Low back pain while running..a real problem in the but? Part 1

There are a number of causes of low back pain in recreational joggers. However, what many people may not know is often the pain can be attributed to other areas rather than the low back.

To believe the body works as different compartments is a false notion. Our body works as a complete unit and in synergy together during exercise. Jogging and running is no exception to this concept. This is why back pain usually can be caused by problems in your hips and buttock region. That's right ...your low back pain could be significantly reduced by addressing muscles in your but.

I don't understand??

1. Your Gluteus Maximus is the biggest muscle in your buttocks area. Although this muscle has many roles in running it is involved in extending your leg through the swinging phase. When the muscle is not firing properly or inhibited, your leg will not extend to a full range of motion it is capable of. Inhibited simply is a term used to describe a muscle which is weak not due to pain or neurological cause.

When the Gluteus Maximus is not as strong or efficient the body has to compensate by finding other ways to achieve the range of motion it would like. So what runners will do without even realizing it is extend or hike their back to gain that extra range of motion.

2. A second muscle involved in this type of faulty running behaviour is the Psoas muscle. This is a muscle which crosses the front of the hip joint. While running the Psoas is involved in flexing the hip forward. Needless to say the Gluteus Maximus and Psoas are contently battling against one another as you run. One helps bring your leg forward as the other brings it back..over and over again.

This is why a Psoas muscle which is tight can also decrease the extension you achieve in your hips. Thus causing you to compensate again by arching your back.

3. Putting it all together - This combination of a weak Glut Max and a tight Psoas muscle will lead a runner towards a compensating gait. Now your back is exposed to extra forces it does not need on a consistent basis.

Its important when running to allow most of the movement to occur from your hips and allow the back to stay neutral. By creating this running technique back pain may be prevented and decreased significantly.

How do I know I have this problem?

Well any type of back pain should be addressed by a trained professional. This is because there can be multiple causes for the pain. It is important to rule out a serious pathology. However, there are ways to see if you have this particular problem. You may need a partner or again someone trained to observe different movement patterns.

1) Your gait - Sometimes this subtle hiking of your back can be seen from a partner while watching you run from a side view. Videotaping patients while running on a treadmill is a great learning tool to use as well.

2) The tight Psoas - You may just feel the tightness in general but can still use different test to see if it is tight.

On a gym bench or table lye on your back with your buttock at the end of the table. Allow your legs to hang off the bench freely. With your hands take one leg and bring your knee towards the chest. If the opposite leg comes off the table almost immediately or in an excessive range this can indicate a tight Psoas. This same test is often used by manual therapist and is called the Modified Thomas test.

3) A inhibited Glut Max- This is something that is very tricky to test for. That is because it is hard to assess how the Glut will function in isolation from other muscles. Seeing how much you can squat is not exactly a reliable measure. It's important to assess how does the Glut Max work in motion which resembles a running gait. Many manual therapist use what is called the Janda Prone Hip Extension Test (named after the famous neurologist Vladimir Janda).

This test should be assessed by someone who is trained to analyze movement patterns. Start by lying on your stomach upon a bench or table. While maintaining this position slowly extend one of your legs up towards the ceiling just a few inches off the table. A faulty movement pattern will be either a bent knee, hinging of the low back or a delayed response from your Gluteus Maximus. A normal test should show a smooth pattern of leg extension with the Glut Max doing most the work. When the back hinges or the knee is bent this is signs of other muscles helping the Glut Max or worse doing its job (Top Right & Lower Left faulty patterns)

In summary, back pain and running injuries can be a complicated manner. The answers are not always this easy and should be addressed by someone who is trained in such a topic.

How do I solve this problem? Stay tuned for Part 2.

LIEBENSON, C. (2007). Hip dysfunction and back pain Journal of Bodywork and Movement Therapies, 11 (2), 111-115 DOI: 10.1016/j.jbmt.2007.01.005