The most common injury treated in physical therapy is lower back pain. People of all ages, activity levels, shapes and sizes can have lower back pain. I want to focus this specifically on the runner. At some point most runners will experience lower back pain. There are multiple reasons that this can occur, some more common than others.
Common causes for lower back pain during or after running
- New activity (fatigue)
- Running long distances (fatigue)
- Postural abnormalities
- Previous or current injuries elsewhere in the body
- Weakness in core or hip muscles
- Decreased lower extremity and lumbar (back) flexibility
- Poor running mechanics
- Running up hills
The lumbo-pelvic-hip complex has a total of 29 muscles that attach to it. Some of the major muscles that attach are the hamstrings, gluts, adductors, abdominals and lumbar muscles to name a few. What that means is that in order to keep the lower back stable during running all those muscles need to be strong and flexible or you run the risk of injury. So it’s not just core training that will keep lower back pain away during running, but training multiple muscles in multi-directions.
If you find yourself at any point during your runs experiencing low back pain I would start to ask yourself a few questions:
- Have I gradually worked into this distance or speed?
- Have I been experiencing any pain in my back or elsewhere during different activities?
- Have I been stretching on a daily basis?
- Have I been working on a strengthening program at least twice per week?
- Do I have any previous injuries or abnormalities?
Exercises for lower back pain
Lumbar rotation stretch: Lay with knees bent up (hook-lying) with arms straight out to the side. Turn head one direction and the legs the opposite direction. Hold 10 seconds each side, 5 times per side.
Cross legs and pull up the knee that is not crossed towards your chest until a stretch is felt in your buttock or hip of the crossed leg. Hold 20 seconds, 4 times per side.
Supine hamstring stretch: Lay face up and grab behind your knee of one of your legs and slowly straighten the knee until you feel a stretch in the back of your leg. Hold 20 seconds, 4 times per side.
Lower abdominals: Lay face up with your knees bent in the hook-lying position, first pull your abdomen up and in, your stomach should be flat and the arch in your back decreased. Lift one foot off the floor until the thigh is vertical and then lift the opposite leg to that position, while maintaining your back flat. Hold one leg in this position and slowly straighten the opposite leg and then bring it back and set it down on the floor. Next, slowly straighten the opposite leg and then set it on the floor all while maintaining your stomach flat and your pelvis not moving.
Repeat each side 10 times. You should not feel your low back with this exercise, but if you do modify it with keeping your knees bent and lifting up and down and not up, out and down.
Opposite arm and legs in all fours: In the all fours position tighten your stomach and slowly raise opposite arm and leg keeping your trunk rigid. Return to all fours position and switch sides. You want to make sure you keep the trunk rigid and don’t let the hip drop on the side that is stabilizing. Also, keep the head in a neutral position so you avoid any neck pain. Perform 10 on each side.
Please also refer to my other exercises in previous post, which will also increase core stability and help with back pain.
So now what?
I would hold off on running until pain ceases or decrease the distance/speed if there is no pain. I would start cross-training, which involves other cardio activities such as swimming, biking, elliptical, rowing, etc and strengthening/stretching activities. I find that most runners benefit from a weekly Pilates or yoga class if they don’t have the self-discipline at home.
It may also be beneficial to go to a clinic that offers running evaluations to see if there are any abnormalities that occur when you run. They can offer some advice on how to change your running pattern. It is also important to keep your shoes current. If you are running frequently you are supposed to change your shoes about every 3 months.
The pain has ceased and now it’s time to return to running …
Remember that it only takes 2 weeks to lose strength and 6 weeks to gain so keep that in mind when you return to running. I would recommend starting with a short distance with a decreased speed and gradually work your way up. Make sure that you do not run everyday, cross-training will help keep the pain away. You will probably not be where you were for at least 3-6 weeks depending how long you were off running. Also, listen to your body…if you have pain and it does not go away after you have tried a few self- corrections then you need to stop running. You may benefit from seeing a physical therapist that can help guide you with exercises/stretches that you need and evaluate your running style.
Meredith Franczyk, PT, MPT has more than ten years of experience and is currently working in outpatient orthopaedics at lakeshore physical therapy. Over this time, she has developed specialities in general orthopaedics, manual therapy, and sports rehabilitation. Meredith has specific interests in sports related injuries. She takes a keen interest in new methods and advancements in physical therapy practice and has taken multiple continuing education courses to improve her skills and enhance her knowledge. If you have any questions or are looking for physical therapy please contact her at Lakeshore Physical Therapy.