Injury: Runner’s lower back pain

“Please help! I’ve got lower back pain. I’m not sure what’s caused it, but its stopping me from running!!”

This is one of the most common phrases that therapists like osteos and physios hear from their running patients.

But there is one very big error in the above phrase. Can you guess what it might be?

Whereas we think of injuries to our feet, legs, knees and hips as being ‘running injuries’, we think of back pain not as a running injury, per se, but more as a nuisance that just happens to interfere with our running.

You may ask ‘so what?’, why does that matter? It matters because if you consider your back pain as a running injury, then you can adjust your running frequency, duration, intensity and style to help your back pain heal quicker.

What is Runners’ Low Back Syndrome?

Runners’ Low Back Syndrome (RLBS) is not a medical term. It is a term that I tend to use to group together the four most common causes of lower back pain from running.

Despite being distinctly different conditions, I group these back injuries together purely because they often occur simultaneously, and the self help treatment I recommend covers all four conditions at once, and can sometimes bring about effective relief from the pain, whichever problem is present.

These four conditions are :

1) Facet Joint Irritation

The spine is made up of building blocks called vertebrae. These vertebrae are connected to each other by discs at the front (you know, the ones that slip!) and by joints at the back. If you have a rather large hollow in your lower back (like a dancer or gymnast) and have weak abdominal muscles for example, these joints can become irritated and inflamed, and be painful during running.

2) Sacroiliac joint dysfunction

The Sacroiliac joints are two joints which sit either side of the lowest part of the back above your buttocks. They’re easy to find, as they lie next to the  two knobbly bits of bone in your lower back. There are also two dimples in the skin overlying the joints, called the ‘Dimples of Venus’ (google it if you dont believe me!). If we land harder on one foot than the other while running, excessive pressure can be put through one of the sacroiliac joints (very rarely through both joints at the same time), and can irritate the joint and make it inflamed and painful.

3) Weak back

This is just what it says. Well, actually, maybe its not exactly what it says. It’s a weakness of the lower back muscles leading to a loss of control while running, but it is also a weakness in the abdominal muscles. These two weaknesses create a global vulnerability in the lower back that means that as we tire through a run, the muscles cannot control movement, leading to stress on the spine, and pain as a consequence.

4) Myofascial trigger points in the lower back muscles

Weak muscles tend to do two things in response to stress on them. Either they cramp up completely, or small parts of the muscles cramp up, resulting in little knots of very tight muscle which we call trigger points. These two responses tend to occur near the end of really important races (following ‘McCarthey’s law’, which states that Sod’s law is far too optimistic!). The result is that we develop a moderate to severe pain while running, that can’t seem to be stretched out easily.

Click Next Page for tips to identify RLBS

Identifying RLBS

Identifying Runners’ Lower Back Syndrome

You should suspect that you may have RLBS if you feel the following -  

1) A pain in the lower back while running, which comes on during the run, normally after 10-15 minutes into the run.

2) A pain that may refer into the buttocks, but not below the knee, and not with tingling or numbness in the legs.

3) A pain and tenderness, while running, over or around one of the two knobbly bony bits right at the bottom of the lower back. (the Dimples of Venus).

4) Pain generally worsened by leaning backwards or sideways, although with myofascial trigger points it can render it difficult to put shoes on when sitting down.

5) Your back often feels stiff and vulnerable, especially but not exclusively when running.

6) The pain comes on for no apparent reason. No apparent injury has occurred.

Click Next Page for some causes of RLBS

The causes of RLBS

If you think you have developed RLBS, it’s useful to ask yourself some questions - 

a) Have I been travelling recently, sleeping in unfamiliar and not necessarily the best type of beds? Often sleeping in unfamiliar beds can prime us to be susceptible to lower back pain due to the strain that it can put on the tissues of the lower back. This is especially so for runners, who really need good support of our backs as we recover from our training sessions overnight (another good reason not to go and visit the in-laws at christmas!).

b) Have I sharply increased the intensity, length or duration of my running, or am i around 6 weeks into my first marathon schedule? The most common time for people to feel RLBS is about 6 weeks into training when we are starting to pump up the volume of runs. Every run will create a little irritation in all joints, which the body then heals and is stronger for it. But an increase in training that you are not used to (and possibly too quickly) can result in your body simply not having the time to heal the irritation before the next time you run. If this happens a few times you will inevitably start to hurt.

c) Are my running shoes giving enough support or cushioning to my foot (are they right for me?) or indeed are they worn out? This I mention regardless of the type of running injury, as it is so very important to get the right shoe, and to replace shoes BEFORE they wear out. The cushioning of good new running shoes helps reduce the shock of foot impact reaching the lower back. Of course, its even better to ensure you include grass or other softer surfaces in your training runs, rather than always pounding the tarmac.

d) Have I been attending to my core strength?

