[Diana]

Pete,

Thank you for this information. I too am experiencing a flare up of a chronic low back pain, diagnosed as SI joint issue when the injury occurred a few years ago. This flare up occurred a few days ago on my first ski of the season, a short ski tour, followed by a short skate ski. I am currently in the acute stage, so I am riding my road bike instead of running or skiing, and doing Foundation Training exercises, which have helped me move through this injury in the past.

I have been doing strength 2x weekly, including the exercises you mentioned above as well as others, for the past month, but I think I may need to shift to more dedicated sessions (I typically do 3 sets x 45 sec (15 sec off) of 2 leg exercises, 2 core, and 2 upper body twice/week).

How would you structure a dedicated strength session? And would you recommend waiting until the pain dies down a bit to begin strength, or go for it? Also, do you have any advice on how to relieve pressure on the lower back while skiing? I experience low back pain regularly while touring, classic skiing, and especially skate skiing. Thank you for your insight!

Topic

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on December 22, 2020 at 9:54 pm #48489

Dealing with low back pain is a common occurrence for the Uphill Athlete. Traveling on uneven ground, big loads through the hips going into the back, loaded posturally challenging positions with packs, all conspire to challenge the lower back. In my travels with our Olympic athletes on the World Cup, 70% of my time is spent treating the lower back. Here are some general thoughts for caring for the lower back:
1. Technique. With skiing, your pelvic position can cause a significant increase in shear loads to the lower back. Maintaining a stabilized neutral pelvis during pole plant/push, and leg action is essential.
2. Strength. Core can be done daily 15min. In season, strength 2x week is common, 3x week when trying to advance strength and you can have sufficient recovery with your other activities. Strength movements include bilateral and unilateral movements of the lower extremities, overhead movements for their significant core challenge, and one speed movement such as a snatch/clean/swing/bounding. Dynamic control during various bounding movements in the sagital/frontal plane are also helpful for the advanced athlete.
3. Mobility. Soft tissue rolling with balls/foam rolls keep the tissue flexible and able to transfer loads effectively through the lower back. I also like a lot of thoracic spine mobility work with various windmill movements to stiffness here isn’t added to the lower back.
Big topic here but I thought I would throw some things out there.
Cheers,
Pete

[Dada]

Dada on January 4, 2021 at 6:35 pm #48492

Hi Diana,

I found this science-backed rehab protocol: Rehab

There are a couple of strength exercises for every phase of the rehab from herniated disc. Maybe, this is also applicable to your SI joint problem.

And there is supposed to be a provocation test for the SI joint: Bulgarian Split Squats. When you don’t experience any pain, you probably don’t have an SI joint problem but rather a lumbar spine issue: YT Video

Best regards
Dada

[Diana]

Diana on February 23, 2021 at 9:00 am #51145

Thank you Pete and Dada for the advice. Becoming cognizant of my pelvic tilt while skiing has been a big game changer. I’ve also been working on some core and single leg combined stability with a PT, as well as post-ski rolling and releasing. When the injury was acute (when I originally posted) the PT and strength were not relieving pain. It was a sports massage that did the trick and gave me instant relief! From there, the PT and strength have proven very valuable to keep me strong and pain free.

Thanks again for the detailed advice! I really appreciate it.