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Paddling and Bad Backs - Do They Go Together?

"Ohhhh, my aching back!"

If you have visited my site regularly since I started it in 2000, you probably have wondered if it was a site about paddling or a medical journal. My paddling journal contains almost as many references to the ongoing problem with my back as it does to my actual adventures on the water. In fact, I refer to it so many times that the e-mails I get from people are often questions from other people who have paddled while battling their own back problems and sometimes just people with back problems.

After a lot of consideration, I've decided to dedicate a page toward relating some of my experiences and treatment options with the hope that someone will find some useful information. Now, as always, I have to begin with an important caveat - I AM NOT A DOCTOR, A PHYSICAL THERAPIST, A CHIROPRACTOR OR ANY OTHER KIND OF HEALER!!!! In other words, use the information I share here at your own risk and consult with your own medical team before you try anything mentioned here.

My Problem
I'll begin by telling you a little more specifically what my problems have been. My family is tall and my mom, my brother and I have all had serious back problems and my brother and I both have had surgery. Apparently, I got the short end of the stick as my problems have been ongoing since 1979 with very little relief. I first injured my back in 1975 and by 1979 it was serious enough to force me to be out of work for several weeks.

Finally, in 1981 I underwent a fusion of the L5-S1 vertebrate (the lowest one in the spine). That seemed to solve my problems but I still had some pain. A few years later I moved to Jacksonville and after three years of non-stop work during the start-up of St. Johns River Power Park, my back was a mess. Finally, I was referred to an orthopedic surgeon who explained to me that the fusion I was given earlier had transferred the stress upward to L5-L4 and that disk was now ruptured. This time I underwent a simple laminectomy which is a trimming of the ruptured part of the disk. This happened in June of 1989.

This time, however, the pain only subsided enough for me to be able to grit my teeth and bear it enough to go back to work. I returned to the surgeon several times when the pain got so bad I had to take time off from work, only to have him tell me that nothing was really wrong and that I probably simply had nerve damage. Needless to say, I never did get along very well with that doctor. I'm not saying he screwed my back up but he sure didn't help it and didn't seem like he wanted to go out of his way to find out why I was still in pain. The best that he could do was prescribe for me some Hydrocodone for pain and a TENS unit.

I finally got to a point where I could function more or less normally as long as I had the pain medication to fall back on. I still couldn't plan my life very well, as I never knew when the pain would simply be too much to handle.

I had started paddling in a canoe a year or so before my 1989 surgery and had tried to get back out there but a 17 foot canoe is a bear to handle solo especially with a bad back. I was feeling pretty decent back in 1998 and I had the urge to get back on the water again, so a co-worker of mine encouraged me to try his Poke Boat. I tried it a few times and realized that my back could handle it fairly well so my wife and purchased a couple.

I thought I was doing great for about a year - I could paddle all I wanted without my back acting up on me too much. Sure, there were days that I had to cancel a trip because of my back but normally I could paddle for several hours and then come home, pop a pain pill and veg out.

That all changed in the fall of 2000. One day, while out paddling, I knew that I had done something - I assumed the worst, of course, and thought for sure that I was headed for another meeting with Doctor Knifey. Because I was thoroughly hooked on paddling, I was determined that I was going to do whatever it took to find out exactly what was wrong and do whatever it took to fix it.

That's where the Mayo Clinic came in. At the time, JEA offered the Mayo Health plan and I decided to join. It was by far and away the best health plan I have ever been a member of and it was no real surprise that they announced that it was going under financially. For the 12 months that we were members, however, I got the most information about what exactly was going on with my back and what was the best plan of action to deal with it. It was so good, that when the plan ended, I spent a lot more money to make sure that the insurance plan I chose would allow me to keep using the Mayo doctors.

What we (the doctors, physical therapists, radiologists and the rest of the "team") discovered was that my fusion had likely also transferred stress to the next joint downward which is the SI or sacroiliac joint. Until then, I thought the sacroiliac was something that only "Granny Clampett" had and that it wasn't an actual body part. Well, it is and it's where the pelvis joins the back and it's a huge joint that can cause a lot of pain very similar to the pain you would have if you had a disk problem. It causes a sharp and burning pain in the buttocks and that pain can radiate to the lower back and down the leg, much like sciatica. We ultimately figured this out when they decided to try a cortisone injection in the SI joint just to see if the pain would go away.

Did it ever! I woke up 12 hours after the injection to use the bathroom and once I was fully awake I suddenly realized that for the first time in 20 some odd years I was PAIN FREE! Hallelujah! You don't realize what constant pain can do to you until it suddenly goes away. WOW!!!

Well, almost. The pain came back a few weeks later and subsequent injections had the same but temporary results. It did cause us to refocus our attention on the SI as a probable problem and it was at that point that it was determined that I had a difference in the length of my legs of a 1/2 inch. A wedge in my shoe and an SI belt were tried to some degree of success but the pain persisted.

Finally, in April 2002, the pain suddenly increased dramatically, to the degree that I had to take off work for two months and stop paddling altogether for three months. When I went back to the Mayo, they suggested that we try something new - Prolotherapy (see below) and also some more physical therapy.

And that takes up the present time - July of 2007. I underwent several Prolotherapy treatments which greatly reduced my pain and increased my activity. I had a relapse about a year later and another Prolotherapy treatment but since August of 2003 I have had the most pain free years of my adult life. So much so that I know longer think of my back as a hindrance to my life. It flares up occasionally, but not so much that I have to shut myself down and I usually get over it very quickly.

