Back on Track

Coping with that oh-so-troubling lumbar region

If it hasn't hit you yet, it probably will. Lower-back blowout will sneak up and humble you, along with some 80 percent of your fellow beings, at least once in your life. The onset will be inglorious: lifting groceries out of the car; roughhousing with a kid; stooping over a derailleur. One day you're active, the next you can scarcely tie your shoes.

Only the common cold prompts more doctor visits than back pain, but given the thinness of some cures, all that experience hasn't netted much. Causal relationships tend to be fuzzy, and the likeliest prescription you'll get is to simply wait. "You have an 85 percent chance of getting better in the first two weeks," says Dr. William Dillin, an orthopedic surgeon at the Kerlan-Jobe Orthopedic Clinic in Los Angeles. "Why try to prove or disprove the exact nature of pain if the progress will be the same?"

But if you really want specifics, acute back pain typically originates in the lumbar region of the spine, where five hardworking vertebrae bear most of the weight of our sitting and standing lives. Because this latticework of bone, cartilage, muscle, nerve roots, and such is responsible for so much, it's particularly susceptible to harm. Unless you have a spinal tumor, infection, or fracture, an out-of-whack lumbar will cause one of two distinct kinds of pain.

Localized pain stems from a mechanical problem, commonly the result of an acute injury to the lower back; you've done something to it. When you strain, tear, or otherwise damage your back muscles, they become inflamed, swell, and push on the surrounding tissue, causing pain. The muscles can even go into spasm, lock up, and restrict mobility of the spine.

The other form of pain — sciatica — is much more insidious. Though it can erupt from injury, the direct cause is the pinching of one or more nerve roots, usually because a disk between two vertebrae gets torn, inflamed, or herniated. Sciatica can also be chronic, perhaps the result of a degenerating disk, a bone chip, or some other recurring pressure on a nerve root. Either way, pain shoots down the back, along the outer side of the thigh, and down to the foot. You may or may not experience localized pain with sciatica.

Happily, whichever type of acute pain you have, treatment is the same. The pain may subside on its own within a couple weeks, but in the meantime we've provided the basics of how to respond if your back flattens you. You can speed recovery. Likewise, you can do a lot by way of prevention within your normal fitness routine. And if you're craving a graphic snapshot of your aching back, consider the upshot of one set of studies in which adults with no back pain were examined using magnetic resonance imaging: Virtually all had bulging disks. So really, the imperfect back is the normal back.

Where To Turn When Pain Persists

Options

 

When you are being consumed by the iron jaws of back pain, it's easy to forget what your lovely, ache-free days were like — and that there are methods of relief. Here are a few common ones.

Traditional Medicine

Medical doctors used to wildly overreact to back pain, throwing drugs and surgery at the mystery, until the federal Agency for Health Care Policy and Research issued new clinical treatment guidelines in 1994. "The era of routine radiography, strict bed rest, corsets, and traction has passed," says Dr. Richard A. Deyo, a member of the AHCPR panel. "It's been replaced by early return to normal activity and greater emphasis on exercise to prevent recurrences or to treat chronic pain." Now your family practitioner is more likely to send you for some ibuprofen and to look at epidural cortisone injections or surgery only as last resorts.

Chiropractic

Gone are the days when your HMO balked at covering chiropractic bills. The AHCPR also endorses manipulation as a safe and effective form of back pain treatment, largely stifling those accusations of quackery that dogged chiropractors in the past.

"Compression equals back pain," explains chiropractor Leroy Perry, president of the International Sports Medicine Institute. By twisting, pushing, or pulling the spine, a chiropractor relieves compression, thus increasing mobility. Long a satisfying avenue for a majority of lower-back pain sufferers, chiropractic certainly has allure — instant relief — over the ibuprofen approach.

Osteopathic Medicine

It's a helpful oversimplification to think of osteopathic physicians as a cross between chiropractors and medical doctors. An osteopath will crack your back just like a chiropractor, but D.O.'s also enjoy the same legal status as medical doctors, meaning they can diagnose and treat illness, employ medical technology, prescribe medications, and perform surgery. However, the osteopathic approach tends toward the noninvasive: They prefer to lay hands on the musculoskeletal system, help to improve posture, and prescribe prevention by exercise. For osteopaths, tugging on the spine is only the starting point for curing what ails you, whereas it's the raison d'Štre for chiropractors.

Acupuncture

Widely accepted for treating chronic symptoms, acupuncture can also alleviate acute back problems. "If you walk into an acupuncturist's office with low-back pain, there's a good chance that you'll feel better in the next 24 hours," says Whitfield Reaves, cofounder of the National Sports Acupuncture Association. In Eastern terms, acupuncture releases blocked energy (qi, pronounced "chee") that should flow freely through so-called meridians in the body, thereby restoring homeostasis. If you must look at it from a Western point of view, studies suggest that needling certain points on the body boosts the production of endorphins, those feel-good hormones familiar to athletes of any bent.

