Non-descript Back Pain in Adult Distance Runners (NOVICE vs. ELITE)
NON-DESCRIPT BACK PAIN IN ADULT DISTANCE RUNNERS (NOVICE vs. ELITE)
Overview:
Back pain is one of those ongoing concerns that plagues the population. Why is it that back pain does not discriminate between the highly trained elite athlete and your weekend park runner?
Understanding the variables related to novice athletes compared to elite athletes can help decrease back pain and target your training towards your lifestyle and running goals.
Let’s start with a brief introduction into symptoms related to back pain. Regardless of whether you are an elite athlete or just out for your Sunday morning run back pain manifests in a similar way.
COMMON SYMPTOMS:
General ache across the lower back – post running
Non-specific pain around hips and down the legs
Increase in pain with single leg loading around tail bone
Pain starting from lower back and continuing into buttocks
Tightness and restriction around glutes and hamstrings
Pain with bending over
Increased pain with long periods of standing or sitting
CAUSES AND RISK FACTORS:
Causes and risk factors of non-descript back pain vary quite largely between novice runners and highly trained runners.
NOVICE:
Non-descript back pain comes from issues around:
Tight musculature;
Poor movement mechanics;
Muscles weakness.
These concerns have a lot to do with lifestyle. More commonly your 35 year old dad spends 5 days a week sitting at a desk and then goes out for his 5km park run on the weekend.
This philosophy comes down to:
Tightness created through the lower back and auxillary musculature from sitting all week;
Weakness through both the prime movers and stabilisers when we run;
This creates unbalanced force through the spine and pelvis causing non-descript back pain.
KEY NOTE:
We all know we feel fine as we get warm and moving but then we don’t cool down and stretch afterwards because let’s be honest that weekend coffee is far more important. So let’s be clear that mobilising before and stretching after are key in preventing that nagging ache you find yourself enjoying on a Sunday afternoon.
Key areas to stretch include:
Glutes – buttocks
Piriformis
Lower back
Lats
Quadratus lumborum
Hip flexors
On an equal level to this, improving movement mechanics through strengthening the appropriate prime and auxillary musculature is key in improving force loading when running. This allows the force to be redistributed in a productive way. So not only do you now decrease your back pain but that 30min 5km park run time you’ve been chasing is finally a reality!
ELITE ATHLETE:
More commonly elite athletes mobilise before a run, cool down and stretch after. They fuel appropriately, recover effectively (most of the time) and strengthen for efficiency. So why is it that these athletes also find themselves with back pain?
Back pain for elite athletes is more commonly caused by:
Ongoing volume
High Intensity
Duration of training
Elite athletes break down from ongoing forces over time.
Strain and stress over long seasons (moving straight from domestic season into international seasons) with very little load recovery.
Programming for stabilisers and single stability can often be overlooked in preference of large power based movements such as cleans.
With the volume of training applied, instability and poor force loading creates large torque through the lower back.
BACK PAIN RELATED TO EVENT SPECIFIC TRAINING:
Let’s now look at a distinction in elite distance runners from an event specific perspective. If we look at back pain in a 1500m runner compared to a marathon runner what do we notice about how the breakdown occurs?
PART 1 – 800m, 1500m and 3000m Runners:
Distance runners who compete in shorter events require a larger force application. Therefore back pain is more commonly associated with:
Large agonist muscle groups (quadriceps, glutes and hamstrings);
Inefficiency and agonist muscle dysfunction creates poor force loading;
Poor pelvic control;
Stress and strain will create degeneration related to high torque.
Creating muscular balance is key in preventing ongoing back pain in these athletes.
PART 2 – Marathon Runners:
In contrast marathon runners produce a lower force sustained over a longer period of time.
Back pain is therefore a result of:
Breakdown in the stabilisers due to fatigue;
Auxillary muscles that stabilise the hip and knee fatigue creating problems in movement efficiency;
Poor pelvic control resulting in poor loading through the hip and lower back;
Stress and strain will create degeneration related to high torque.
So the key comes in training the stabilisers is to resist fatigue for longevity.
PART 3 – Novice Runners:
We find that back pain in our ‘Bridge to brisbanites’ as I mentioned previously is specifically related to tight musculature, muscular imbalance and poorly distributed force.
Issues are related to:
General muscle weakness – specifically related to hip and knee;
Inefficiency of movement;
Muscle Tightness;
Lifestyle Considerations.
The important things to remember when training your average runner is to stretch effectively and strengthen for muscle engagement to increase movement efficiency.
EXERCISE INTERVENTION PROGRESSION PLAN:
NOVICE RUNNER:
As a novice runner it’s important to take into account a few considerations when starting your running training. If you are a 34 year old accountant who has just decided you want to do the bridge to Brisbane this year. PLEASE do not google ‘how to train for 10km’ or ‘distance running program.’ Often when we google, we receive programs out of context and inappropriate for your circumstances. Let me assure you that if you start following the Kenyan national team distance running program you will get injured. That kind of volume and training plan is not ideal for your average runner due to the aforementioned reasons!
