Back pain affects nearly 80 percent of the population and can severely interfere with your ability to train and compete if you are an MMA athlete. Contrary to what most people believe, the most common cause of back pain is not poor lifting mechanics, but it is more often the result of poor postures and muscular imbalances. This applies to the average sedentary working person, but for those of you who train in MMA, there is more to back pain than meets the eye. The MMA athlete puts a higher demand on the lower back than many other sports, which can lead to bouts of acute and chronic lower back pain resulting from herniated discs.
THE SOURCE OF THE PROBLEM
When you have back pain that radiates past your knees and there is numbness or tingling in your legs, you probably have a herniated disc along with a pinched nerve in your lower back. The discs are cartilage, or “shock absorbers” found between the vertebrae, which allow for flexibility in the spine. I like to use the analogy of a jelly doughnut when explaining what can happen to discs. The disc is composed of a cartilaginous outer layer (annulus fibrosis) and a soft center (nucleus pulposis). A disc does not “slip” as most people believe, but it can do one or a combination of three things: it can degenerate, bulge, or herniate.
Disc degeneration is a process that occurs as a normal part of aging, but it can also be accelerated from excessive stress on the body. The disc essentially wears away and dries out, becoming less flexible and less soft over time (the “dough” becomes dry and the “jelly” loses its fluid content). Abnormal pressure in the lower back from repetitive movements can cause a disc to bulge. A bulge occurs when the soft center of the disc (the “jelly”) pushes out on the outer cartilage layer (the “dough” is pushed outward) which can potentially pinch a nerve. If a disc herniates, the soft center of the disc actually leaks outward and compresses or irritates the sensitive nerves in the lower back. This is a common cause for the radiating pain down the back of the thigh and leg, which is referred to as sciatica. X-rays can rule out a fracture or dislocation, but they do not show the integrity of the discs. An MRI will accurately diagnose whether you have a degenerated, bulging, or herniated disc.
Many disc injuries are predisposed by muscle imbalances. Mixed martial arts and grappling athletes often have flexion dominance in the lower back and pelvis. In neutral spinal postures, the lower back should curve inwards, but many of the movements in Jiu Jitsu and submission grappling occur with the back in the opposite direction with the lower back flexed forward and the hips flexed. Additionally, most training drills involve repetitive flexion at the waist and abdominal strengthening movements, causing tightness of the hip flexors and weakness of the hip extensors. Over time, the lower back muscles become under utilized while the hip flexors become shortened. Addressing these muscle imbalances often makes back pain disappear or at least helps them to become more manageable.
REPRIEVE FROM THE PAIN
The good news is that most cases of herniated or bulging discs are self-limiting and usually get better if you give it enough time. Unfortunately, the pain is often too much for athletes to cope with and less conservative options don’t always provide the immediate relief patients are seeking. Treatment typically involves an initial period of rest with anti-inflammatory and pain medications. Physical therapy modalities including electrical stimulation, ultrasound and mechanical traction can also help with pain relief and speed up recovery. Once the initial painful symptoms have resolved, you should start a physical therapy program that includes stretching the tight muscles (usually hip flexors and hamstrings) and a good spinal stabilization program. The goal of any rehab program is to prevent future recurrence and allow you to safely return to training and competition.
When conservative measures fail, a short term course of corticosteroids taken orally or epidural steroid injections applied directly into the spine can decrease the inflammation and lessen the symptoms. When all else fails, surgery may be necessary to remove part of the disc or fuse the vertebrae so there is no pressure on the nerves. Any back pain that is accompanied by loss of bowel or bladder control, weakness or inability to control your legs may indicate damage to the spinal cord and requires immediate medical attention. Though there are many treatment options available, one thing remains clear: it is imperative that you undergo aggressive rehab following a disc injury to stay active in mixed martial arts. For more information on disc injuries and how to rehab back pain, you can contact Dr. Park at the address to the right.