 

Fighting Back

Prescriptions

Though the definitive root of your back pain may be murky, your immediate course of action is clear.

Back off strenuous activity, but stay mobile. Trying to override the pain by ignoring it won't do any good, but neither will spending a week in bed. If you let your pain be your guide — do what you're able to do without making it hurt — you won't feel so stiff. Get up and move around, even if it's difficult. Perform a few exercises. If you are incapacitated, stay in the sack, but for no more than 24 to 48 hours.

Apply ice and heat. Ice is particularly therapeutic for acute spasms and inflammation. When your back goes, ice it immediately and follow up two to three times a day for the first several days — more often if you need it. (A bag of frozen peas works great, because it conforms to your body.) After 72 hours, if the pain persists, you might try contrast therapy, in which you apply ice for ten minutes and then take a hot bath with Epsom salts or apply a hot pack.

Take mild pain relievers. Aspirin and nonsteroidal anti-inflammatory drugs, such as ibuprofen, will help reduce inflammation and thus pain. If it persists without improvement for a week, seek help.

Stretching and Strengthening to Keep Your Lumbar in Line

Regimens

Injury or no, enhancing the mobility of the spine with stretching is a good thing. And when the acute agony of lower-back pain passes, strengthening the postural muscles, which run along either side of the spine between the shoulder blades, will help prevent a recurrence. We're not talking the old toe-touch here, perhaps the most widely known and worst exercise for any back. Rather, this is a combination of moves culled from several disciplines. Be sure to combine these exercises with crunches — squeezing a pillow between your thighs makes the standard technique work that much better — to strengthen your abdominals. Indeed, your abs serve as the body's built-in corset, maintaining stability in the lower back.

Pelvic Tilt
Restores mobility in the lumbar spine

Lie on your back, knees bent, feet flat on the floor, and arms at your sides. Keeping your legs relaxed, tighten your lower abdominal muscles to press the small of your back into the floor, as if you're crushing a grape. Then arch the small of your back.

Knee-hugger
Stretches lower-back and gluteal muscles

Assume the pelvic tilt position, holding the phase when the small of your back is pressed into the floor. Keeping back and legs relaxed, hug both knees to your chest, pulling them to your armpits. Hold for a ten-count.

Horse Stance
Strengthens back extensors and postural muscles

Start on all fours and, keeping your back flat, extend your left arm and hold it slightly to the side, with your thumb pointing toward the ceiling. Now raise your right leg; hold each limb parallel with the floor for ten seconds. Alternate sides to complete one rep. To advance, "draw" the alphabet in 12-inch-high letters with your raised foot.

Heel-Hand Rock
Stretches lumbar muscles, increasing range of motion

Start with what's known in yoga as the cobra position: Lie on your stomach, toes pointed and hands on the floor alongside your chest. Press your torso up until your arms are straight, keeping your pelvis on the floor. Now roll your shoulder blades down and raise the crown of your head toward the ceiling, elongating your spine. Keeping your hands planted, go onto your knees, lift your hips, and rock back onto your heels until your butt rests over them; you end up prostrate with your head down. Finally, uncoil back into the cobra and repeat.

Million-Dollar Hamstring Stretch
Stretches hips, hamstrings, and back

Sit on the floor with one leg extended in front of you, the other bent with your foot flat on the floor. Rest your chin on your bent knee, grasp the arch of that foot with your hands, and slide your heel along the floor until you feel that slight twinge of muscle discomfort that indicates a good stretch. Then, while you are holding the stretch for six seconds, rotate your straight leg inward, which improves the mobility of your nerves, allowing you to stretch even further. Now switch legs and repeat the whole routine.


TRIAGE
You'll want to take a different tack with your back when you're hurting, but don't stop exercising altogether-no matter what the temptation. In the midst of a painful flare-up, adopt the following therapy routine using the exercises laid out on this page, and be sure to forgo anything that inflicts more pain.

Therapy
Do a set of 20 pelvic tilts several times a day, especially after a period of inactivity.
Prevention
Do 15 pelvic tilts, holding the up position for five seconds, interspersed with sets of 30 crunches.

Therapy
Do three repetitions of knee-huggers; increase to ten reps as you're able.
Prevention
Do a set of five knee-huggers, holding the position for 30 seconds.

Therapy
Segment the heel-hand rock, doing the cobra and rock-back portions independently, five reps each. Your cobra may not get far off the floor at first.
Prevention
Do ten reps minimum of the heel-hand rock.

Therapy
Do five reps of the horse stance one limb at a time, holding each for five counts. As your condition improves, extend opposite limbs simultaneously.
Prevention
Do ten reps of the horse stance, holding the pose for up to a count of ten. Then, if you can draw the entire alphabet with each foot, you're doing well.

