Lower back pain is common and has many different causes, but sadly for us runners, training can often make the pain worse, as the shock from hitting the hard pavement jars our sore muscles. The good news is, it's easily treatable and very rarely does it develop into a chronic problem.
We asked the experts at PhysioMed to share their knowledge on how to treat and prevent back pain, to keep your running training on track.
Signs and symptoms
Symptoms from lower back problems vary, depending on a person's condition and which structures are affected. Some of the more common symptoms of lower back problems are:
- Pain in the lower back
- Pain spreading into the buttocks and thighs
- Pain radiating from the buttocks to the foot
- Back stiffness and a reduced range of motion
- Muscle weakness in the hip, thigh, leg, or foot
- Sensory changes in the leg, foot, or toes such as numbness, prickling, or tingling
Rarely, symptoms can include changes in bowel or bladder function.
If symptoms include numbness/tingling between the legs, significant weakness in both legs/feet, or changes in bladder/bowel function and feeling occurs, medical help should be sought immediately.
Causes of lower back pain and how to prevent it
Every back problem is different, there are many causes of lower back pain and some may have more than one cause or contributing factor. Causes can be physical, mental and emotional, and more often than not a combination of all three!
Everyone has to find the best way to manage their own condition and occurrence or re-occurrence may be helped by the advice below.
Poor posture eventually damages the structures within the back, which causes pain and dysfunction. Good posture is the term applied when the three spinal curves are maintained with low muscular effort.
Poor posture does not just apply to those who sprawl on their sofa, hunch over their desk or slump as they stand – it also includes those who sit perched rigidly on their chair without supporting themselves against the back of it.
To avoid poor posture when you're standing:
- Keep your ears, shoulders and hips in a straight line
- Raise or tilt your work surface for tasks, and keep the task at a suitable and comfortable height, so you don't have to bend to view. For example, if you're washing up, put an upturned bowl under the washing up bowl to elevate your work surface to prevent stooping
- Avoid standing still in one position for more than 20 minutes
- Don't stand for long periods on a hard surface, or if you must, wear shock-absorbing footwear
- Don't stand for long periods in high heels or shoes with little cushioning or support
To avoid poor posture when you're seated:
- Sit with both buttocks on the seat, ensuring the seat is stable and firm, to take your weight evenly through the tail bones of the pelvis
- Rest your feet easily on the floor and support your low back arch with the chair back or an additional cushion or rolled up towel
- Your hips should be slightly higher or equal to your knee joint (at a 90 degrees bend)
- If you sit at a table or desk using a computer, the middle row of the keyboard should be level with your elbow and the top of the screen level with eye height
- If sat at a table or desk writing, the elbow should be just below the table top. A writing slope helps stop the body from needing to learn forwards
- Office chairs can be easily altered to fit the individual; however, home furniture is not so easy. To check if your sofa is right for you, you should be able to sit down into the correct position (back supported and feet on the floor) in one motion holding a cup of tea. Also you should be able to stand up again from that position in one motion still holding and not spilling the tea, without putting your hands down
- If your sofa is too deep, pack the back with firm cushions
- If it's too soft, wrap a wooden board in foam and put it under the seat cushions
- If it's too low, raise your sofa up on wooden blocks
- If you're not getting enough back support, use rolled up towels
To avoid poor posture when you're asleep:
- Assess your bed by lying on your back, your hands (palm down) between your lower back curve and the mattress
- If you can slide your hand through fairly easily with no gap your mattress is OK
- If there is a gap, your mattress is too hard
- If you can't fit your hand through, it's probably too soft
Sleeping positions and actions that can help:
- Side lying with pillow between knees
- Put a pillow under the knees when lying on your back
- Put a sleep roll (or rolled up towel) round your waist (especially if side lying)
- ‘Log roll’ to turn over in bed (keep body in a straight line, cross ankles and bring arm across body to roll)
- Fidget when awake, don’t try to lay still
- Do not ‘heave’ sit-up style into sitting from lying on your back; roll over onto your side, move your feet over the edge of the bed and use your arm to push you upwards (while your feet move down to the floor as a counter weight).
