Went to see the osteopath as planned on Thursday for my lower back pain, my first visit to a joint mobility specialist. After stripping down to my underwear, he had me bend forward and sideways to assess mobility. Then he poked his way down my spine and concluded that I had come just in time. “Seems like we have quite a mess here”. Just what I wanted to hear. I knew I was in good hands.
He told me to get on the bench sideways with my stomach facing him and the upper leg bent. “Now fill your lungs… exhale…”. I felt a nice crunch in my lower back as he pressed his bodyweight down on my leg. “Ok, that jumped into place. Now turn around”. Within minutes he had crunched both my lower and upper back from several angles and I was feeling increasingly satisfied with having come. He told me that my lower back was not as static as he had first thought, but I had had a lock in my upper back that must have been there for quite some time. After locating some sore points in my gluteus, he gave me a brisk but hard glute and hamstring massage. “Done!”.
Standing up, I could indeed feel the difference. My shoulders felt light and I had more ease of movement in the upper back. My lower back pain had also sharply diminished. Pointing down at my lower back, he said that three of the vertebra had been out of sync restricting full movement. “You have tight gluteus” he continued, “those often cause pain to radiate to the lower back”.
At this point I was all smiles, and blurted out that I would continue taking it careful with my lower body training and work on technique. “Nah, just don’t do any twisting movements for the rest of the day”. He then assured me that my musculature was in quite good shape and that I could begin to train hard very soon. Happily paid the 35 euro and scheduled a check-up appointment for two weeks later.
The next day, the pain had reappeared, this time to the right side. Some very light soreness was also to be felt around the spine where the therapist had exerted his well-channeled therapeutic spinal violence. Deadlift day? No way, Josť! Went swimming instead, figuring that it would be an ideal low strain activity with which to push some needed blood into the area. Hitting the sack in the evening I did indeed feel better.
Waking up today, I still had some light stiffness on the right side. Halfway through a morning stroll with Sanna, it stiffened up some more. Once home, Sanna pulled out The Trigger Point Therapy Workbook to see whether there could be any of those nasty buggers involved, something that looked somewhat likely as the osteopath had already suggested that the back pain could be traceable not to the back itself but to the gluteus. For those of you unfamiliar with trigger points, here’s the general enlightening gist summarized from a chapter aptly titled “All about Trigger points”:
Travell and Simons define a trigger point as “a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue”. The first part of that definition just means that a trigger point hurts like the devil when you push on it. [..] The “nodule” in the formal definition is the trigger point itself. To your fingertips, it feels like a knot or a small lump that can range in size from a pinhead to a pea. [..] The “palpable taut band” is a semihard strand of muscle that feels like a cord or cable and is easily mistaken for a tendon. Taut means it’s tightly stretched. Palpable means you can feel it with your fingers. [..]
A trigger point is not the same thing as a muscle spasm. A spasm involves a violent contraction of the entire muscle. A trigger point is a contraction in only a small part. [..]
The defining feature of a trigger point is referred pain. [..] Back pain always has a myofascial component, no matter the official diagnosis. Although arthritis, bad disks, and displaced vertebrae come quickly to mind when your back hurts, back pain very often is nothing but referred pain from myofascial trigger points. Pain in your lower back can come from trigger points in surprising places, such as your buttocks, your stomach muscles, or even knotted-up muscles in your calves. [..] Some of the activities that create trigger points are obvious, like accidents, falls, strains and overwork. [..]
Most systems of therapeutic touch, like acupressure, shiatsu, craniosacral therapy, myofascial release, Swedish massage, and even deep tissue bodywork - despite their good uses - are also too nonspecific to guarantee success with trigger points. For dependable results, therapy needs to be applied directly to the trigger point. [..] The safest and most effective method of trigger point therapy, according to Travell and Simons, is deep stroking massage applied directly to the trigger point.
Davies, Clair (2001): The Trigger Point Therapy Workbook. New Harbinger Publications; pp. 17-33.
I have briefly mentioned trigger points before in the shoulder context. For much of September I had problems with my right shoulder which would get very tender after benching. Unlike other trigger points, those in the shoulder do often not refer pain, so in this case locating the source of the trouble was easy enough. It cleared up with some hard direct massage of the trouble spot. In December and January, the problem returned. Although I did not write about it in the blog, I had some fears that I might not be able to complete the benching intense Prilepin bench program if it turned out that the shoulder could not take it. After Sanna bought the above book, I learned that these problems are very easy to take care of oneself with the aid of a tennis ball, or similar, which is placed between the wall and the trigger point. Massaging the trigger point hard (pain should be roughly 7-8 on a scale from 1 to 10) in one direction for one minute several times a day once or twice a week results in instant relief and keeps shoulder pain away completely. The chance of the back problem being in the same league sounded almost too good to be true.
Sanna got me on her massage bench and started feeling her way through my gluteus, hamstrings and calves. The end result was that she located one tender spot on both gluteus (the left one is probably the one shown in the picture), plus one on the right calf muscle. Although it is not very easy to determine whether the gluteus ones are indeed true trigger points, or just local stiffness, due to the heavy layer of fat and muscle on top (I like to think more of the latter), initial treatment of these spots with a tennis ball against the wall have shown positive results. Invariably, most of the pain has dissipated for some time, save for the local gluteus tenderness caused by the ball. Based on her experience with clients, Sanna told me that the gluteus tend to get sore very easily from hard massage. I am taking it a little easier now with the ball to allow some of the soreness to disappear, but do hit them hard a few times per day. I will continue doing this for a while. I gather it is the only way to find out if this removes the back stiffness or not. I have also started massaging the shoulder trigger points several times a day in an effort to totally get rid of them instead of just pacifying them for the moment.
But where did this back trouble come from? From the type of pain, I can tell that this is not the ligament sprain reappearing. Besides, much of this stiffness has been off to the sides, not at the old injury spot in the middle of the lower back. The scenario that appears most likely is that this new back pain is a direct by-product of other muscles having had to protect the back injury and trying to compensate for the loss of back strength. Hence the displaced vertebrae and the tight gluteus; they could not cope with this increased burden and imbalanced musculature. In this context trigger points could also very easily develop if we are to trust Davies’s argument. In fact, he states that trigger points are often latent at first (they can be for years or forever), but then suddenly become active when straining (such as performing a heavy lift or getting into an awkward position). This would be a plausible explanation for why I suddenly started feeling pain on the left side of my lower back when squatting on Monday.
Trigger points or not, we will just have to see how things develop from here. In the meantime, I highly recommend buying the trigger point book. The fact that Dave Tate’s Elite Fitness Systems also stocks this book should testify to its importance for powerlifters. You might be pleasantly surprised to find out that you can clear up your pain with just a tennis ball.