The muscles around the trunk provide a secure belt or corset that increases the stability of the lower back under the stress of running, and reduces vulnerability in the spine. The exercises that develop core strength can easily be learned from Pilates classes or videos, Yoga classes or videos, personal training sessions or just doing good old reliable planks (front and side ones please!).

d) Have i had in the last year or so an injury to my feet, knees, or hips that could have a knock on effect on my lower back?  The leg bone’s connected to the thigh bone, which is connected to the lower back…….. in which case a prompt visit to a specialist running osteopath or physio can help to reduce or eliminate the adverse effects of these injuries.

e) Have i been running a lot of hills? A lot of people can develop stress in their lower back from being unaware of keeping their core strong as they run downhill. Holding your stomach in as you go down steep hills can take a lot of pressure off your lower back.

g) Could I be running asymmetrically due to some of my muscles being tighter on one side? As I discussed in my last blog on Runner's Knee, this is my all time most important running bugbear, and one that i bore my patients with day in and day out. I have repeated here a lot of what i wrote before, because it is so very, very important. Everyone’s muscles are tighter on one side compared with the other. So why is it that when we stretch, we spend the same amount of time stretching for example both calf muscles?? Surely that just perpetuates the difference in flexibility that is already there? And surely that means that we would run asymmetrically, creating potential for all manner of running injuries?

Balance and symmetry is so important to healthy and pain free running, so when you stretch I would recommend doing the following. Let’s take the calves as an example. Test which calf feels tighter by simply testing a stretch on each side. Identify the tighter muscle. Stretch the tighter side for 50% longer than the more flexible side. Do this protocol for every muscle that you stretch on a regular basis.

h) Have I seen a health professional? It is vital that you see a specialist running osteopath or physio. They will check your muscular balance, your spinal joint alignment, your pelvic alignment, and the bio-mechanical efficiency of your hips, knees, ankles and feet. The forces of your feet pounding the pavement are transferred quickly to the knees, hips and ultimately the lower back, which is often the last port of call. If there is any small imbalance or restriction of movement in your lower back, the forces being transferred up to the lower back will be distributed unevenly, resulting in strain and pain. Well worth the 50 odd quid of an appointment, I would say!

Click Next Page for tips to treat RLBS

Things to do to help RLBS

Do - Spend time stretching your hips and buttocks. It may sound weird unless you are a yoga connoisseur, but you can always google these poses which are all really good stretches for the hips…. Half Lord of the Fishes, Pigeon, Cow and Ghecko poses

Do - Perform the Child’s pose, which is a fabulous stretch for the lower back muscles, and takes pressure off the joints of the spine.

Do - Stretch your hamstrings, calves and hip flexors on a regular basis.

Do - try running with a low back support belt for a while. This will act as a second set of muscles, allowing yours to recover their strength and integrity.

Do - strengthen your hamstrings and glutes, as you will need their support and invariably these muscles are weak in runners.

Do - try wearing some heating pads, that can be purchased from large high street chemists. These will keep you hot for the whole day, and will promote circulation and ease pain.

Do - strengthen your upper back with gentle rowing exercises, as a strong upper back can take the pressure off a weaker lower back.

Do - Try AquaJogging. This is where you wear a buoyancy aid around your waist and run along in the water (not touching the bottom of the pool). Its a great way to train with no impact on the legs, and really forces you to use and strengthen your core muscles.

Do - Get regular sports massages. A good sports massage therapist will be able to rid your back of trigger points, and give your back an all round muscular workout.

Do - Lie on your back on the floor with a tennis ball under your back in the areas of most tenderness. Lie with the ball pressing in for about 30 seconds before moving on to the next tender spot.

Do - Consider investing in an ‘Inversion Table’. This is a table which you lie on, which gradually tilts you backwards until you are upside down, and because your ankles are strapped in, you will get a lovely stretch of the spine, essentially removing the compression that impact and gravity has had on your spine. I use one every day, lovely!