Poor body mechanics
Tight, overstretched or weak muscles and stiff joints within the low back and surrounding body parts can cause altered postures and activity in the lower back which can cause pain.
For example, tight hip joints mean that the lower back has to overcompensate for the lack of movement, which causes increased loading to the low back and therefore pain. Or weak and underused stomach muscles lead to a sway back posture, which in time becomes painful. Normally the opposing muscle groups to those which are tight are lengthened and weak and need to be strengthened.
- Tight muscles in your lower back can cause pain, stiffness and weakness
- If you feel this is an issue, gently stretch your back muscles to correct their length restoring both comfort and function
- Your stomach muscles may be weak, as the stretching starts to work over a couple of days, start some gentle abdominal strengthening and build the effort gradually
- Tight front hip muscles or buttock muscles cause overloading compensation in the lower back and reduced capability and function
- If you feel this is an issue, gently stretch your front hip muscles or buttock muscles to correct their length restoring both comfort and function
- If your front hip muscles are tight, your buttocks may be weak (and vice-versa) therefore gently strengthen the opposite muscle group to the one you are stretching and build the effort gradually
- Tight stomach muscles cause overloading compensation in the lower back and reduced capability and function
- If you feel this is an issue, gently stretch your stomach muscles to correct their length restoring both comfort and function
- Your low back muscles may be weak, as the stretching starts to work over a couple of days, start some gentle low back strengthening and build the effort gradually
- Tight posterior thigh muscles (hamstrings) cause overloading compensation in the lower back and reduced capability and function
- If you feel this is an issue, gently stretch your hamstring muscles to correct their length restoring both comfort and function
- Weak/underused pelvic floor muscles are a significant cause of instability and irritation in the low back for both men and women respectively. In combination with the deep abdominal muscles and deep low back muscles they make up the muscular pelvic girdle which holds the pelvis (foundation of the spine) in place
- You will not feel if this area is tight or weak, therefore should undertake strengthening exercises as a matter of course
Poor lifting and carrying technique
Lifting and carrying without checking the weight and stability of the load first, or using poor technique, is a significant cause of lower back pain. Such an activity doesn’t just happen at work where you have correct training, policies and equipment to help you, but in the home within such activities as childcare, gardening, housework and DIY.
- Avoid the activity in the first place. If that is not possible:
- Reduce the load/task
- Get help
- Use equipment e.g. hoist or trolley
- Breakdown the load or distance to be carried
- Assess and clear the route that the load will travel
- Ensure all doors are big enough and open
- There are no trip / slip hazards
- The new location is clear, large enough and at a safe height
- Ensure that you are appropriately clothed
- Clothes allow a full range of movement
- Shoes are sensible for the task
- Use safe lifting technique – 8 steps to safe lifting (Base Movement)
- Assess the load – can you lift it safely?
- Place your feet at ten-to-two
- Bend your knees and stick your bottom out (like a silverback gorilla!)
- Back – keep it straight (bend from the hip like a silverback gorilla)
- Neck and head – keep your chin up
- Grip – ‘front knee, high hand, far corner’ and ‘back knee, low hand, near corner’
- Load – hold it close to your pelvis
- Lift using thighs and buttocks for power with stomach and pelvic floor braced
People who spend a large amount of their time driving are more likely to get back problems. This is because the task combines static posture in a constrained environment, exposure to constant vibration, occasional jarring and it can be a stressful environment and activity.
- Proper adjustment - starting with the seat in a completely wrong position makes it easier to get the right position so push the seat all the way back, place it as low to the floor as possible and recline the seat 40 – 45 degrees
- Bring the seat height up until you can comfortably see the road and instruments and your hips are as high as your knees. If you are still too low, try adding a small cushion or folded towel under your tail bones
- Move the seat forward so you can reach and fully depress all the foot pedals with a comfortably bent knee (110 – 135 degrees)
- Bring the back forwards until you are reclined at a 100-110 degree angle (check the previous sitting posture information in this leaflet for more detail)
- Adjust your headrest so it rests in the middle of your head – it should not push your head forwards!
