Back Injury During Peak Iron Distance Training

author : AMSSM

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I strained by lower back last week. I know that I need to rest in order for it to heal fully, but I am concerned that I am going to lose needed fitness for the race. Will this affect my performance?

Member Question

I am four weeks away from my first iron distance race. I did not have any specific time goals other than to finish (but 13 hrs or less would be nice). This will be my 4th season doing tris. I have two halfs and ten sprint/Olympic distance races under my belt. 

Unfortunately I strained my lower back last week. After seven days of no training and pain, I found myself at the doctor with some muscle relaxers and a lot of stretching. I woke up yesterday feeling a lot better. I took advantage with an hour swim before work and an evening one hour bike ride on the trainer followed by a two mile run. I woke up this morning to my lower back in pain again. 

I know that I need to rest in order for it to heal fully, but I am concerned that I am going to lose needed fitness for the race.  Will this affect my performance?

Answer by Kyle Goerl, MD
Member AMSSM

Back pain is one of the most common reason adults seek medical care, and athletes are not spared this affliction. The majority of adults will experience back pain/injury in their lifetime. Typically, the first injury is usually between ages 20 and 40. Muscles strains of the lower back are common back injuries in athletes. Generally, the pain is felt in the musculature to the side of the spine, and it hurts with movements like back flexion and rotation. This kind of injury almost always gets better with time. Athletes should be aware of more concerning symptoms, though, that would require immediate attention. These include pain down the leg, weakness or numbness in the legs, bone pain, or fever. Symptoms like these may indicate a more serious medical issue.

Athletes with a back strain often describe the injury occurring during a bending, twisting or lifting movement. It is also possible to injure the back with repetitive movements, such as weight lifting. The pain may present immediately, or it may present the next day, such as when the athlete is getting up out of bed.

The back is critical for functional movement in the body. Injury to the back can significantly affect an athlete’s performance, as core strength and stability is important for optimal athletic performance, so prompt and effective treatment is critical for return to sport. Immediate treatment includes medications for pain control (ie, ibuprofen or acetaminophen), muscle relaxers, ice, and heat. Rest would be advised against, as this generally leads to increased pain and stiffness, and prolonged recovery. That being said, a gradual return to activity would be recommended. Certainly, we want athletes to get back to activity as soon as possible, but going from limited activity one day to heavy activity the next would not be recommended, and it may lead to a prolonged recovery.

Starting with one modality, likely swimming or biking, at a lower threshold to begin with, and subsequently adding in other exercises over the course of 1-2 weeks would be supported. Running may be too much pounding to be tolerated initially, so maintaining fitness by doing increased work via swimming or biking is likely a better option. These recommendations can be generally applied to many muscle injuries that occur in an athletic population, and the aim is to perform these activities within the limits of pain.

Ultimately, we want athletes to avoid future injury or prolonged recovery in order to stay active and competitive. In order to help prevent future injury, meeting with a Physical Therapist to learn an exercise regimen designed to enhance core strength and stability to protect the back would be highly recommended.

Kyle Goerl, MD

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date: March 12, 2014