Low back pain in runners

Many runners will have felt back pain at some point during and/or after running. Runners ultimately put enormous stress on to the back with the constant pounding and shock waves travelling through the body.

Posture is more important to people participating in sport. Differences between shoulder level, pelvis level, leg length, foot posture etc. can place extra stress onto the back. The following figures show how back pain can be caused through imbalance.

For someone who does not run they may not feel any symptoms at all if their posture was incorrect but for a runner its about distributing forces equally. Any joint out of alignment is a point where shock can cause impact and injury can happen.

Predisposing factors for runners can include tight hip flexors which produce a forward body lean, leading to an anterior pelvic tilt and hyper lordosis (increased curve) of the lumbar spine. Because the lumbar muscles develop tension to counteract the forward bending movement of the entire trunk, when the trunk is in flexion those muscles are particularly susceptible to strain. This coupled with tight hamstrings can lead to a shorter stride length. Weakness of the hip stabilizers (gluteus medius) can cause the pelvis to tilt to one side (swaying running technique). Foot posture is important to assess, particularly when selecting trainers. Many runners will have orthotics specially made. When back pain is present and pelvis alignment is altered through leg length it needs to be decided whether its a true leg length discrepancy (needs orthotics no matter what) or an apparent leg length discrepancy (joint out of place (usually caused by incident), muscle imbalance) which can be corrected with manual techniques.

Symptoms include localized pain that increases with active and resisted back extensions (face down on the floor and lift trunk). The pain does not radiate to the limbs. Posture may show an increased lumbar curve due to a forward pelvic tilt. 

What to remember. There is a whole host of causes for lower back pain. Conditioning of the muscles that help to maintain solid posture should form part of the schedule of anyone who exercises regularly, whatever their discipline or sporting standard.

Treatment

Immobility can prolong pain so keep moving (gently), ice can reduce inflammation from irritated structures and decreases pain (20min every 2 hours). Lumbar stabilization exercises are important. Changing to swimming or biking for a change to keep up endurance may help, the muscle imbalances still need to be corrected. Look at your posture, running technique, trainers and foot posture. Sports massage is essential to treat soft tissue tightness. Also remember that the nervous system stimulates muscles and produces motor programmes for every movement. If posture is altered the brain will get use to the new position and forget the old, it becomes a bad habit. Treatment should also address this through proprioception and muscle stimulation to reconnect the correct motor programme for good posture.

Tips

If feeling any niggles, pain, discomfort seek advice from a sports injury specialist. Soft tissue tightness may need sports massage and other treatments to unlock the posture.

Wear properly fitted shoes that control heel movement and absorb shock. Always check footwear for condition, it's usually best to alternate between two pairs of shoes over six months. Even if you do not wear the shoes very often they will lose their cushioning ability.

Increase and keep flexibility of hip, knee, ankle and trunk.

Increase strength of core stability, back stabilization (yoga, pilates). The following links will take you to 3 videos of 9 back exercises, (you may recognise the diagrams at the beginning). The videos are from peak running and explain why each exercise is especially for runners. http://www.youtube.com/watch?v=KWUHTEJOyKs  http://www.youtube.com/watch?v=78Pt_e5gHyc  http://www.youtube.com/watch?v=Te7gFcy_AiQ

Warm-up thoroughly and cool down properly. A warm-up should be dynamic and cool down is the time for stretching.

Run with an upright stance rather than leaning forward.

Avoid side-to-side swaying.

Cross country runners/fell runners are more prone to back pain. When feeling back pain avoid hills for a while and introduce slowly when ready. Ideally posture should be upright, working on a good knee drive.

Avoid over striding as this increases leg shock.

Reducing training can help to ease symptoms whilst treatment can be sought. when getting back increase distance gradually 10% each week is recommended no more.

You may need your foot mechanics analysed and orthotics made. If you have orthotics already and you start to get back pain maybe they are incorrect or need renewing if they are old.