Q I suffer from recurring lower back pain, which is a result of minor scoliosis and narrowing of the lumbo-sacral disc space. My GP says I should stop running, while my occupational health doctor says running wont do me any further harm. Who should I believe?
Scoliosis is the bending of the spine to one side and, depending on the cause, there are different implications for your running. If the narrowing at the lumbo-sacral discs is wedged in shape, the vertebra above will be tilted as your spine compensates, resulting in a scoliosis. If this is the case, your GP is probably right: the long-term pounding of running is likely to aggravate your back, and could lead to arthritic changes and pain later in life.
If you do not have wedging at the lumbo-sacral disc level, a muscle imbalance or a leg-length discrepancy (or both) would most likely cause the scoliosis. If so, theres no reason you shouldnt be able to continue running once the problem has been resolved.
Muscle imbalances can be caused by, among other things, an old injury, your running style, protection for a nerve that is trapped or compensation for an immobile joint. If a physiotherapist can establish one of the above as the cause of your scoliosis, the chances of your continuing to run are good. Mobilising, strengthening and re- educating your back, as well as stretching any tight nerves, is often enough to deal with this type of problem.
A leg-length discrepancy causes a spinal tilt to compensate for one side of the pelvis sitting higher than the other. This is usually caused either by a hereditary bone-length differential in your leg, or by your pelvis being rotated, which makes one leg appear shorter.
If you have a genuine leg-length discrepancy, a heel raise and exercises to accustom the spine to the new position will usually deal with the problem, and running in the long term should be okay. If the discrepancy is caused by a pelvic rotation, then one of your sacro-iliac joints is probably misaligned and needs to be re-orientated. In this case, get a sports osteopath to mobilise the area and prescribe strengthening and stretching exercises to stabilise the pelvis in its correct position. Once this has been completed, you should be able to return to running.
Martin Haines, chartered physiotherapist and sports-injury specialist