- Adjust the lumbar support so that you have even back support, you can feel it support your lower back comfortably. Use a rolled up towel if your seat lacks sufficient support
- Bring the steering wheel down and towards you to minimize reach. You should be able to reach it with a slightly bent elbow and your back resting on the seat back
- Now adjust the mirrors – if you start to slouch down or get into a bad position the mirrors will feel like they need to be adjusted – this is your cue to correct your posture!
- Holding the steering wheel
- Lower your hands from the ten to two position to the quarter to three and feel your shoulder and neck muscles relax
- Getting in and out
- Always remove your wallet from your back pocket before sitting (it causes the pelvis to twist which stresses the back)
- When getting in, sit first and then swing your legs into the car
- To get out, slide the legs out first and then stand up to decrease low back strain
- Give your body a few minutes out of the car before lifting things out of the boot, do a few back straightening movements first
- Take frequent breaks to get out and stretch a least every 2 hours
- Exercise in traffic jams
- Shrug shoulders, hold for 5 seconds, relax & repeat x 5
- Pull shoulder blades back, hold for 5 seconds relax and repeat x 5
- Tuck chin in, hold for 5 seconds, relax and repeat x 5
At-home recovery for lower back pain
When suffering from back pain, the temptation may be to rest in bed until it resides, however this often makes the pain worse. Where possible, the best advice is to stay active and continue your daily activities as normal. Obviously if these activities are adding to the pain then do not continue them, but getting back to work and keeping the area moving is often the best way to minimise the pain.
First aid advice (immediately after the injury)
Any bed rest should be kept to a maximum of two days – any longer the detrimental effects outweigh the benefits.
Pain-relieving medication should help with the discomfort. Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner. These medications include common over the counter drugs such as ibuprofen. Talk to your doctor or pharmacist if you have specific questions about which pain reliever is right for you. Also see your GP if over-the-counter medication is not easing your pain after a day or two.
Apply hot or cold packs to the painful area. You may decide which the best approach is for you. You can buy hot and cold packs from most pharmacies, but you can also use a hot water bottle or bags of ice or frozen peas (wrapped in a damp tea towel) will often be as good.
Both approaches help to reduce the pain sensation, but they also help to increase the blood flow to the area which brings oxygen and nutrients to the tissues to help them heal more quickly.
- Ice pack to be applied to the lower back for approximately 20 minutes every two hours. It is advised that you check the skin every five minutes to avoid the possibility of an ice burn from the cold temperature. Apply frequently in the first two days
- Hot water bottle to be applied for 20 minutes every two hours. The hot water bottle should be warm and not actually hot. If in severe pain, avoid a hot bath in case you cannot get out of it.
Position yourself in the most comfortable position and postures but try to change position every 30 minutes. Avoid sitting for longer than 5-10 minutes at a time.
Attempt gentle walking and movement to prevent ceasing up.
Sleep in the most naturally comfortable position on a comfortable surface.
Further self-help for when you're in pain
- Do regular gentle mobilising exercises, as advised by your physiotherapist
- For short periods, 10 minutes, lie on your back with your feet up on a chair or pillows to relax the deep muscles that might be in spasm
- Generally keep changing your position every 30 minutes
- Try to walk short distances at least twice a day
- Always take the recommended dose of medication
- Make sure work surfaces are at a comfortable height so you don't have to bend your back
- Replace a sagging mattress
- When performing tasks around the home, keep your back in mind and try to minimise straining or stretching it and pace yourself. For example, squat or kneel when cleaning the bath or reaching for low shelves and use an upright vacuum cleaner, keeping it close to your body. Divide up your tasks by room or activities into bite-sized pieces and rest in between each task
- If you have young children, bend your knees and don't twist to pick them up. Adjust the height of the cot so you don't need to bend. And try to avoid picking toddlers and slightly older children up at all
Please remember to use this advice under the guidance of your physiotherapist and for more tips and advice visit PhysioMed online.