BY ANDREW WARD, PT & DPT.
“I’ve got a bad back!” Low back pain is a frequent complaint and is common in runners. Sound like you? When experiencing low back pain, it’s tempting to blame it all on your “bad back,” but the cause of discomfort is not always where you feel the pain. Often, the true cause of low back pain lies in the nearby joints. This is especially true if you experience low back pain after running but not during daily life.
Our body is one long chain of joints; ankle, knee, hip, low back, etc. Different joints have different purposes in the kinetic chain. Some joints are meant to provide stability, while other joints are designed for mobility.
Consider your ankle. Your ankle joint can rotate and bend in all directions. Now, consider your knee. Your knee functions similarly to a door hinge, allowing you to flex and extend your leg, but not much else. The ankle is a mobile joint, while your knee is a stable joint. These adjacent joints rely on each other to function properly. If your ankle doesn’t flex appropriately when you step on an uneven surface, your knee is forced to move instead, a job it is not designed to perform, forcing a stable joint to become a mobile joint. In this way, the function of one joint can affect another, possibly leading to dysfunction and pain.
Let’s look at the hips and the lower back, the next two joints in the chain. Your hips are designed to be very mobile, allowing the leg to move in all directions. Picture the Radio City Rockettes to get an idea of the full range of motion. On the other hand, your lower back is designed to stay upright and should move very little. However, if your hips are not as mobile as they should be, movements that should be performed by the hip joint end up being performed by the lower back, causing pain. This is why hip mobility is so important!
In runners, we frequently see a lack of hip extension. What does that mean? In order to run, your leg needs to get behind your body. If the hip stops at neutral and cannot move into extension the low back will extend instead, creating an anterior pelvic tilt and excess lumbar lordosis (the inward curve of the lumbar spine). Once again, your low back, a stable joint, is required to become a mobile joint.
With repetition, forcing the low back to be mobile can cause discomfort and stress in inappropriate areas. In the short term, this may present as post-run soreness, but in the long term, it may be a risk factor for more chronic low back pain.
This image from myrehabconnection.com provides a nice visual of this relationship:
If you have low back pain, consider a physical therapy evaluation. There may be a mechanical cause for your symptoms that will be picked up by a professional evaluation and gait analysis. Come see us for help!
** Disclaimer** This blog is for educational purposes only and is not written to diagnose or treat your low back pain. If you are experiencing pain, please seek professional and personalized care.**