Low back pain can be a frightening experience for a runner, especially with all the myths you hear from others in the running community.
More than any other injury, pain in the lower back produces feelings of fear and uncertainty because acute back pain can be debilitating and potentially have a huge impact on racing and training plans. The good news is that acute low back pain does get better and most episodes of back pain are self-limiting, so it does not mean the end of your running.
By debunking some unhelpful myths about back pain you can concentrate on becoming pain-free and getting back out on the road, trails and track.
What causes acute low back pain?
Acute low back pain is usually an indicator of lack of control or fatigue within the tissues rather than an overload of the tissues. Runners with an acute episode will often recall a specific incident that triggered the pain such as overstretching, a trip or fall or twisting awkwardly. Did you twist running around a tight corner or slip running on wet ground?
The pain will worsen as inflammation develops and can be central in the low back or to one side and can even radiate into the buttock region.
People often focus on the structure or tissue that is responsible for the pain but there are many structures in the low back that can give rise to back pain: ligaments, muscles, fascia, the intervertebral disk, joints of the spine known as facet joints, the sacroiliac joint just to name a few.
90% of low back pain is non-specific i.e. cannot be connected to a specific structure, and tends to settle within 6-7 weeks of onset.
An acute episode of low back pain will not always require an X-ray or an MRI scan. In fact, most episodes of low back pain will resolve with no investigations being performed. It is common for people to want to know whether there is ‘a disc out’ or if their ‘spine is crumbling’ but these are unhelpful terms and actually what is found on a scan very rarely changes the management of acute low back pain.
Your doctor will be able to give advice on pain relief if you’re struggling to manage the pain but usually over the counter medications are sufficient.
What can you do?
Managing the pain is the first thing to do because if you can effectively manage the pain then you will be able to keep moving. Pain relief may take the form of anti-inflammatories taken with paracetamol. Other ways of managing the pain include heat or ice therapy.
Visiting a physiotherapist, chiropractor or osteopath may be of benefit as they can advise on the best exercises to keep you mobile, to reduce pain and maintain your flexibility. They can also perform any other pain relief methods that they feel may be of benefit. These could be soft tissue techniques or acupuncture (although not all therapists are qualified to perform acupuncture).
Going forward for runners, it may be beneficial to ask you treating therapists about exercises that can help strengthen the low back and prevent it from impacting your running again. As the pain subsides you will be able to try low-impact activities such as swimming and cycling before progressing back to running. If you have concerns that your technique may be responsible for causing your low back pain then this is worth discussing it with a running coach or therapist.
What about other symptoms?
If you are experiencing other symptoms such as persistent leg pain, pins and needles and/or numbness along with weakness in the lower limb you need to see your doctor or your therapist for a further assessment. These symptoms usually mean a nerve in the low back is inflamed. Again nerve pain can settle in time but may take longer than just low back pain alone.
Common myths about low back pain
‘I will have to give up running’ – This is not the case at all. As with most injuries, low back pain needs time and the appropriate rehabilitation and exercises, but it is not a sign that you need to give up running. In fact, running can help strengthen the spine.
‘I’m going to end up in a wheelchair’ – have heard this from a patient who had low back pain and he believed that he would need a wheelchair. I had to reassure him that he would not be needing mobility aids and that he needed to keep moving.
‘I will need an operation’ – It is very, very rare that acute low back pain would ever require an operation. Most episodes are for benign reasons and settle quickly.
‘My doctor says my spine is crumbling/my discs are popping out/my nerves will be damaged’ – Scans and X Rays will show age-related changes within the spine, the majority of which start to happen from our twenties to thirties.
Most of what a scan shows has no relation to the current painful episode and would have been there regardless. The best thing to do is to chat through any concerns with your therapist. But unless you have a more sinister pathology, spines are incredibly robust and do not crumble!
There are other causes of low back pain in runners such as stress fractures. A stress fracture in the spine is known as a spondylolysis and do require an investigation to confirm the diagnosis. A stress fracture of the spine sounds scary and again could conjure up images of wheelchairs and surgery but depending on symptoms this condition can be managed conservatively with a graded exercise programme under the guidance of your clinician or therapist.
About the Author
Kathleen Walker is a physiotherapist, runner and owner of Fast Track Physio. A lover of track, road and cross country, Walker has over ten years experience in treating all levels of runners, from beginners to elite.