Here are some Links on Sacroiliac Problems:

Sacroiliac Resources
 

Go To The Doctor
First of all, don't ignore persistent back pain. Most people are afraid of going to the doctor about their backs because they don't want to have to have surgery. Believe me, the last thing any good doctor will do is recommend surgery. But if you have persistent back pain that is accompanied by leg pain, you should find out what is causing it. X-Rays and MRI's are pain free ways to diagnose the problem and there are a lot of non-surgical options to deal with it.

Physical Therapy
A good doctor will try physical therapy as the first option to deal with back pain. This may involve re-training you how to do certain things like lifting or sitting but it should also involve an exercise regimen that will strengthen your back. The "low back stabilization" program I underwent at Mayo was different than anything I had done previously. It trained the hundreds of other muscles in my back to work together to do the job that in most people only a few major muscles do. Take my word for it - it works!

Here are some links on Physical Therapy:

Spine Inc. - Exercises - Intro

Medication
There are a lot of options out there. Anti-inflammatories as well as pain killers. Most back pain is caused by an inflammation of the nerves and even after you take care of what is causing the inflammation it can still hurt. Cortisone is the main drug but it can only be taken a limited number of times. There are others that can be taken regularly - Relafan  is one that I took with some success. Sometimes, a pain reliever is all that is needed. Hydrocodone is a fairly powerful one that I use but I don't take it unless I plan on doing nothing - I feel a little too good when I use it. Ultram is another drug that I use now instead of Hydrocodone and it's effect is much milder but still effective.
Note: As of July 2007, I am taking Ultram almost exclusively for pain and very little of that. When I have a "flare up" I take Mobic which is a new anti-inflammatory that works very well.

Chiropractor
I have varying degrees of success with chiropractors. I think if you catch your problem early, they can do a lot of good. I've come to the conclusion that they are no longer for me because of my specific problems but if you can find a good one they are certainly a valid option.
 

Acupuncture
This something I have yet to try but I think it is something that could be in my future. I've talked to my team at Mayo and they agree that it may be helpful although they can't say why it seems to work for certain people. I will let you know if I try this option and how it works.

Prolotherapy
This is where I am now. Actually, as soon as I found out that my problem was in the SI area, I did some research on the Internet and one of the first places I found was someone's personal web site where he mentioned his own SI problem and how a therapy called "prolotherapy" had helped him tremendously. When I mentioned this to my team at Mayo, they didn't seem to know anything about it.

A year later when my problem got worse, prolotherapy was brought up by my lead doctor and, of course, I jumped at the chance.

Basically, prolotherapy, has been around a long time but it is started to gain wider acceptance in mainstream medicine. It is a procedure where an irritant (various solutions are used) is injected into the joint in order to prompt the body to send more of it own natural healing properties to that area. The result is a build up of collagen and a tightening and strengthening of the joint and hopefully, a reduction in pain.

The procedure is somewhat painful, involving a couple of dozen shots per session in the area of the joint. The doctor I have - Dr. Lamer, is tremendous. He's slow and gentle and always asking me how I'm doing and if I need a break. With all I have been through with my back I always tell him to press on - pain is a relative thing and compared to some things I have had to endure, prolotherapy is a breeze.

I've been through four sessions with Dr. Lamer and we are taking a break to see if any more are needed. Dr. Lamer feels like I'm good to go but it's possible that more may be needed at a later date.  Shortly after the third session, I had a period of a month of almost pain free days. It has since slipped back somewhat but it is still vastly improved over what it was. All in all, prolotherapy has been the most positive treatment option for my back/SI joint that I have ever encountered.

Note: I have had a couple of people e-mail me telling me what a horrible experience they had with Prolotherapy. All I can say is that it worked for me but it is not for everyone. I think having the Mayo Clinic and specifically Dr. Lamer administering it makes a huge difference.

Here are some links on Pholotherapy:

Prolotherapy
 

Surgery
Back surgery has come a long way since 1981. Unfortunately, as most of my life is a testament to, my timing is terrible. Within a few years after my fusion, "laser" surgery became the norm and from what I understand it is a much better option than undergoing the knife. The recovery time is much quicker and the prognosis much better. Unfortunately, because of my prior surgeries, I am no longer a candidate for the laser procedure - gosh darn it!

So, if you do have to have surgery, it is a whole lot better than it used to be. Chances are, you will be back on your feet in a few days and back in your boat and on the water in a few weeks.

The Final Question
Should you even be out there paddling with a bad back? A lot of people, who know what I have been through think I am thoroughly nuts for even attempting to paddle with the problems I have had with my back. None of my doctors have ever had a problem with my paddling when I tell them about it. Basically, their belief is - "if it feels good - do it". Well, it doesn't always feel good but I am so hooked on it that I don't see myself ever stopping. I hope to still be out there paddling when I'm 80 years old. I'd much rather have a heart attack in my boat in the middle of the Timucuan Preserve than in a nursing home.

So, the question is really up to you to answer for yourself. You can do things to make it easier on yourself like taking care of your general health, doing stretches before you paddle and buying a boat that is easy and comfortable to paddle in.

I do know this from all of my conversations with medical professionals - the worst thing you can do for a bad back is to let it turn you into a couch potato. Paddling may not be for you but find an activity that you love and do it regularly. Above all - don't let it get you down. I have a phrase from one of John Irving's books - "The Hotel New Hampshire" :

"Keep Passing the Open Windows"

In other words - don't give up - it's gonna get better.