Transcription:
Dealing with Back Pain After Running

Introduction: This is BayCare HealthChat, another podcast from BayCare Health System. Here's Melanie Cole.

Melanie Cole: Welcome. This is BayCare HealthChat. I'm Melanie Cole and today we're discussing dealing with back pain after running. Joining me is Dr. John Gross. He's a Family Medicine and Sports Medicine Physician with BayCare. Dr. Gross, so many people are runners, so many people like to get out there and pound the pavement. We've always heard about our knees, right? But is running considered hard on the back?

Dr. Gross: It unfortunately very much can be. And so first of all it's my pleasure to be here. Thank you for asking me to speak on this topic, which is unfortunately very near and dear to my heart as a I am a runner and a triathlete and had some pretty bad problems with back pain despite all the education about it. I got to learn the hard way that the back can be affected by running. The first point that I would make is that if you are having back pain either during running or after running, it should never be ignored. All too often we have athletes that feel like they should run through the pain, to take time off would affect their training and their endurance. Back pain is one of those injuries that can be just detrimental to varying degrees to that athlete's health. And so, if I can't emphasize anything else, it should not be ignored ever. Now that being said, there's different kinds of back pain and to be very general, there's bone related pain. There's what's called discogenic pain or pain that's related to the disc in between your vertebra and muscle related pain, which is actually the most common source for back pain in runners. And the specific traits of the back pain that you have are important in discerning between those three types of pain. And so that's where the discussion with your physician when you meet with them is going to be the most helpful as far as discerning how to treat your back.

Host: So that's great information. So now before we have back pain, let's talk about some things that people can consider. Hamstring strength and flexibility and shoes. Will you touch on those? If they are at all involved in helping to prevent back pain even a little bit.

Dr. Gross: Hamstrings are actually the key for keeping your back from straining against the plodding impact of running. All too often we have runners that have just very tight hamstrings. And if you can imagine in your mind's eye tight hamstrings, actually rotate your hips backwards, putting a strain in straightening out the lower portion of your lumbar spine. And so that creates an awkward transition of force as your heels strike the ground. So if you have limber hamstrings, you don't have that rotation of the hips as much, and the lower back has the normal curvature that allows for that spring or shock like mechanism that we like to see as far as absorbing the shock that comes with running. So hamstrings in my opinion, are the key to preventing a lot of back pain and making sure that you're limber there. And you know, it doesn't matter how you do it through massage or through your own stretches or, you know, warming up to stretch.

Keeping those hamstrings limber are definitely a big part of it. Now your feet is how you are, that's how you articulate with the earth. And so how your feet land on the earth, you know, the old song goes, the feet bones connected to the leg bone and leg bones connected to the hip bone, all the way up to the back. And so it starts with your feet knowing whether or not you have high arches, knowing whether or not you are a heel striker or you, run on your fore feet. That's all those things play into risk for back pain later on. And so I am actually a big fan of going to the running store and having one of the sales persons, you know, look at your feet, do the video tape on the treadmill, and seeing what your gait in general is. If you have a lot of heal translation, whether or not you are a supinator or a pronator, and then finding the shoe that will support your foot the best for the types of running that you're doing. In general, that can prevent a lot of back pain. And frankly, consternation later on.

Host: Well that is such great, usable advice for the listeners. So if they do have back pain, do you advise they stop running, for how long and when can they get back into it? Or can they start walking and doing it that way? What do you, what do you want them to do?

Dr. Gross: So in general, you got to listen to your body like, I preach that all day and every day you have to listen and it's going to talk to you and don't ignore it. It really does depend on the type of back pain. And so if you want to speak in the general terms that we've referenced before, muscle related pain usually is self-limited. So you ice it, maybe even use some anti-inflammatories and do some light stretching. The muscles will heal relatively quickly, but you will want to do exercises that are non-running related. Swimming is the big one to not have that kind of impact on the muscles that are affected by the injury. Bone related pain, usually associated with osteoarthritis of the hips or the sacroiliac joint can be inflammatory in nature as well. And a lot of times responds to rest. Discogenic pain though is a whole different ball of wax and that's where a lot of times we'll see back pain that's associated with the kind of shocking pain or nerve pain that radiates down your leg or into your buttocks. And that you definitely need to stop running.

You definitely need to confer with your physician and maybe even have imaging, especially if the back pain is long lasting. And even, I'm going to throw out some numbers but it's all different for the, in the context of the specific athlete. But if you have back pain for more than four weeks, you should likely see a physician and you will most likely have some imaging done to further objectify what the injury is all about. Whether or not there's a bone related injury or if it's discogenic, an MRI can a lot of times elucidate just how much of the back pain is associated with a disc injury. So you know, a lot of times it is working with your physician to finding the smart way to rest your back. And one thing that I push and propose to my patients often is using physical therapy. Once we start to see a good amount of improvement as a springboard to get back into activity. So it is under supervision and you've got someone giving you very specific exercises to embellish the benefit you've had thus far and then you use that to spring back into your running regimen that you had prior to your injury.

Host: Wow. What great advice, if you were to wrap it up for us and give us your best advice about running and as a runner and triathlete yourself and back pain, pains that we develop, whether they're in our back, I mean runners come up with all kinds of pains but specifically back pain, what would you want them to know? What's your best advice, Dr. Gross?

Dr. Gross: First things first is to not ignore. So I'll reiterate that point. Don't ignore the pain. And the second is to pay attention to the when and the where and the how of the pain as you are running. Do you have it before you start running? Do you have it after you start stretching? Do you have it at mile X of your running? Is it only after you've stopped running that you have the pain? All of those are very helpful clues to your physician as they try and get you back out there.

Host: Thank you so much, Dr. Gross for coming on and sharing your expertise with us today. What great information. That concludes this episode of BayCare HealthChat. Please visit our website BayCare.org for more information and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. Be sure and share this show with any runner friends that you have, because the advice that we've given today was just excellent and can help so many people. For more health tips such as these and updates, please follow us on your social channels. I'm Melanie Cole.