A blog by runners. For runners.

Lower back pain, a runner’s most common foe

wjr-lower-back-pain-when-runningAs a follow up to our physical therapist blogger’s post on lower back pain after running, Dr. Nace examines this running injury from a doctor’s perspective.

Most of us have had lower back pain to some degree or another. In fact, well over 80% of U.S. adults experience this particular ailment throughout their lives. The percentage of runners that have lower back pain may be even higher! If left untreated, it can linger and become a regular problem that lasts a lifetime.

How does the back function?

To help understand this condition, we should know a little more about the anatomy of the lower back. There are 23 discs in the spinal column sandwiched between the vertebrae. Their primary function is to serve as shock absorbers for the back, but they also act as ligaments that hold the vertebrae together to help with spinal mobility.

These discs have two parts: the outer portion is tougher and is responsible for absorbing impact. The inner section is soft, containing a loose network of fibers sealing the points of contact to evenly distribute pressure. The spinal column protects the spinal cord and the lower back is the key point at which all the nerves branch out from the spinal column to connect the legs and lower extremities.

What can cause lower back pain?

Running is a high-impact repetitive activity and as your feet pound the pavement, your legs absorb the impact and they do their best to transfer this energy to the upper body evenly. Often times the transfer process is not fluid and conditions like lower back pain can develop as the back takes more than its share of energy. Some of the common causes for lower back pain include overuse, unsound body mechanics and muscular imbalances.

When runners change distances and terrain, their pelvic tilt adjusts accordingly and the energy absorption from the impact of their feet distributes differently compared to flat surfaces. I like to call this mechanical back pain because the aches and discomfort are localized to the lower back area and it is most often due to improper body mechanics, overuse, and muscular imbalance.

In most cases, runners experience this because their exercise regimens consist solely of running or sprint training and the muscle groups throughout their lower body are not equal. The protective mechanisms that allow the stronger muscle groups to compensate for the weaker ones become less effective over time because of fatigue. This system of compensation promotes unsound body mechanics and overuse exacerbates the situation.

In the worst cases, lower back pain could be sign of a more serious condition if runners are experiencing numbness or tingling that spreads down the legs, hips and buttocks. If this occurs then it could mean a disc is deteriorating, it may be out of place or there is pressure on the nerves going down the legs. Some of the most common conditions are pinched nerves or “sciatica,” bulging or herniated discs, back sprain/strain, degenerative disc disease and spinal stenosis.

Back pain is a broad term that encompasses a wide array of ailments, and would take hours to fully address. It is sometimes difficult to diagnose because back pain can refer to the buttocks, hip, thigh, knee, and even all the way down to the ankle. Each one of these areas need to be evaluated. Major red flags include bowel or bladder changes, focal weakness, and numbness. If you have these symptoms then you should schedule an appointment with a physician as soon as possible or a trip to the emergency room should be considered.

Treatment options

Lower back pain can be tricky because initially rest is important but too much can also have detrimental effects such as stiffness.

For general aches and mild lower back pain, I recommend conservative treatment plans that include rest, light stretching, activity modification and modality treatment such as moist heat, ultrasound, or massage. OTC pain medication such as NSAIDS and acetaminophen can be helpful if you are medically able to tolerate it. When lifting objects, remember to bend at the knees and make sure the objects are as close to your body as possible (this also helps prevent back pain).

Tight muscles, muscular imbalance and body mechanics are most often the cause for lower back pain. If your pain persists longer than a couple weeks, I would recommend evaluation by a healthcare provider and obtaining video of your running from a running store or medical facility. This information can help evaluate the causes and will provide insight on a course of treatment.

Cross-training and a good core strengthening/stretching program can be extremely helpful and I am a big proponent of aqua therapy because it is low impact. Developing well-balanced fitness is key to longevity and reaching your fitness goals.

When to seek treatment

If the lower back pain persists for more than two weeks after following the treatment options mentioned above, then it is time to visit your physician. Other symptoms that warrant a more immediate trip to your physician’s office include numbness or tingling in the lower back, legs or buttocks, focal weakness and bowel or bladder changes.

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Dr. James Nace, MD

James Nace, MD is an orthopedic surgeon-joint replacement and doctor of general orthopedics specializing in hip, knee and shoulder joint preservation and reconstruction. He practices out of the Rubin Institute for Advanced Orthopedics at Sinai Hospital of Baltimore, Maryland. Throughout his career as a physical therapist and orthopedic surgeon, Nace has gained the most satisfaction from treating runners and all types of athletes for their injuries and helping get them back to training and competing.