Acute Back Pain Treatment Benefits
History:
A professional racing cyclist presented with low back pain after finishing stage two of a 17-day stage race. Earlier in the stage, the cyclist crashed into a concrete barricade while attempting to maneuver around a crash in the peloton (group of cyclists). The cyclist collided with another bike and was thrown into the barricade. He struck the barricade with his low back first, mostly on the right side, hyperextended over the barricade and fell onto his knees. Initial evaluation after the stage revealed a large hematoma forming on the athlete’s right paraspinal muscles at the level of the 4th lumbar vertebra, which was roughly 5 cm in diameter. After a 30-minute bus ride, he could barely stand to exit the bus. Upon re-evaluation of his condition, the hematoma remained the same size. The athlete had a difficult time sitting and lying on his back, as well as getting into any position that would assist in making a quality diagnosis.
A professional racing cyclist presented with low back pain after finishing stage two of a 17-day stage race. Earlier in the stage, the cyclist crashed into a concrete barricade while attempting to maneuver around a crash in the peloton (group of cyclists). The cyclist collided with another bike and was thrown into the barricade. He struck the barricade with his low back first, mostly on the right side, hyperextended over the barricade and fell onto his knees. Initial evaluation after the stage revealed a large hematoma forming on the athlete’s right paraspinal muscles at the level of the 4th lumbar vertebra, which was roughly 5 cm in diameter. After a 30-minute bus ride, he could barely stand to exit the bus. Upon re-evaluation of his condition, the hematoma remained the same size. The athlete had a difficult time sitting and lying on his back, as well as getting into any position that would assist in making a quality diagnosis.
Limited ROM/Pain
Every range of motion in the lumbar spine was limited and was accompanied by pain. In a side lying position, the iliac compression test was performed as well as a modified straight leg raise. Both were positive. Upon palpation of the lumbar spinous processes, there was tenderness at levels L3, L4, and L5. At this time, the athlete was referred for X-rays of the lumbar spine and pelvis. The X-rays were negative for any fracture, but showed a significant amount of soft tissue swelling in the lumbar and sacral regions.
Every range of motion in the lumbar spine was limited and was accompanied by pain. In a side lying position, the iliac compression test was performed as well as a modified straight leg raise. Both were positive. Upon palpation of the lumbar spinous processes, there was tenderness at levels L3, L4, and L5. At this time, the athlete was referred for X-rays of the lumbar spine and pelvis. The X-rays were negative for any fracture, but showed a significant amount of soft tissue swelling in the lumbar and sacral regions.
Treatment:
The athlete’s lower extremities and low back were massaged for 90 minutes in an attempt to break up forming adhesions. Afterwards, noticeable swelling remained in the lower lumbar region, specifically in the right flank region around the iliac crest. The athlete was informed of the Graston Technique® (GT) and how it would promote healing in his low back. GT2 was used to assist in edema removal by gently gliding over the visual hematoma from the iliac crest up the right paraspinal to the min-thoracic level. A moderate fluid wave was caught numerous times during the gliding strokes. After approximately a dozen strokes, GT4 was used with a fanning stroke along the right flank to assist in the removal of edema. Overall, the hematoma was reduced by 50 percent. The athlete was instructed to ice for 20 minutes every hour for the rest of the day and he received laser treatments in-between ice applications.
The athlete’s lower extremities and low back were massaged for 90 minutes in an attempt to break up forming adhesions. Afterwards, noticeable swelling remained in the lower lumbar region, specifically in the right flank region around the iliac crest. The athlete was informed of the Graston Technique® (GT) and how it would promote healing in his low back. GT2 was used to assist in edema removal by gently gliding over the visual hematoma from the iliac crest up the right paraspinal to the min-thoracic level. A moderate fluid wave was caught numerous times during the gliding strokes. After approximately a dozen strokes, GT4 was used with a fanning stroke along the right flank to assist in the removal of edema. Overall, the hematoma was reduced by 50 percent. The athlete was instructed to ice for 20 minutes every hour for the rest of the day and he received laser treatments in-between ice applications.
