towards my first tri. Are there any recommendations or warnings I should heed?

Question from thorazine
I am new to triathlon, having spent a long time on the couch and generally deteriorating. I am 43 years old. I have been active sporadically in the past. A few years ago, I was diagnosed with two lumbar herniated discs (L1-L2), so I spent a further couple of years taking things really easy...but in the last three months I have started a very slow build towards my first tri. It seems that my back is well and strong. I take care, and do some core strength work too. Is this normal, or am I suddenly going to do my back in? I feel that the exercise every day is curing me. Are there any recommendations or warnings I should heed?

Answer from Andy Peterson, MD

Member AMSSM

Thank you for your question. I am glad you have been able to increase your level of physical activity. In fact, your increase in physical activity may be helping to control your back pain. In the past, physicians recommended rest and sometimes even prolonged periods of bed rest for the treatment of low back pain. Studies done in the 1980s and 1990s demonstrated that this was bad advice. An evidence-based review written in 2000 and updated in 2004 looked at all of the well-done studies on low back pain and physical activity. It concluded that for people with acute low back pain, advice to rest in bed is less effective than advice to stay active.(1)

There are things you can do to improve your chances of successfully training for and completing triathlons. First, continue to work on your core strength. Being able to stabilize your spine with your muscles protects it from small injuries that can cause big pain. Core strength doesn’t just mean doing sit-ups. It is important to engage the deep core muscles such as the transverses abdominus. If you don’t know how to do this, I would recommend working with a spine physical therapist or a certified personal trainer. They would be able to teach you some basic movements or work with you to design a progressive core-strengthening program.

Second, take a close look at your position on the bike. Triathletes (including me) like to ride in very steep, aerodynamic positions that require a lot of hamstring and low back flexibility. However, patients with lumbar disc disease often have worsening of their symptoms with forward flexion of the low back. The popular aerodynamic position may not be right for you and may worsen your back pain. If you are unfamiliar with the principles of bicycle fitting, most high-quality bicycle dealers have specialists in their shop that can help you. Make sure you discuss your back issues with your fitter.

Third, don’t rush your training or advance too quickly. This piece of advice is not specific to your back, but is intended to help prevent overuse injuries of all types. It is most important for running where the jarring forces of ground impact can do damage to your bones, ligaments, and tendons if your body is not conditioned for it. A general guideline is to not increase your running mileage by more than 5-10% per week.

Fourth, if your back pain does return, don’t despair. A short period of relative rest and spine physical therapy can usually help you return to the sport quickly and safely.

Patients commonly ask about surgery for the treatment of lumbar disc disease. In general, surgery is saved for a last resort when treating low back pain. This is because we are not entirely sure that it works any better than rehabilitation. A large study called the SPORT trial recently tried to answer the question. Unfortunately, even though the study was very large, it was unclear if surgery was superior to usual non-operative care for the treatment of lumbar disc disease. However, in one branch of the study, patients got to choose between having surgery and not having surgery. Those that chose surgery did have better outcomes than those who did not choose surgery. The most important message from the study, however, was that patients in both groups had significant improvement in their symptoms with either rehabilitation or surgery.(2, 3)

There are a few things to worry about with lumbar disc disease. If you develop numbness, tingling, weakness, or shooting pains in your legs, you should be reevaluated by your physician. If you begin having trouble with bowel or bladder incontinence or if you develop numbness and tingling around your anus or groin, you should seek medical attention immediately as these can be the first signs of a serious problem called cauda equina syndrome.

Overall, the most important thing to remember when starting triathlon training is to have fun and enjoy the benefits of becoming more physically fit.

Andy Peterson, MD
Sports Medicine and NRSA Research Fellow
University of Wisconsin
 

References
1. Hagen Kb Fau - Hilde G, Hilde G Fau - Jamtvedt G, Jamtvedt G Fau - Winnem M, Winnem M. Bed rest for acute low-back pain and sciatica. (1469-493X (Electronic)).
 
2. Weinstein Jn Fau - Lurie JD, Lurie Jd Fau - Tosteson TD, Tosteson Td Fau - Skinner JS, Skinner Js Fau - Hanscom B, Hanscom B Fau - Tosteson ANA, Tosteson An Fau - Herkowitz H, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. (1538-3598 (Electronic)).
 
3. Weinstein Jn Fau - Tosteson TD, Tosteson Td Fau - Lurie JD, Lurie Jd Fau - Tosteson ANA, Tosteson An Fau - Hanscom B, Hanscom B Fau - Skinner JS, Skinner Js Fau - Abdu WA, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. (1538-3598 (Electronic)).

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date: April 14, 2008