While we think of injuries to the feet, legs, knees, and hips as "running injuries," we consider back pain less of a running injury per se, and more of a nuisance that happens to interfere with our running. You might ask "so what?", why is this important? This is important because if you treat your back pain as a running injury, you can adjust the frequency, duration, intensity, and style of your running to help your back pain heal faster.
What causes low back pain from running?
Runner's low back syndrome (RLBS) is not a medical term. I tend to use this term to group the four most common causes of low back pain from running into one category. Despite the vastly different circumstances, I group these back injuries purely because they often occur at the same time, and the self-help treatments I recommend cover all four conditions at the same time, and can sometimes be effective in relieving pain no matter what kind of problem is present. The four conditions are:
1. Facet joint stimulation
The spine is made up of members called vertebrae. These vertebrae are connected to each other by the intervertebral discs in the front (you know, those vertebrae that slide!) and the joints in the back. If you have a sizable depression in your lower back (like a dancer or gymnast) and weak abdominal muscles, these joints may become inflamed and inflamed, and you can feel pain while running.
2. Sacroiliac joint dysfunction
The sacroiliac joints are the two joints on either side of the lowest part of the back above the hips. They're easy to find because they're next to the two gnarled bones in your lower back. There are also two dimples on the skin covering the joints, called "Venus Dimples" (Google it if you don't believe me!). If we hit the ground with one foot heavier than the other while running, we may put too much pressure through one of the sacroiliac joints (rarely through both joints at the same time) and irritate the joint and make it inflamed and painful .
3. Weakness of the back
This is what it says. Well, actually, maybe it's not what it says it is. It's a weakness in the lower back muscles that causes loss of control when running, but it's also a weakness in the abdominal muscles. These two weaknesses create a global vulnerability in the lower back, which means that when we get tired from running, the muscles can't control movement, which can lead to pressure on the spine, and therefore pain.
4. Myofascial trigger points for lower back muscles
Weak muscles tend to do two things in response to stress. They are either full cramps or small muscle cramps that cause very tight nodules in the muscles that we call trigger points. Both of these reactions tend to happen towards the end of the really important game (following "McCarthy's Law", ie Soder's Law is too optimistic!). The result is that we experience moderate to severe pain while running that doesn't seem to stretch easily.
Identifying Lower Back Syndrome in Runners
You should suspect that you may have RLBS if you feel -
1. Lower back pain during running that occurs during running, usually 10-15 minutes after running.
2. Pain that may involve the hip but not lower than the knee and is not accompanied by tingling or numbness in the leg.
3. Pain and tenderness while running, above or around one of the two bony spots at the base of the lower back. (Dimples of Venus).
4. Leaning back or sideways often exacerbates pain, although myofascial trigger points can make it difficult to put on shoes while sitting.
5. Your back often feels stiff and weak, especially but not limited to running.
6. Pain occurs for no reason. No apparent injury occurred.
What causes low back pain from running?
If you think you've developed RLBS, it's useful to ask yourself some questions:
1. Have I been on a business trip recently and slept in an unfamiliar bed, not necessarily the best bed? Often sleeping in an unfamiliar bed can make us vulnerable to low back pain because it puts pressure on the tissues of the lower back. This is especially true for runners who really need good back support as we recover from training sessions overnight (another good reason not to visit in-laws at Christmas!).
2. Have I significantly increased the intensity, length or duration of my run, or am I about six weeks into my first marathon? The most common time people feel RLBS is about six weeks after training, when we start increasing our running volume. Every run creates a little stimulation for all joints, and then the body heals and gets stronger. But adding a workout you're not used to (and possibly going too fast) may cause your body to simply not have time to heal the irritation before your next run. If this happens a few times, you will inevitably start to hurt.
3. Do my running shoes provide adequate support or cushioning for my feet (do they fit me?) or are they really worn out? I mention this regardless of the type of running injury, as it's important to get the right shoes and replace them before they wear out. The cushioning of a good new running shoe helps reduce the impact of the foot hitting the lower back. Of course, it's best to make sure you're training on grass or other softer surfaces, rather than always pounding on the tarmac.
4. Have I been focusing on my core strength? The muscles around the torso provide a secure belt or corset that increases lower back stability under running pressure and reduces spine fragility. Exercises to develop core strength can be easily learned from Pilates classes or videos, yoga classes or videos, personal training sessions or just doing some good old reliable planks (front and side rows please!).
5. In the past year or so, have I injured my feet, knees, or hips that could have a knock-on effect on my lower back? The leg bones connect to the thigh bones, which connect to the lower back….. In such cases, timely visits to a professional orthopaedic surgeon or physical therapist can help reduce or eliminate the adverse effects of these injuries.
6. Have I run a lot of hills? Many people can put pressure on the lower back by not realizing they keep their core strong when going downhill. Tightening your abs when descending a steep incline can take the pressure off your lower back.
7. Will I run asymmetrically because some muscles on one side are tightened? Everyone's muscles are tighter on one side than the other. So why do we spend the same amount of time stretching both calf muscles when we stretch? Surely this only perpetuates the flexibility differences that already exist? Does this of course mean that we run asymmetrically, creating the potential for all kinds of running injuries? Balance and symmetry are very important for healthy and pain-free running, so when you're stretching, I recommend doing the following. Let's take the calf as an example. Test which calf feels tighter by simply testing the stretch on each side. Identify the tighter muscles. Stretch the tighter side 50% more than the flexible side.