This is a report from a Chiropractor from Texas, maybe more detail then some would like. My many thanks to Shannon for helping me get this on the blog.

History:
A professional racing cyclist
presented with low back
pain after finishing stage
two of a 17-day stage race.
Earlier in the stage, the
cyclist crashed into a
concrete barricade while
attempting to maneuver
around a crash in the
peloton (group of cyclists).
The cyclist collided with
another bike and was
thrown into the barricade.
He struck the barricade with his low
back first, mostly on the right side,
hyperextended over the barricade
and fell onto his knees.
Initial evaluation after the
stage revealed a large
hematoma forming on the
athlete’s right paraspinal
muscles at the level of
the 4th lumbar vertebra,
which was roughly 5 cm in
diameter. After a 30-minute
bus ride, he could barely
stand to exit the bus.
Upon re-evaluation of his
condition, the hematoma
remained the same size.
The athlete had a difficult
time sitting and lying on his back, as well
as getting into any position that would
assist in making a quality diagnosis.

Limited ROM/Pain:
Every range of motion in the lumbar spine was limited
and was accompanied by pain. In a side lying position,
the iliac compression test was performed as well as a
modified straight leg raise. Both were positive. Upon
palpation of the lumbar spinous processes, there was
tenderness at levels L3, L4, and L5. At this time, the
athlete was referred for X-rays of the lumbar spine and
pelvis. The X-rays were negative for any fracture, but
showed a significant amount of soft tissue swelling in
the lumbar and sacral regions.

Treatment:
The athlete’s lower extremities and low back were
massaged for 90 minutes in an attempt to break up
forming adhesions. Afterwards, noticeable swelling
remained in the lower lumbar region, specifically in
the right flank region around the iliac crest. The
athlete was informed of the Graston Technique® (GT)
and how it would promote healing in his low back.
GT2 was used to assist in edema removal by gently
gliding over the visual hematoma from the iliac crest
up the right paraspinal to the min-thoracic level. A
moderate fluid wave was caught numerous times
during the gliding strokes.
After approximately a dozen strokes, GT4 was used with
a fanning stroke along the right flank to assist in the
removal of edema. Overall, the hematoma was reduced
by 50 percent. The athlete was instructed to ice for 20
minutes every hour for the rest of the day and he
received laser treatments in-between ice applications.

Inflammation Subsides
The athlete was in considerable pain the next day, but
rode and finished the stage. The inflammation in the
lumbar region was considerably less and he was able
to walk without an antalgic gait. The cyclist was having
a difficult time flexing at the waist, as well as laterally
flexing to the right. He had no radiating pain into his
extremities, but moderate pain in the lumbar region.
GT4 was used in a static mode to scan the right and
left flank areas, focusing specifically on the thoracolumbar
fascia and latissimus dorsi origin. GT3 was
used around the hematoma to continue breaking down
the adhesive tissues forming in the area. After
treatment, the athlete was able to flex at the waist and almost touch his toes. The next day, the cyclist was in pain and barely finished the stage. He attributed the pain and
soreness to too much treatment the previous day.
(The previous stage was a very hard climbing stage
as well.) At his request, we did not treat him. The
cyclist received roughly 90 minutes of massage
therapy and ice treatments and called it a day. The
next day, he raced and felt more comfortable on the
bike, but complained of moderate to severe amounts
of pain in his lower back when in the saddle and even
more when he stood up to climb or gain extra speed.

Static/Slowly Flexing Treatment:
We continued GT treatments after this stage by
scanning the area with GT4 in a static position, then
slowly having the athlete flex at the waist with the
transverse abdominus (TA) activated. A fanning
stroke was used in a superior and lateral motion with
GT4 along the fibers of the latissimus dorsi while
the athlete laterally flexed and rotated to the left.
Significant fascial restrictions were felt throughout the
posterior compartment. Upon completion of this
treatment, the cyclist had improved range of motion
in flexion and lateral flexion at the waist, as well as
decreased pain. The next day, the cyclist felt improvement, but still complained of soreness in his lower back while on the bike. He finished in the middle of the peloton and was
pleased with his ongoing recovery. He said a fall like
the one he had after the start of the race would
usually have removed him from the race for its
entirety. We continued the same treatments, but
added GT3 and GT6 in a more specific nature on the
origin of the lats at the iliac crest and the iliocostalis
muscles where these areas were quite defined on
him. (This is a common characteristic in elite cyclists
because these muscles are used in and out of the
saddle to stabilize the sacrum and pelvic structure.)
During the next few stages, it seemed as though
we were reaching a plateau. The athlete was continuing
to have a moderate amount of soreness in his low back,
but more than anything, he was not getting the power
output he normally had. He was also complaining of a
specific spot in his lower back that we later pin pointed
to be just below the origin of the hematoma. This spot
was just above the base of the sacrum at the level of
the right mammillary process of L5. After stage 10, we treated the cyclist on his bike aboard rollers. The next day was an off day for the event so it was a perfect opportunity to try a new technique. The cyclist armed up for 10 minutes at a
power output of 100 watts (computer-aided device).
We scanned the thoracolumbar fascia with GT4 and
evaluated how his muscle system responded. The
cyclist increased his output to 200W and held for four
2-minute bursts. During these bursts, we treated at
the base of the sacrum, mostly on the right side with
GT3 and GT6.

Cyclist Stronger
Finally, we had the cyclist come out of the saddle and
hold for 2-minute bursts at an output of 250 W. We again
treated the specific area the cyclist was complaining of,
as well as into the paraspinals of the lumbar spine.
The next day, the cyclist did a light 2-hour ride and felt
he had more power in his train. No treatment was
performed on this day. At stage 11, the cyclist felt even
stronger in his race, but was hindered by several flat
tires. After this stage, he received another treatment,
but the intensity and duration were decreased.

Result:
Stage 12 deemed to be the time where everything
came together for the cyclist. He was ahead for most
of the stage, but fell back at the very end, finishing
fourth. The cyclist continued to ride strong through the
last four stages and complained of minimal pain in the
affected area. Continued treatments were done with
the cyclist on his rollers and again the treatments
were modified to reflect how the athlete was feeling
after the respected stage. One month later in a prestigious stage race in China,
the cyclist complained of no pain in his low back,
only soreness after the big climbing stages. The
cyclist ended up winning the overall race and another
major race back in the states a few weeks later. This
is a classic example of learning how to listen to an
athlete’s body and knowing when is too much and
when is not enough. Most importantly, after fascial
restrictions are removed with GT and proper
remodeling of tissues are completed, it is amazing
what the human body can do.
Great article, hope you all enjoyed it!

Filed under: Uncategorized by admin on June 16, 2010