Low back pain, we are not friends!

Have you ever had low back pain? If my readers are representative of the general population, then most of you have suffered with low back pain at some point during the year.  As a matter of fact, while in kinesiology graduate school, most classes brought up the overwhelming statistic mentioned repeatedly in the evidence-based literature, 80% of the general population suffers from low back pain at least one time each year.  Yikes! My back hurts just thinking about it.  Well, with some scoliosis and spinal degeneration according to my chiropractor, I should have back pain, but I don’t.  Does that mean there isn’t a problem if I don’t have pain? No, I do have a structural problem despite being pain free.  I also ran 42 miles last week and don’t have any pain from that either.  In my cross-training blog (May archives, runwithgina.com) I mention that the chances of injury increase when running over 19 miles per week, yet with some existing structural issues, I am asymptomatic. The bottom line is that I remain aware of my structural issues and routinely do additional exercises to at least maintain my state within what is structurally possible to minimize the potential for pain and the downward spiral that could generate from it.  As should every runner and member of the general population for that matter.

So, what’s up? Are runners at greater risk for back problems?  No more than the general population, but it is true, increased spinal compression and degeneration is common in athletes.  In upright standing alone, the lumbar vertebrae withstand 80-90% of the compressive load.  While running, the mid-lumbar vertebrae accepts compressive loads of 2.7-5.7 body weight at ground foot strike.  In a study of 25 runners, Dimitriadis and researchers (2011) measured the intervertebral disc height and position before and after one hour of running using MRI technology.  Interestingly, results showed a reduction in body height to varying degrees after the spinal loading of the run.  Although in the above study, the researchers did not re-measure the disc height after a period of time, similar research demonstrates full restoration of the disc height within 24 hours.

If you have been following the Run With Gina blogs on the Facebook page or tuning in on my website, then you may remember me blogging about the multifidus muscle in my core training blog, which can be found in the July archives.  Just as a reminder, the multifidus spans the entire length of the spine, but is thickest at the lumbar spine, with observational research suggesting it stabilizes the lumbar spine and controls intervertebral motion without compromising spinal movements or generating torque.  Armed with this information is one of the many ways that I keep my structural issues at bay without pain.  I mentioned in the core blog that the multifidus co-contracts with the transverse abdominis muscle.  A low back pain prevention training program should improve the function of the multifidus and transverse abdominis with exercises that require proximal stability (stable core) and distal mobility (moving arm or leg).  Himes et al., (2012) suggests planks and bridges, including a side-bridge progression, where distal mobility of abduction (moving away) of the non-weight bearing arm or leg is included.

Don’t get me wrong, I am not implying that the general population have low back pain because they have weak core strength…although potentially a contributor.  By the way, a general physician would more than likely tell a patient with low back pain that it is because of a weak “core”.  Low back pain as noted with functional movements of spinal flexion and extension can also be from weaknesses of the gluteus maximus, gluteus medius, and hamstring group (Nagarajan & Nair, 2010). Yes, you can find my previous blog posts on all those muscles too.  I’m going to geek out on you guys here, but stick with me because you need to pass this info along to all your friends suffering from low back pain.  When I think of all the muscles I have mentioned throughout this blog post, I immediately think of what connects all of them together, the thoracolumbar fascia. Think sausage casing, which connects all of them together, including a few others, through three slings in our bodies.  Weaknesses in one can impair the function of others.  The other day on the Run With Gina Facebook page I mentioned acting towards prevention, not cure, because cure is often difficult to find.  I had low back pain in mind when I made that statement.  Why?  Because 85% of low back pain problems are of unidentifiable pathology or commonly referred to as “non-specific” low back pain!  The answer could be in a plethora of structures in the body but unfortunately, healthcare practitioners do not have x-ray vision to identify the source of the problem, therefore making the “cure” difficult to find.

I will tell you this again, weaknesses.  Many issues in our bodies are from weak structures.  So many people want to go for pain management through massage, foam rolling, the stick, stretching, and pain medication. You think, “I’m tight”, God forbid you think, “I’m weak”.  Guess what?  Often the problem is in the weak, shut down structures both in runners and our non-running friends. So, for your non-running friends that suffer from low back pain with a non-specific origin and afraid to move because of pain, they need to move.  They need to get strong where they are weak for stability and mobility of their body.  Encourage your friends and family with low back pain to hire a personal trainer with a Corrective Exercise Certification, if they do not have access to a physical therapist or a chiropractor with a rehabilitative program.

I think I went off on this blog post folks, but I could not stop myself from delivering correct and important information for runners and non-runners to be more informed! Please pass this blog post along to friends and family, runners and non-runners!
Fight ON!
Coach Gina

References:
Dimitriadis, A.  T., Papagelopoulos, P.  J., Smith, F.  W., Mavrogenis, A.  F., Pope, M.  H., Karantanas, A.  H., Hadjipavlou, A.  G., & Katonis, P.  G.  (2011).  Intervertebral disc changes after 1 h of running: A study on athletes.  The Journal of International Medical Research, 39(2), 569-579.

Himes, M.  E., Selkow, N.  M., Gore, M.  A., Hart, J.  M. & Saliba, S.  A.  (2012).  Transversus abdominis activation during a side-bridge exercise progression is similar in people with recurrent low back pain and healthy controls.  Journal of Strength and Conditioning Research, 26(11), 3106-3112.

Nagarajan, M., & Nair, M. R. (2010).  Importance of fear-avoidance behavior in chronic non-specific low back pain.  Journal of Back and Musculoskeletal Rehabilitation, 23, 87-95.