We often get asked, "Is it normal to have back pain while running?" While running can be a strenuous exercise and we experience three to five times our body weight with each impact, it is not normal to have back pain when running. There are many causes of back pain for runners and we will concentrate on a few of the more common reasons we have observed over the years.

Running Shoes and Your Feet

Believe it or not, the cause of your back pain may start in your feet. Any time a runner complains to us that he has developed aches and pains without having changed his training regimen, we often look at their running shoes and feet as part of the problem. If you do not change your shoes often enough, you run the risk of not having enough shock absorption and the result is that more stress is transmitted through your body and to your spine as well. You have to remember that the cushioning of the shoe is in the midsole, so your outersole may look barely worn but after many miles the midsole materials compress and you lose shock absorption. If this is the cause, changing to new shoes will immediately give relief. The other issue with running shoes is whether you are in the correct shoes for your feet and gait. It is amazing how many runners continue to wear improper shoes. We have numerous qualified running specialty stores in the region so it is not worth trying to save a few bucks at the mall or online at the expense of your health. The other issue with your feet relative to your back is whether or not you need additional support due to pronation, flat feet, high arches, etc. At our office we utilize shoe analysis, gait analysis, and a weight-bearing scanner to assess these issues.

Sacroiliac Joint Dysfunction

A common cause of back pain in runners is problems related to the sacroiliac joints (SI for short). If your pain is lower in your back and off more to one side or the other, this may be the culprit. Runners with SI joint dysfunction and inflammation often will tell us they have pain by this bump they just noticed on the right or left (more rarely both). Well, the bump has always been there, as the SI joints are large joints where the hip and back come together; you are only now paying attention to it because it hurts! The SI joints need to move fluidly and symmetrically for a smooth and pain-free gait. If one "locks up" and inflames, the runner will notice pain upon impact on that side and it can often have secondary effects to associated muscles like your piriformis, glutes, and hamstrings. Icing after runs will help the inflammation but manipulation of the SI joint may be necessary to restore proper functioning.

Facet (joint) Jamming

The fancy term is imbrication, but either way it is painful. Each vertebra of the spine has joints on each side and there are two with the vertebra above, and two with the vertebra below. Any undue stress on these joints can result in inflammation and pain and there are numerous causes for this condition, including some of the ones we have already discussed. Other causes can be increased weight gain, imbalanced muscle flexibility, weak core strength, excessive downhill running, alignment issues of the spine causing unequal loading of the joints, and other structural issues that are congenital (things we were born with).

Short Leg Syndrome

Many runners think having one leg shorter than the other is "normal." This is a misconception. While having one leg shorter than the other is common, it is certainly not normal for a runner who wishes to stay healthy. Having one leg shorter than the other causes unequal loading from one side of the body to the other and may lead to some of the conditions already presented. Picture doing a run on a slanted road for many miles; eventually it becomes very irritating and you cannot wait to cross to the other side. Having a shorter leg will provide the same unequal stress over many miles. The important thing is to determine whether you have an anatomical short leg (one leg is actually shorter in bone length) or a functional short leg, which is due to a structural alignment imbalance. It is important to determine which type you have for the proper remedy. Simply shoving a heel lift under the shorter leg is not enough and can actually make the condition worse in some cases.

Finding the cause of low back pain in runners is like trying to find all the correct pieces of a puzzle. Back pain is a symptom, but the important thing is to determine the cause. The above causes and conditions only scratch the surface. There are also issues related to arthritis, degenerative disc conditions, infection, and conditions or illness unrelated to your back that can refer pain to your back. All of these things need to be considered. That is why it is important to get an evaluation from a qualified doctor or therapist who specializes in the treatment of runners. You do not have to rely on anti- inflammatory medication and ice, and you certainly do not have to run with low back pain. You can run away from it!

Dr. Neil P. McLaughlin, Certified Chiropractic Sports Physician, and Dr. Ronald S. Kulik, Chiropractor, have been evaluating and treating runners in the National Capital area for 17 years. They are also well known for their running and coaching exploits and are sought-after public speakers on topics of health, wellness, and fitness. If interested, please contact them at Commonwealth Chiropractic Center of Reston, (703) 742-7856, or www.cccreston.com.