Therapy
Take a rain check on the million-dollar hamstring stretch until the pain subsides.
Prevention
Do six to ten reps of the million-dollar ham- string stretch. Repeat set with opposite leg.

Marathon Training on a New Yorker's Schedule

Routines

The party line of the new York Road Runners Club is that you should adopt a 16-week program — minimum — to prepare for November's New York Marathon. Who are they kidding? If, like most of us, you've yet to plan your next weekend, don't despair: Any reasonably fit runner can achieve respectable marathoning shape on a much more realistic schedule. "If your training buddy bet you the farm that in ten weeks you couldn't complete a marathon, try this program," says NYRRC program director Shelly-lynn Florence (right), helpfully hedging her club's official stance. "With any luck, you'll own the farm."

Here's how: Each week you'll go short on Wednesday and Sunday, middle-distance on Tuesday and Thursday, long-distance on Saturday, and take Monday and Friday off. Run at 70 percent of your maximum heart rate except on Saturdays, when you'll reduce your pace slightly. Stick to the plan, and by race day you'll be harvesting miles with the best of them.

WEEK ONE: 20 MILES
Do two-milers on the short days, four-milers on the medium days, and an eight-miler Saturday. Use the talk test to gauge your pace: At 70 percent, you should be able to chat normally — even if it's to yourself.

WEEK TWO: 22 MILES
Repeat last week, except run ten miles Saturday, and try to minimize heat, hills, and headwinds. Says Florence, "Those factors make your heart rate soar and your legs falter."

WEEK THREE: 24 MILES
Bump the distance run to 12 miles, and sometime on Monday you'll become acquainted with delayed-onset muscle soreness, which has the nasty habit of peaking 48 hours after a big effort. Stretching and ibuprofen will provide some relief, but time is the true painkiller.

WEEK FOUR: 26 MILES
Tack two more miles onto Saturday. You'll need plenty of energy, so start chowing three hours beforehand; as always, carbohydrates should comprise 60 percent of your intake. During the run, stuff down energy bars or gels every hour and eight ounces of carbo drink every 20 minutes.

WEEK FIVE: 29 MILES
Increase Thursday's run to five miles and Saturday's to 16. At this distance, Florence suggests using a skin lubricant, such as Body Glide, to prevent blisters and chafing. Wear broken-in running shoes, and opt for synthetic-blend socks over cotton, which keep your feet clammy.

WEEK SIX: 30 MILES
Dial Thursday back to four miles, and do 18 miles Saturday. Avoid rubbing your skin raw by wearing proper clothing: loose waistbands, shorts without inside seams, and CoolMax tops. "The last thing you want on a long run is to be tired and uncomfortable," says Florence.

WEEK SEVEN: 30 MILES
Run four miles Tuesday, five on Wednesday, and four on Thursday. Then on Saturday, replace your distance run with a half-marathon race. Start at your usual long-distance pace, and if you're feeling spunky midway, kick it up to 70 percent. Sunday, do a slow four-mile run to recover.

WEEK EIGHT: 34 MILES
Now's the time for your longest pre-marathon run — 20 miles — so drop Wednesday to four miles and Sunday to two. Don't psych yourself out at the long distance, just run at your normal pace.

WEEK NINE: 20 MILES
Start tapering to ensure that your legs will be fresh for the big day. Put in two miles on the short days, three miles on middle-distance days, and a mere ten-miler on Saturday. Use the extra time to relax — with a book, not a bike.

WEEK TEN: 33.2 MILES
Assuming you race Sunday, do three miles Tuesday, two miles Wednesday and Friday, but skip Thursday. Three days before the race, boost your carbohydrate intake to 70 percent of your diet. Come Sunday, start at the pace you used in week eight's 20-miler, and ratchet it up from there. After all, you didn't take on this routine to walk 26.2 miles.


A Quad Stretch You Won't Soon Forget

Standards

Speed skaters can't afford to have their quadriceps cramping when they're careening around icy turns, which is why the brutal quad-pull stretch has been such a favorite among the speed skating set. "It's the best stretch for the big muscles in front of the thigh, and if you make small changes in your position you can also get to other minor muscles," says Gerard Kemkers, coach of the U.S. National Speed Skating Team.

After a five-minute aerobic warm-up, kneel on your right knee with your left foot on the floor in front of you and that knee bent at 90 degrees — like Reggie White resting on the sidelines. Hold a chair with your left hand for balance and, keeping your torso upright with your back slightly arched, reach back with your right hand and grasp your right ankle. Now, ever so gently, pull toward your backside until you feel a slight burn, and hold for 15 seconds. Relax, reposition the chair to your right, and repeat by stretching the same leg with the opposite hand. Repeat both variations with the opposite leg.

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