An example progression plan would be as follows:
1 – Range of motion –Flexibility is key to avoid ongoing dysfunction
2 – Muscle activation – Auxillary (stabilisers)
3 – Muscle activation with coordinated neural development – unilateral and bilateral
4 – Strength – Prime Movers
5 – Running Progression – Volume should progress less than 10% every 4-6 weeks; making sure muscular adaptation is right first. Once there is good engagement, strength and movement patterning you can then begin to increase volume.
As a novice, starting your running is not about distance and kilometres covered! It is about getting the musculature right. Removing restriction and strengthening for muscular balance, so force is distributed evenly. Once this is right, then you can start to SLOWLY progress your volume.
ELITE RUNNER:
With elite runners we make the assumption even though mechanics are good, stress and strain occurs due to high torque. The progression plan for an elite runner applies a delicate balance of intensity vs. duration.
Example of marathon progression plan is as follows:
1 – Stabiliser/Auxillary engagement
2 – Unilateral strength/force loading
3 – Muscular endurance
4 – Running Progression:
Either working above race pace for lower duration or work below race pace for longer duration.
General Considerations:
Severity and ongoing pain levels related to lower back
Strength of hip, knee and lower abdominal stabilising muscles
Pelvic control both isolatively and in compound movements
Muscular range of motion (ROM) around hip and knee
Muscular efficiency
Movement mechanics – hip and knee
Engagement of stabilisers
Single leg stability
Pelvic Rhythm
Specific and Personal Considerations:
Mechanism of injury and timeframe of onset of pain (acute vs progressive onset)
Injury history – acute vs chronic problem
Training History
Weekly Training Volume
Competition phase
Lifestyle Considerations – work type, family, time (ie desk job vs. active job)
Event type including duration and intensity
CASE STUDY:
Non- Descript Back Pain in Novice Runners
47 yr old Male – Novice Runner and Boot Camper
Client Presented with:
Pain in Left lower leg – outside of foot and calf;
Knee pain across the top of the left knee – burning;
Lower back pain – R side form several years ago that was never really resolved.
Pain quite bad with running. Feels unstable in unilateral movements including lunging and single leg exercises.
7-8months of pain- slow build up no distinct event.
Right hip and lower back issue unresolved from many years ago
Post assessment clients major issues were:
Hip stability issue – Right side
2. Right side cause of Left side Pain – shifting weight to L side
– poor lower quad engagement
– poor femoral control
– lateral deviation of patella
Tightness through ITB and hip flexors
Exercise Intervention – Program Outline:
Phase 1 – Muscle Engagement
This phase has 2 distinct sections within the session:
Priority one in this phase is getting range of motion by decreasing resistance through muscles with greater tension.
We then engage musculature that is underdeveloped or inactive.
Within this case study, it’s important to target the following areas:
Lower Abdominal engagement – TA
Med/Min strength – deloaded
Lateral hamstring engagement
Unilateral pelvic stability
An example of exercises used in this phase:
Warm Up:
Mobility – ITB rolling; hip flexor stretches
1a) TA act
1b) TA act + FL
1c) Modified V sit – sweeping – feet on ground
1d) TA lowers
2a) Clams – deloaded
2b) SL GB bosu
2c) VMO ext + LL
2d) Lateral hamstring – curl
Post stretching:
Glute
Hamstring
Lower Back
Sartorius
Hip flexor
Calf
Piriformis
Lats
Quadratus Lumborum
Phase 2 – Muscle Activation with Neurological Patterning
This is where people can often go wrong in programs, it is important that once you have taught engagement you then teach the muscles to work in a neurological pattern. There is no point being able to engage a muscle if you can’t use it!
Following on from the last phase, we start to introduce larger complex movements where the muscles are challenged to work in combination with other muscles.
Example session would include:
1a) Transverse abdominis activation
1b) Transverse abdominis activation + feet lifts
1c) Modified V sit – sweeping – feet on ground
1d) Transverse abdominis single leg lowers
2a) Monster Walk
2b) Single leg glute bridge on bosu
2c) Leg Extension on Machine +10kg
2d) Lateral hamstring curl
3a) Sprinter Squat
3b) Squat to box – bodyweight
3c) Single leg pistol – assisted to bench
Phase 3 – Strength Prime movers
In the phase we introduce larger strength movements to develop the prime movers required to improve running mechanics and decrease back pain. There is a decreased focus on engagement, so we only do one set and an increased focus on strength adaptation.
Example session would include:
1a) Round the worlds (1 set)
1b) Transverse Abdominis lowers- Double leg
1c) Transverse Abdominis Upper Lowers
2a) Single leg glute bridge on bosu (1 set)
2b) Leg extension on machine; partial range (last 10 degrees) + 15kg
2c) Monster Walk
3a) Romanian Deadlifts (3 sets)
3b) Loaded Squat to box
3c) Split Squat
*Progression of these exercises leads to back squats, rack pulls and loaded split squat
Phase 4 – Running
Now that we have correct muscular engagement, neural development and strength, it’s important to start to progressively add running load. The foundation set will allow for proper force distribution. This does not mean you will not get sore post running, it is still very important to mobilise before and stretch after! Just because you are efficient doesn’t mean the muscles will not get tight and sore. You must maintain your body over time! This also means concurrent strength training as your load increases so your body can handle the increases in volume.
By Lisa Campbell
Accredited Exercise Physiologist – START Training