Back pain is a common problem in runners
Running places a high level of repetitive stress on the back and pelvis, and for those with previous or current lower back problems it is particularly important to take measures to reduce the strain on these areas. For all its strength and versatility, the spine generally doesn’t cope well with abnormal or sudden and excessive forces. For runners, this can occur as a result of abnormal stride mechanics or strength imbalances.
What goes wrong to cause back pain in runners?
Stiffer hip joints, longer stride length, tight hamstrings and overactive hip flexors can result in excessive forward/backward tilting of the pelvis and lumbar spine. Poor hip/foot stability, longer stride length, stiffer hip joints or weak hip muscles can result in increased sideways tilting of the pelvis. Each of these causes forces the pelvis to move which then causes excessive movement in the lumbar spine. Additionally, this effect can be more pronounced and easier to trigger if the spine itself is stiff. This stiffness may be related to previous back injury, wear-and-tear or a prolonged period of irritation of the area.
Excessive forces due to muscle action can also result in lower back pain. For example tight or overactive hip flexors can cause trouble during the stride while the leg is behind the centre of body weight. As the leg moves backwards the hip flexors pull directly on the spine, creating a forward shearing force on the vertebrae. Once the leg lifts off the ground, strong forces from overactive hip flexors add to the shearing forces. By comparison, tight/overactive hamstrings exert their pull while the leg is in front of the body, causing a backwards tilt in the pelvis which can add load to the back.
What can you do?
Any treatment should be targeted at the cause (or causes as there are often multiple). So firstly, a thorough assessment evaluating spinal function, muscle strength and joint mobility is essential. Once the problems have been identified, individualised treatment can begin. This will generally involve techniques to improve the mobility of the spine, pelvis and hips like manipulation and/or mobilisation. Exercises to strengthen weak muscles and stretching to relax tight muscles might also be prescribed. Advice on activity modification might involve a short period of reduced running load. A referral to a podiatrist for a review of your footwear may also be appropriate.
