Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and throughout the western world.
It is also the most common source of pain for runners. Runners often suffer from low back pain due to prolonged sitting and weak core muscles.
LBP can be safely self-treated if you handle your pain and symptoms quickly. In this post you will learn how to implement prevention strategies during exercise in order to avoid episodes of LBP.
Low Back Pain Prevention for Runners
Sitting to Much!
Sitting is a major risk factor for LBP as many runners like to travel for destination races. Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments. It also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function. Now combine all of these risk factors with running 26.2 miles and a long car ride!
- Limit your sitting. Limit the amount of sitting that you spend at one time. Move from your sitting position every hour, and ideally, walk. If you aren’t able to walk, then try to shift your position at least once every twenty minutes. Frequent position changes can help to avoid LBP. Avoid a long car trip directly before or after a long run or a race. For destination races, it’s best to arrive at least a day or two early and wait a day prior to returning home.
- Sit with correct posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve. A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.
Weak Core Muscles
Often when we hear about low back pain, we also hear about core muscles. Core muscles are part of the body’s natural method of stabilizing the spine. The core muscles, along with intra-abdominal pressure, help to form the round cylinder that is utilized to support the spine. The core actually consists of two separate groups of muscles, the inner and outer core muscles.
Inner Core Muscles
The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine). The TVA wraps all the way around the stomach and attaches to the spine. This is what helps to form the cylinder. When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine. When this is performed, it is known as the Valsalva maneuver.
Outer Core Muscles
The other muscles that help to support the spine are known as the outer core muscles. These muscles are responsible for movement of the trunk and spine as well as aiding in stability. The inner core muscles do not actually produce any trunk or spine movement.
The outer core muscles consists of the following muscles: lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors).
The glutes, hamstrings, and quadriceps may also be referred to as outer core muscles by many people. The rectus abdominis, “the six pack” muscles which are responsible for lumbar flexion, don’t aid much in spinal stability although they look cool!
- Most runners don’t spend enough time strengthening their core muscles. In Effective Core Training for Runners, Angie addresses how core work provides your body with a solid foundation, gives your legs more strength, and increases your running efficiency. Angie is absolutely correct. When designing a program, all of the muscles of the core need to be exercised.
- My Low Back Pain Prevention Guide for Runners.pdf (complete with detailed exercise descriptions and photos) specifically targets and strengthens the muscles of the inner core as part of a LBP prevention strategy. Focusing on mobility and lumbar strength on a regular basis has been proven to help prevent episodes of LBP.
Moves that Help Prevent Low Back Pain
Perform standing back extensions. After any prolonged sitting, stand up, and perform standing back extensions. I encourage performing at least 10 repetitions each time you stand. As you spend more time slouched or flexed, it is critical that you also counteract with extension biased movements. The spine is designed to move in all directions, not just forward. The repeated movement into extension also helps to improve circulation and blood flow into the spinal discs. This allows for vital nutrient exchange and provides a gentle range of motion of the spinal structures.
Stretch your hip flexors. After performing standing back extensions, it’s time to stretch your hip flexors. The hip flexors tend to tighten during prolonged sitting. Spasms in this particular area can cause LBP because the hip flexors attach directly to the spine.
Stand with upright posture, with your feet straight ahead, and bend your front knee until you feel the opposite hip flexor stretch. Hold for 30 seconds, and then repeat two to three times on each side.
Perform press-ups. Lie on your stomach and perform 10 to 20 press-ups before you leave from home, when convenient and safe during your travels, and when you arrive at your destination. I also recommend press-ups as part of a warm up and cool down strategy. Move slow and easy, but work your way up to full motion. I encourage performing this multiple times a day as time allows. When possible, press-ups are preferable compared to standing back extensions.
Stretch your hamstrings. A great static stretch for your hamstrings is known as the doorway stretch. Find a doorway and stretch your hamstrings before you leave from home, when convenient and safe during your travels, and when you arrive at your destination.
I recommend at least one minute per side and preferably two repetitions per side. There are other more active methods of stretching your hamstrings that are more appropriate before a work out. Static stretching may impede performance and should be performed either after prolonged sitting or after a workout as part of a thorough cool down.
Perform core strengthening exercises. Lumbar extension strength is critical to avoiding LBP. Certain studies report that as little as 10 minutes a week of focused lumbar paraspinal muscle strengthening is an effective method to control and prevent low back pain. I recommend starting with the superman and bridge exercises (as shown in the prevention guide above).
LBP Prevention Strategies during Exercise
The following strategies are designed not only to avoid episodes of LBP, but to enhance sport performance and recovery. A warm up should be a multifaceted approach in order to prepare the body for movement and activity. If the exercise or activity is performed first in the morning or after a day of sitting or sedentary activity, then the warm up is even more important.
- Cardiovascular warm up. The idea is to increase blood flow throughout the body, but particularly in the core muscles and spine. This allows for improved mobility and also promotes healing as movement is necessary to bring in nutrients. Walk initially, and then progress into a light jog for 3-5 minutes in order to increase the heat rate.
- Dynamic warm up. After the initial cardiovascular warm up, progress into a dynamic warm up series which involves warming up the muscles and joints of the spine, pelvis, and lower legs. Adequate mobility in the hamstrings, hips, and pelvis will insure lower leg mobility in order to perform your specific exercise or activity. Perform exercises such as forward and backward leg swings, side to side leg swings, and running specific drills such as butt kickers, strides skipping or bounding. Utilizing a foam roller as part of a warm up is acceptable. However, I don’t advocate static stretching before activity as it has been shown to decrease force production and performance.
- Cool down. After your run, be sure to take extra time to cool down and stretch. Start with a slow jog, and then progress to walking until your heart rate returns to normal. This is an excellent time to utilize the foam roller as well as perform static stretches and press-ups.
Implement these prevention strategies during exercise in order to avoid episodes of LBP. Avoid prolonged sitting and work on strengthening your core muscles. Seek help early from a running coach, physical therapist or physician if you are experiencing chronic pain or just struggling with an aspect of your training. Running and fitness is a lifelong pursuit. If you are injured or just not having fun, then you will not stay engaged and motivated in the long term.
If you are prone to LBP and want to dig deeper into self-treatment options, I highly recommend reading Robin McKenzie’s book, Treat Your Own Back. His method is the easiest, yet most effective, method in self-treating and managing low back pain.
If you handle your pain and symptoms quickly, LBP can be safely self-treated. If you’re not experiencing relief after two to three weeks of aggressively managing the symptoms, contact your medical professional for an assessment and help in managing your LBP. For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.