Inflammation Subsides
The athlete was in considerable pain the next day, but rode and finished the stage. The inflammation in the lumbar region was considerably less and he was able to walk without an antalgic gait. The cyclist was having a difficult time flexing at the waist, as well as laterally flexing to the right. He had no radiating pain into his extremities, but moderate pain in the lumbar region.
GT4 was used in a static mode to scan the right and left flank areas, focusing specifically on the thoracolumbar fascia and latissimus dorsi origin. GT3 was used around the hematoma to continue breaking down the adhesive tissues forming in the area. After treatment, the athlete was able to flex at the waist and almost touch his toes. The next day, the cyclist was in pain and barely finished the stage. He attributed the pain and soreness to too much treatment the previous day. (The previous stage was a very hard climbing stage as well.) At his request, we did not treat him. The cyclist received roughly 90 minutes of massage therapy and ice treatments and called it a day. The next day, he raced and felt more comfortable on the bike, but complained of moderate to severe amounts of pain in his lower back when in the saddle and even more when he stood up to climb or gain extra speed.
The athlete was in considerable pain the next day, but rode and finished the stage. The inflammation in the lumbar region was considerably less and he was able to walk without an antalgic gait. The cyclist was having a difficult time flexing at the waist, as well as laterally flexing to the right. He had no radiating pain into his extremities, but moderate pain in the lumbar region.
GT4 was used in a static mode to scan the right and left flank areas, focusing specifically on the thoracolumbar fascia and latissimus dorsi origin. GT3 was used around the hematoma to continue breaking down the adhesive tissues forming in the area. After treatment, the athlete was able to flex at the waist and almost touch his toes. The next day, the cyclist was in pain and barely finished the stage. He attributed the pain and soreness to too much treatment the previous day. (The previous stage was a very hard climbing stage as well.) At his request, we did not treat him. The cyclist received roughly 90 minutes of massage therapy and ice treatments and called it a day. The next day, he raced and felt more comfortable on the bike, but complained of moderate to severe amounts of pain in his lower back when in the saddle and even more when he stood up to climb or gain extra speed.
Static/Slowly Flexing Treatment:
We continued GT treatments after this stage by scanning the area with GT4 in a static position, then slowly having the athlete flex at the waist with the transverse abdominus (TA) activated. A fanning stroke was used in a superior and lateral motion with GT4 along the fibers of the latissimus dorsi while the athlete laterally flexed and rotated to the left. Significant fascial restrictions were felt throughout the posterior compartment. Upon completion of this treatment, the cyclist had improved range of motion in flexion and lateral flexion at the waist, as well as decreased pain. The next day, the cyclist felt improvement, but still complained of soreness in his lower back while on the
bike. He finished in the middle of the peloton and was pleased with his ongoing recovery. He said a fall like the one he had after the start of the race would usually have removed him from the race for its entirety. We continued the same treatments, but added GT3 and GT6 in a more specific nature on the origin of the lats at the iliac crest and the iliocostalis muscles where these areas were quite defined on him. (This is a common characteristic in elite cyclists because these muscles are used in and out of the saddle to stabilize the sacrum and pelvic structure.) During the next few stages, it seemed as though we were reaching a plateau. The athlete was continuing to have a moderate amount of soreness in his low back, but more than anything, he was not getting the power output he normally had. He was also complaining of a specific spot in his lower back that we later pin pointed to be just below the origin of the hematoma. This spot was just above the base of the sacrum at the level of the right mammillary process of L5. After stage 10, we treated the cyclist on his bike aboard rollers. The next day was an off day for the event so it was a perfect opportunity to try a new technique. The cyclist armed up for 10 minutes at a power output of 100 watts (computer-aided device). We scanned the thoracolumbar fascia with GT4 and evaluated how his muscle system responded. The cyclist increased his output to 200W and held for four 2-minute bursts. During these bursts, we treated at the base of the sacrum, mostly on the right side with GT3 and GT6.
