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.

The post Lower Back Pain in Runners: Causes and Common Myths appeared first on Fast Running.

A stress fracture is a classic overuse running injury and can be very common amongst long-distance runners. It first begins with a micro-fracture developing when the loads and stresses placed on the bone exceed its ability to manage with the strain, remodel and heal.

The accumulation of this microtrauma from a repetitive activity such as running results in fatigue failure in the bone. Under normal circumstances, the body and can cope with this with appropriate rest and training, but if the microtrauma continues excessively then this can lead to a stress fracture developing.

What causes a stress fracture?

Just as with any other injury it is helpful to both runner and the treating clinician to understand the possible factors that may have contributed to the development of the fracture. Excessive mileage, a sudden increase in training and not enough rest are factors that can contribute to a lower limb fracture.

It is also worth looking at the surfaces the runner has been training on, the condition of running shoes or new shoes, and whether the runner has been using equipment inappropriately, such as a weighted vest.

Nutrition and diet can also be contributors to a stress fracture first developing. Particularly with female runners, poor nutrition and irregular menstruation can increase the risk of a stress fracture. And then there are other risk factors that are more intrinsic such as muscle weakness, biomechanical issues and pre-existing medical conditions.

For more on nutrition and stress fractures read ‘7 Nutrients & Foods That Help Prevent Stress Fractures‘.

Signs you may have a stress fracture in the lower limb

The main symptom of a stress fracture is pain which usually develops gradually, and the pain is further aggravated by exercise. Occasionally the pain can occur while walking or with rest and can become an issue at night. There will be tenderness on the site of the fracture e.g. if the stress fracture is in the shin bone (tibia) then the shin will be tender.

Most common stress fractures in runners

The shin bone (tibia) is the most common site of stress fracture for endurance runners followed by the metatarsal bones of the foot.

Stress fractures of the navicular bone of the foot tend to occur more often in sprinters, middle distance athletes and jumpers.

Stress fractures of the neck of the femur (hip) and the pelvis are less common but do occur in endurance runners.

What to do?

If a stress fracture is suspected then the first thing to do is to get help. Other overuse injuries need to be ruled out first and it may be that a stress fracture hasn’t yet developed but the warning signs are there. Your GP or sports doctor may also decide to investigate further with an X-Ray, MRI or ultrasound scan to confirm the diagnosis.

How is a stress fracture treated?

The main management for any stress fracture initially is rest. This will mean rest from the activity that aggravates the pain, usually weight bearing, so possibly no running for a while.

The imposed rest period will vary depending on the site of the fracture and its severity. In some cases, an air cast splint (a great big boot) can be used if the fracture is in the lower part of the leg to enable some weight bearing while the pain settles.

Depending on the site of the fracture through the treatment may be slightly different and may require longer periods of rest and in some cases further investigations to establish a cause.

As pain reduces and the tenderness at the fracture site settles, you can begin activity again under the guidance of your clinician. For runners, cross training such as aqua jogging will enable you to keep your fitness levels up until weight bearing activities are permitted.

Strength work may also be advised if weak supporting muscles were found as a possible contributing factors. As a physiotherapist, I have had success with walk/run programmes while rehabilitating runners with stress fractures. It allows gradual loading of the fracture site without overloading the area and causing a relapse in pain.

Preventative measures

It may sound simple, but the best thing you can do is try and avoid a stress fracture occurring in the first place. Training smart, and avoiding overtraining, excessive mileage and progressing too quickly in new activities or sessions are all ways to help prevent the overload of tissue such as bone.

Revisit your diet to ensure you are eating the required nutrients for bone health especially if we are running high weekly mileage. If you are unsure, it might be helpful to get professional advice from a qualified dietician with experience in sport. Female runners who are prone to missed periods need to seek advice from their GP as nutrition; the menstrual cycle and bone health are interlinked.

Also, make sure you have adequate recovery time for the body to have adequate time to repair in between hard sessions.

It is important to note though that a stress fracture doesn’t mean your running is over, and with the right treatment, advice and considerations of the factors that may have caused the injury in the first place, runners can get back out there after a stress fracture, pain-free.

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.

The post Stress Fractures: Everything a Runner Needs to Know appeared first on Fast Running.