Running with back pain... ouch!
By Michael Gordon, MD, Milwaukee Orthopaedic Group, Ltd. Orthopedic Surgery, Sports Medicine Fellowship
We've all experienced it... that sudden sharp pain in our back or waking up with a sense of stiffness in the low back that just won't go away. Back pain, a fairly common complaint amongst runners, can be attributed to a number of possible sources. However, it's important to distinguish the pain that shoots down a person's leg ("sciatica") from "back pain" which stays in the lower back.
Sciatica – or radiating pain, is generally associated with an irritation of a nerve exiting from the spine. In most cases, this is due to a herniated disc or arthritis of the spine. On the other hand, pain that lingers in an athlete's back is almost always due to a "musculoskeletal" source triggered by a strain of the many muscles used to stabilize the spinal column. Other causes of this pain can also include arthritis of the spinal column or a degeneration of the discs that act as shock absorbers throughout the spine.
Here's another one of my quick anatomy lessons: The spine is composed of a column of 24 bones separated by gel-like discs. Running through the middle of these bones, as well as sending out a pair of nerves at each of the 24 levels, is the spinal cord. Stability of the column is dependent on the bony anatomy, multiple ligaments, the "stiffness" of the gel discs, as well as the many muscles that connect these bones.
There are 2 major groups of muscles that are responsible for holding your back together. The first group consisting of a column of 3 muscles lies adjacent to and travels along the entire length of the spine. The other group, comprised of multiple little muscles that run at a variety of angles, connects the bones at each individual level. Additional secondary muscles help to stabilize the spine and are involved with functions such as flexing the hips.
Why is back pain such a big deal to runners? The answer is related to the role that all of the muscles along the spinal column play in protecting the spinal cord, as well as keeping the brain from experiencing too much shock from each step. Just as the repetitive nature of running can lead to injury within an athlete's major leg muscles, the spine can experience the same problems.
Treatment of lumbar strains is determined by the presence or absence of radiating, or radicular, pains, along with any loss of nerve function in the legs. Worth noting, nerve loss can exhibit itself in the form of numbness/ tingling, muscle weakness, or absence of reflexes. In the most severe cases, patients can lose control of their bowel and bladder functions making this condition a true surgical emergency. If a patient is exhibiting any neurological compromise, I strongly rely on additional work-ups, specifically, x-rays or an MRI.
When pain is isolated to the lumbar spine area, treatment is based on controlling the acute symptoms, along with preventing future reoccurrences. I generally recommend a gentle stretching program and the use of a heating pad to try to loosen up the tightened muscles. To assist with this, I'll often prescribe physical therapy accompanied by deep tissue massage. Anti-inflammatories, muscle relaxants, and pain relievers may also prove to be beneficial.
Here's the key: To help prevent an initial injury or a reoccurrence of back pain, a core strengthening and stretching program is vital. The focus of your program should be on stretching and strengthening the muscles of the low back, abdomen ("6 pack") and hips. There are many ways to strengthen these muscles. The easiest is to concentrate on sitting, standing and walking with good posture.
It is important to note that several very serious conditions can cause back pain, including pancreatitis, aortic dissections/aneurysms and kidney stones. If you experience back pain that is out of the ordinary, don't ignore it! Seek medical care from your physician or at the nearest emergency room.
Dr. Michael Gordon, of the Milwaukee Orthopaedic Group, Ltd. is an orthopedic surgeon with a fellowship in sports medicine. For questions, you can reach Dr. Gordon at 414-276-6000.