We continued GT treatments after this stage by scanning the area with GT4 in a static position, then slowly having the athlete flex at the waist with the transverse abdominus (TA) activated. A fanning stroke was used in a superior and lateral motion with GT4 along the fibers of the latissimus dorsi while the athlete laterally flexed and rotated to the left. Significant fascial restrictions were felt throughout the posterior compartment. Upon completion of this treatment, the cyclist had improved range of motion in flexion and lateral flexion at the waist, as well as decreased pain. The next day, the cyclist felt improvement, but still complained of soreness in his lower back while on the
bike. He finished in the middle of the peloton and was pleased with his ongoing recovery. He said a fall like the one he had after the start of the race would usually have removed him from the race for its entirety. We continued the same treatments, but added GT3 and GT6 in a more specific nature on the origin of the lats at the iliac crest and the iliocostalis muscles where these areas were quite defined on him. (This is a common characteristic in elite cyclists because these muscles are used in and out of the saddle to stabilize the sacrum and pelvic structure.) During the next few stages, it seemed as though we were reaching a plateau. The athlete was continuing to have a moderate amount of soreness in his low back, but more than anything, he was not getting the power output he normally had. He was also complaining of a specific spot in his lower back that we later pin pointed to be just below the origin of the hematoma. This spot was just above the base of the sacrum at the level of the right mammillary process of L5. After stage 10, we treated the cyclist on his bike aboard rollers. The next day was an off day for the event so it was a perfect opportunity to try a new technique. The cyclist armed up for 10 minutes at a power output of 100 watts (computer-aided device). We scanned the thoracolumbar fascia with GT4 and evaluated how his muscle system responded. The cyclist increased his output to 200W and held for four 2-minute bursts. During these bursts, we treated at the base of the sacrum, mostly on the right side with GT3 and GT6.
Cyclist Stronger
Finally, we had the cyclist come out of the saddle and hold for 2-minute bursts at an output of 250 W. We again treated the specific area the cyclist was complaining of, as well as into the paraspinals of the lumbar spine. The next day, the cyclist did a light 2-hour ride and felt he had more power in his train. No treatment was performed on this day. At stage 11, the cyclist felt even stronger in his race, but was hindered by several flat tires. After this stage, he received another treatment, but the intensity and duration were decreased.
Finally, we had the cyclist come out of the saddle and hold for 2-minute bursts at an output of 250 W. We again treated the specific area the cyclist was complaining of, as well as into the paraspinals of the lumbar spine. The next day, the cyclist did a light 2-hour ride and felt he had more power in his train. No treatment was performed on this day. At stage 11, the cyclist felt even stronger in his race, but was hindered by several flat tires. After this stage, he received another treatment, but the intensity and duration were decreased.
Result:
Stage 12 deemed to be the time where everything came together for the cyclist. He was ahead for most of the stage, but fell back at the very end, finishing fourth. The cyclist continued to ride strong through the last four stages and complained of minimal pain in the affected area. Continued treatments were done with the cyclist on his rollers and again the treatments were modified to reflect how the athlete was feeling after the respected stage. One month later in a prestigious stage race in China, the cyclist complained of no pain in his low back, only soreness after the big climbing stages. The
cyclist ended up winning the overall race and another major race back in the states a few weeks later. This is a classic example of learning how to listen to an athlete’s body and knowing when is too much and when is not enough. Most importantly, after fascial restrictions are removed with GT and proper remodeling of tissues are completed, it is amazing what the human body can do.
Stage 12 deemed to be the time where everything came together for the cyclist. He was ahead for most of the stage, but fell back at the very end, finishing fourth. The cyclist continued to ride strong through the last four stages and complained of minimal pain in the affected area. Continued treatments were done with the cyclist on his rollers and again the treatments were modified to reflect how the athlete was feeling after the respected stage. One month later in a prestigious stage race in China, the cyclist complained of no pain in his low back, only soreness after the big climbing stages. The
cyclist ended up winning the overall race and another major race back in the states a few weeks later. This is a classic example of learning how to listen to an athlete’s body and knowing when is too much and when is not enough. Most importantly, after fascial restrictions are removed with GT and proper remodeling of tissues are completed, it is amazing what the human body can do.
By Vince Scheffler, DC, CCSP, CSCS, Reagan ChiroSport Center, Plano, TX
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